A woman about whom I posted 2 1/2 years ago has just had her second child.
The first time, she had severe trauma on both nipples, only one of which we
were ever able to fix. One nipple became fully comfortable after several
months, the other only when she weaned from both nursing and pumping.
Nipples and breasts gave her no problems after weaning.
The problem side produced gelatinous blobs, which I described as being about
the size and shape of garden slugs (the little ones, not the 10 cm ones).
They might disappear for a few days, then reappear. I've seen those blobs
one other time since, in a woman who was pumping with a hand pump fitted
with a flexible flange that flattened her nipple and areola with each
stroke. Once she switched to a hard flange she had no further problems. I
assumed from that that the blobs were a result of some sort of internal
mechanical damage.
But back to today's mother. She had not pumped until she came to see me 5
days pp with badly engorged breasts, both of which were too sore to nurse
from. She double-pumped with an 015 starting on minimum and moving it
herself to medium. With better positioning, she was able to nurse pain-free
on the side she used with her first child. I think we're all set there
(except perhaps for thrush, which the baby may have on his tongue).
The problem breast produced a bloody blob perhaps 4x4x1 cm (floating in a
dish), then nearly clear fluid, then transitional milk with a few smaller
bloodless blobs. The nipple looked traumatized afterwards, as if having to
stretch to pass the blobs caused damage.
She has no plans to nurse on that side. Enough's enough. My questions:
1) What causes the blobs and what are they made of?
2) How can she wean off that breast most safely? By "pumping down" over a
period of a week or two? Or by using cabbage and ibuprofen, with no pumping
at all? For now, I'm encouraging her to pump only as she feels a desire to,
since I don't know which way is better.
Last time, no one else had seen something like this. Lactnet is 2 1/2 years
older and lots bigger. Has anyone seen this before??
Diane Wiessinger, MS, IBCLC NY
Janis had a lot of trouble initiating breastfeeding with her first,
ultimately weaning from the left breast completely and nursing comfortably
on the right. But it took several months.
Her problems this time are not as severe, but the same things are happening.
She came here very engorged this morning, wanting to rent a pump, having
been in too much pain to nurse comfortably on either side for some hours.
The right sideıs problems seem to be wholly positional, although it may be
that Aidan has thrush, which Iım hoping sheıll check with you.
The left side is something Iıve never seen. She pumped here to begin
reducing the engorgement, and the left breast pumped first a large (about 4
cm x 4 cm x 1 cm) blob of ³bloody gelatin² after which she pumped something
like serum, then finally transitional milk with smaller non-bloody blobs.
These same gelatinous blobs occurred in the same breast with her last child,
but without the blood. Iıve seen these clear blobs in only one other woman,
when they were pretty clearly the result of areolar trauma. In that case,
the woman had been using a hand pump with a flange that compressed her
breast. When she switched to a rental pump with a hard flange, the blobs
were gone by the second pumping. The blobs in Janisıs left breast would
disappear for a time, then reappear, and her nipple never healed completely
until she weaned from both baby and pump on that side.
Janis plans not to use the left breast this time, but the engorgement has
been such that I had thought she might do better to pump regularly for the
next day or so, then taper off, using cabbage for comfort, to avoid mastitis
or further internal damage. But since neither I nor any lactation
consultant with whom Iıve spoken has seen anything quite like Janisıs
history, Iıve encouraged her to talk with you. The nipple itself is
damaged, but the blob is almost certainly internal. Some of the nipple
damage could even be from the passage of the blob; it certainly clogs a
bottle teat! I wonder if the ongoing nipple trauma the first time was a
result of forcing those blobs through her nipple pores, and wonder if she
should be pumping at all on that side. How do you think she should manage
the left? Iım posting her situation to an international e-mail group of
breastfeeding specialists for suggestions, but when I did so the last time,
no one had seen anything similar.
Iıve urged her to come back if she continues to feel pain on the right. Her
nursings here were comfortable with slightly revised positioning, and
although the right nipple is already damaged, probably from minor
positioning issues, if thereıs no complication from thrush I think we can
fix it quickly. If Aidan does indeed have thrush, theyıll both need
treatment for that.
Janis is ahead of where she was at this time with her first, 2 1/2 years
ago, but Iım hoping we can suppress her milk supply on the left without
causing further damage - either from pumping or from failing to pump - and
establish comfortable, damage-free nursing on the right as soon as possible.
And Iım not sure how to do it. Iıll be calling her when she gets home to
urge her again to make an appointment with you, and to pump only for comfort
on the left, since Iım not sure which is more damaging - pumping or not.
Sincerely,
Diane Wiessinger, MS, IBCLC
International Board Certified Lactation Consultant
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