I have permission from my client to share information and ask for advice/ input.
Young teen mom, hx of rape, got pregnant from later relationship. During pregnancy, had relations with a guy with red, itchy penile lesions. (client had negative serology titers for HSV 9/2001; stated that she had a cold sore a couple of months ago.)Hx includes tx with Quell (for body lice). Delivered by c/section due to fetal intolerence to labor. Wants to BF but has lesions described as blisters over most of right areola. Client stated that blisters have been there since October and itch at times. Her PHC provider has not seen the lesions, declines to examine them or to culture them, stating that she had a negative titer, and "besides, the lenght of time she has had them precludes them being infectious." The PHC provider stated that he would consider dermatological referral after client is discharged. In the meantime...Staff assisted the client to initiate BF on the non affected side using a regular size nipple shield because of flat nipples and baby's difficulty with latch. Client has poor hygiene habits, handles lesions and then baby without washing hands in between. Client is non-complient with instructions for self or baby care.

Besides my concerns re: the use of the nipple shield, I'm hesitant to encourage BF on affected side without definitive diagnosis. I am also reluctant to introduce use of electric breast pump to stimulate milk production. I have read recent posts re psoriasis on areolae and don't want to cause further challanges to already friable tissue.

TIA, Kathy Bowers, RN, IBCLC

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html