Hello!


I am Pia Ruohotie, mother of two daughters, RN and a mother-to-mother
bf support group leader from Finland (Europe). I´m working in a
volunteer association of mothers who are building a bf support and
knoledge sharing network in our country. My interence on bf began with my
eldest daughter and bf problems. Luckily I found a support group and
found my true motherhood. I was going to stay at mother-to-mother
advicing, but with my younger daughter I learned how little help
is given when a mother want´s to bf her sick or LBW baby at NICU.
Emma (my younger daughter) and I succeeded fighting through
difficulties and demands from her various diseases (she was SGA
weighting only 1380 g and has a congenital diabetes (on pumptherapy)
and several other diagnoses including pancreas insuffisiency and
multiple allergies). She´s still breastfeeding at 1,5 years old and
our next goal for bf is 2 years. I´m on quite restricted diet because
of her allergies.) So I´m at home with my children and doing this
volunteer mother-to-mother support work and planning to start studying
for IBCLC examination to become one of the first LC´s in our country.
We haven´t had any so far but I have had a priviledge of learning
in action (not only by reading) from the best Finnish bf educator
who works with us in our association and in one of our support
groups.

Here´s my question:

I have been working a couple of weeks with a mother of three
children. She breastfed her first baby partially 3 months,
second 6 months exclusively with no difficulties. Between second
and a third baby she had a breast reduction operation. This third
nursing experience has been very hard. All her children are still
very young.

Nursing was very painful at first and both nipples got cracked. The
other breast healed in time and the pain during feedings eased but the
other one didn´t. She had one mastitis and got antibiotics for
a treatment. During the treatment the wound got worse. Nursing was so
painful that she couldn´t bf from that breast but expressed. This
rest didn´t cure the wound. She told that her nipples are different
after the operation, the areola and a nipple has been moved during
the operation.

The other problem is that baby lost weight during two first weeks
on exclusive bf and supplementation was started. The weight gain
didn´t improve much and her health visitor and GP suggested more
supplements. It seems that this mother´s milk supply might have been
affected because of the reduction. After more supplementation (after
every feed) the growth improved at fourth week and baby reached his
brth weight.

At third week she seeked for bf help through internet from Finnis bf
support mailing list which I follow regularly. I gave her treatment
suggestions wich she followed. I recommended her to seek a bf support
group for herself. I also encouradged her supplement baby enough for
now, she can try weaning from the formula later when the breast
situation is better. She came "my" support group meeting at forth
week where we discussed and she show me her breasts. I noticed the
scars and she confirmed that an operation has been done. Almost the
whole nipple was a wound and looked like infected and excreted puss.
I suggested that a sample from the wound would be appropriate and it
turned out that my quess was right. There was pathogen bacterial growth
in the wound. She got different antiobiotics and the wound started to
heal. She shower her breast 2-4 times a day and use cabbage
leaves/naclbandage between nursings.

We fixed another meeting with the mother and she came to my home
a week later. I don´t think that baby´s suckling technique is
the cause for this persistent wound. The baby was at breast correctly
and sucked my finger properly. The other breast has alredy been
healed and the wound side looked better and smaller. We planned
that she would try to cut down the formula if baby´s weight was
rising normally next checking.

She wrote me email and we talked on the phone a couple days later:
there has been dull pain deeper in this sick breast all the time.
The pain has got worse in these last days and the wound hasn´t got
better any more. It has started bleeding during feedings ( the baby
has vomited blood with milk). The antibiotic treatment is finished
now (it was 10 day treatment). It seems to me that there might be
more things to worry with this breast. I called the bf educator
and she agrees with me. We are afraid that there might be infection
inside the breast that keep the wound open. There might be some
scarring after the operation that worse the situation.

Is it safe to bf from this breast or would it be better to stop
eventually bf from this breast? There might even be an abscess.
The mother will contact her surgeon to ask his/her opinion.

Has anybody here had similar situation to assist? (breast operation
and persistent infection/wound) Do you have any suggestions?
(I searched the archives, but didn´t find anything useful
yet.)

Thankfully
Pia Ruohotie, RN, mother-to-mother support group leader, mother of
two daughters from Helsinki, Finland (Europe)

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