June, you wrote about a mother who, by now, is 14 days postpartum, with mastitis. What a disappointment to the mother to have her experience deviate so much from the anticipated experience she had come to expect prenatally. Grieving the loss of the expected experience, complete with the stages of denial, anger, guilt, bargaining and hopefully, acceptance of whatever outcome that follows, are all part of the process of grief work now upon her. Facilitating her grieving is a skill that not all IBCLC's may have gained as part of their background. This may be your most important role as you help her regain her breast comfort with evidence based information about the effect of sudden weaning on mastitis. One of the most important things, IME, is to listen carefully to the mother, reflect back what you think you hear her saying, and generally, validate the fact that her feelings have been heard, and that they are important. This is good for her long term mental health, and therefore, important in her care of her baby, no matter how the baby is eventually fed. <Baby hasn't been put to the breast for 48 hrs because of the pain due to chewed, cracked and bleeding nipples and the mastitis > High probability of cause and effect here. Chances are good that perhaps if there had been no nipple damage, there might have been no mastitis. <To-day had a call from her partner to say that she has mastitis in her armpit of her left breast. temp 39. and she now wants to stop breastfeeding > Very understandable. I think it might be important to ask her if her feelings are of regret and or disappointment, and if so, what degree, or are the feelings more like relief (that the end of this "nightmare" is in sight)? That might give you a clue about how to proceed from here. I think your plan for "tamping down" the supply to avoid prolonging the resolution of the mastitis is very sound. I hope she understands the importance of it in the speedier resolution of the mastitis. Would now, or soon, be a time to suggest that one possible alternative she might want to consider would be to continue some pumping to allow the baby to receive a significant amount of breastmilk, for whatever time the mother is willing to continue pumping??? That might reduce her perception of loss and betrayal by "the system", both the health care she didn't receive in avoiding nipple damage, and the glowing expectations she picked up about breastfeeding in the first place. If she is willing to consider that, it would preserve her supply until later when she is physically and emotionally more ready to make a long term decision about cautious, supported, supervised transition back to direct breastfeeding again, without the interference of breast swelling, continued indirect breastfeeding, or complete abandonment of breastfeeding. It is my experience that when a nipple-areolar complex is distorted by postpartum breast swelling, be it physiologic engorgement or edema preceding or superimposed on physiological engorgement, larger babies, with more generally powerful jaws and tongues, may possibly remove more milk than a baby with a weaker suckling power. But the potential for damaging the tissue during the process may be greater with the larger baby, unless the areola is thoroughly softened before each latch attempt, preferably from the beginning. A "good asymmetric latch" is good in theory, but a distorted, swollen, overly firm nipple-areolar complex "stacks the deck" against the mom's getting by without nipple pain and damage, no matter how good the latch may seem from external observation. Suckling is an interactive process, involving a reciprocal response from the mother's tissues, and that requires a certain amount of pliability. Keep us posted on the resolution of this situation. Jean ************ K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html