I've read through lots of the archives on yeast and while there is a great deal of info, I don't feel well enough informed.  Please forgive if this is too rudimentary.

The mom had a traumatic birth of twins, lost 1/2 her blood volume, uterus failed to contract, had internal bleeding, infection and failure to clot - by 5pm next day some clotting  was evident and she went for surgical repairs, her lung was punctured and she was in great pain for next 6 days.  Breastfeeding which had been the plan was at the bottom of the list.  Milk came in on day 6 and she made one attempt to bf one of the babies and pumped a couple times.  I got the call on day 7 as she was engorged and in pain. We got both babies on and made a feeding/pumping plan to relieve engorgement - not sure if she will stick to it as she is overwhelmed with the concept of continually nursing the twins and her own needs for recovery (still has chest tube, IV antibiotics and incisional drain) but she seemed to want to.   Most of her engorgement complaints were about the right breast (also the side with the chest tube.)  She was reluctant ot offer that breast becuaese of the pain she had "inside."  On the phone consult she had told me it felt like a steel cable and I asked her to gently massage it - she said that that action caused it to burn.  At the conclusion of the first baby's feed on that side, he slipped of beautifully and then she gasped and physically withdrew at the painful pins and needles stab she felt in that breast.

It sounds like ductal yeast to me.  She has been on loads of antibiotics.  She is supposed to see a hospital based LC but hasn't yet.  She mentioned to her OB that she was worried it might be yeast and would he give her Diflucan to which he replied something to the effect that LC's see women with problems so they think everybody has a problem and that there were other causes of the pain she described, including engorgement itself.  Hmmm.   He consented to culture her milk for her and that was it.  

Won't this take a lot of time and is it true that yeast often won't culture?  She doesn't seem the type for the lower-tech treatments of gentian violet, vinegar, acidophilus etc. (at least not at this point) but I will suggest it.  Is it too soon to tell if it's yeast?  If it begins in the ducts will it work its way out to the nipples?  Is it considered a worse case when the deep breast pain begins while still in the hospital?

With her own condition severely compromised I feel this needs to be "nipped in the bud" before she is finally sent home with 2 babies.  I greatly appreciate any list or personal replies on how to best approach and manage this.

Lisa Dugan
LLLL Southern NJ

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