What a train wreck!  Any large loss of blood during delivery is a known red
flag for poor early milk production.  As is anemia.  If the placenta tore,
there may also be risk of retained placenta; another potential reason for
poor early milk production.  Mastitis typically causes the supply to drop.
So there are a number of reasons why the baby could be gaining poorly in
addition to or apart from the nursing frequency issue.  Suggest an
ultrasound to identify possible retained placenta, check maternal diet and
iron status and make sure any issues related to anemia are resolved.  Any
suspicious mass in the breast should be dealt with the same way in a
pregnant or nursing mother that it is in a non-pregnant or non-nursing
mother.  The lump can be visualized non-invasively with ultrasound, and if
it is a cyst of some kind, then it can be safely ignored unless the size of
it is somehow impacting on the drainage pattern of that breast.  In which
case, it may be that she'll need help managing the mastitis risk until that
breast regulates.  This mom needs some pretty focused help.  Can a local
IBCLC be consulted?

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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