Breast infection is an important cause of deep breast pain.  In at least one
study, deep breast pain was a better indicator of bacterial than of fungal
infection.  (Thomassen, et al:  Breast-feeding pain and infection, Gynecol
and Obstet Investigation 1998; 46:73-74.)

 More and more I see mothers who appear to have been colonized by staph as
the result of nipples that get cracked in the hospt.  Somehow, perhaps
because they have strong immune systems, or are slow to develop febrile
symptoms, or they are masking those symptoms with drugs like ibuprofen, the
mothers appear unaware that they have mastitis.  The symptom of engorged,
poorly draining breasts and pain -- esp. if there were early cracked
nipples -- is an indicator that the mother should be evaluated and managed
for mastitis.  What I have been seeing here in Austin that is starting to
worry me is mothers who call in with sx like those I've just described, are
put on antibiotics that used to clear up mastitis fairly quickly, but who go
on to develope two and three recurrences. There have been several moms
lately (three that I can easily recall) who have weaned because they felt
they simply couldn't endure another episode of mastitis.  My feeling is they
didn't have seperate cases, but one long episode that needed different drug
therapy.  Now, at the first recurrance, I am asking my clients to make an OB
appt. and go in and at least discuss the idea of a culture and sensitivity
to see what grows so that the drug therapy can be more accurate.

I think this really emphasizes the importance of early nipple care in the
hospt. with the addition of gentle cleansing of early cracked nipples to
prevent colonization.

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