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