Hello Lactnetters!
I have permission to post the following.
This patient (Gravida 1/ Para 1) was breastfeeding well until mastitis
diagnosed at day 7 postpartum. The patient was treated for 5 days prior to
seeing an IBCLC. She was treated with dicloxacillin for 7 days total, and
is now on ammoxicillin/clavulanic acid (augmentin) for 7 days per her
OB/GYN.
Since the mastitis was diagnosed, the patient developed severe engorgement.
The left breast looks engorged- plain and simple. No redness, streaks,
lumps, pitting, cracks, discharge or other skin changes noted. The breast
is extremely firm, with bright veins, skin is normal sheen.
Baby breastfeeds well, many swallows noted, good latch, no pain. Baby also
breastfeeds well on the right side- however, no engorgement or mastitis
noted to that breast.
History is negative for surgeries/injuries of the chest.
Despite rest, fluids, ibuprofen, and cold packs, the engorgement remains
after 7 days. (Patient admits that cold packs were not used routinely until
today). Minimal moist heat (3 minutes) prior to pumping in office acheived
greatest output with the pump (5ml opposed to a few drops).
Recommendations today included:
*brief moist heat (3 minutes) prior to breastfeeding on-cue,
*offering affected side first to enhance drainage,
*immediate cold packs (20 minutes on/ 20 minutes off, to repeat as often as
possible before next feeding).
*continuing ibuprofen and antibiotics as directed
*pumping to soften breast for latch, only if needed.
Has anyone encountered prolonged engorgement such as this? Is there
anything I am not asking?
Please reply- on or off list.
Sincerely,
Kate Cropp CNP, IBCLC, MSN
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