The 3rd mom is ready to stop breastfeeding any day now. Her pain is 
unchanged with larger flanges, she is on Clindamycin for mastitis. I amd 
not suspecting a yeast infection because the baby wasn't suckling and does 
not have thrush. Mom did receive proph antibiotics for her c-secn.
She has been pumping every 2-3 hrs inspite of the pain but only manages to 
get 1-2 oz each time. The milk does not flow/spray, it mostly just drips. 
Her breasts are somewaht swollen, very lumpy and moderately tender. She is 
also on fenugreek. 

Please advice regarding mom#3. IS there anything I am missing?

 
    This mom received antibiotics at the time of birth, and has also been receiving antibiotics for mastitis.  As Kathy has already mentioned, there are fungus cells on the skin, and they can get in through breaks in the skin which happen from the rubbing of improperly-fitting pump shields. I have also frequently seen mothers who have had numerous vaginal yeast infections (and some who didn't)who just seem to have a lot of yeast in their bodies.  Then, as soon as an antibiotic is introduced, they immediately get a yeast infection. 
    I have seen moms who had many plugs in the breast, who did not respond to antiobiotics, who in reality had ductal yeast.  When they were given oral antifungal instead of oral antiobiotic, the lumps resolved and the pain went away.  Then, after continuing to pump, a couple of days after the lumps resolve, the supply builds back up because the milk can flow without the lumps getting in the way.
    You might want to switch this mom from Clindamycin to an oral antifungal.
   Dee Kassing, BS, MLS, IBCLC, RCL
   

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