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Hi Peggy, I second the idea of hand expression for this mother.  In addition
to the comprehensive suggestions Laurie Wheeler has posted (which I don't
need to repeat), I would see disinfecting relevant components of any pump as
an issue, whether the nipples have a bacterial infection, or bacterial
infection complicated by yeast.  Hand expression is likely to be gentler,
and mothers who learn this well can be efficient.  With any nipple/areola
infection, basics such as hand hygiene, appropriate laundering of the parts
of the bra in contact with her nipples, use of disposable breast pads, are
all relevant in this situation.  Though these matters are really basic, they
can easily be overlooked by mothers unless discussed.

 

Virginia 

 

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA 

Private Practice Lactation Consultant

Brisbane, Qld, Australia 

E: [log in to unmask] 

 

 

On Sun, 13 Jun 2010 laurie wheeler wrote:

Hi Peggy, I know you asked about how she can pump more comfortably but it
seems pumping is not her answer either. I suspect she has bacterial
infection and not yeast, and would suggest she be seen/treated for that. She
could certainly take some yeast med p.o. like the brand name diflucan, and
use the APNO cream which contains antibacterial, antifungal, and cortisone
as I'm sure you know. Often vasospasm is seen after nipple damage from
another cause occurs.

I would suggest she do hand expression, as you have suggested, she could
perhaps pump after she gets a letdown and flow going by hand first. Of
course, I'm sure you've checked the size of the flange. I would suspect some
latch problem or baby oral anatomical problem, and would look for that. If
she is doing nipple rest "now and then" does that mean she is still
breastfeeding mostly? If so, you would be able to assess latch. Mother/baby
may have been "cruising" on the oversupply or just the usual abundant supply
in early postpartum, but as we know, this can down-regulate with poor latch
or tongue-tie for example (poor milk removal).

So this is what I would be thinking to sum up: check baby's mouth
structures, assess the latch and breast/baby/back support throughout
feeding, pain meds and/or anti-inflammatory and probably antibiotics, hand
expression/later pumping if not able to directly breastfeed with the first
interventions.

 

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