Thank you in advance for any help...Permission to post. Mom is 2 months postpartum, had high blood pressure issues and was induced 4 weeks early, vag delivery, Mag therapy was used, and baby was in NICU for period of time. Pt pumping with Hospital grade Symphony pump during hospital stay and currently,  baby has never successfully latched.  She had mastitis in left breast recently, 7 day antibiotic treatment done, and discomfort has lessened, no fever or other symptoms related to mastitis remain. Her left nipple has a crack that has been present for about 5 weeks, she states is appears to be healing but remains painful. She is using triple antibiotic, states pump flanges fit comfortably. She uses her hands during pump sessions to aide in draining breast. Pumps 6-8 times a day, (has admitted to going about 6 hours but very rarely). During pump session last night, a large amount of blood was present during let down. States has had small amount of blood tinged milk before but nothing like last night. Blood appeared to flow straight out of nipple pore (did not appear to be from crack but rather inside breast). She waited a short amount of time and pumped again because breast needed emptying and did not notice blood, nor has she noticed blood in subsequent sessions. Milk blisters appear on both nipples fairly frequently, she pops them and milk releases through duct. Right breast has redness,and soreness presently, and pt has requested antibiotics to be started today as precaution. She pumps on average 3 ounces from each breast per pump session. My questions are...treatment of the crack? Would she be considered an over producer leading to the issues of blisters, clogged ducts, mastitis? Do you increase pump sessions to insure breast are drained more often preventing milk stasis? But what do you do about over supply wouldn't this make it worse? I have encouraged hand expression instead of pumping, rest and fluids.  Thank you, thank you!

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