Help!!! fellow lactnetters.

1 mo. ago I wrote re: mom with nausea, dizziness, sleepiness while pumping for
hosp baby born 12-24-95 at 30 weeks gestation. Birthweight approx 4# 5 oz.  Baby
d/c/d fro hosp. 1-21-96. Mom pumping 4x/day with poor results total
10cc/session., supplementing with Neocare.

(1/31)Home visit observations:  mom has a butterfly shaped keliod (scar) tissue
below  sternum area,  in middle of chest, brownish red in color. States due to a
bite from a "grillo" (cricket) in Mexico at age 11, which became infected. At 12
yrs  reoperated  due to inflammation.  5 years ago while still in Mexico treated
with "gases"(Spanish name) , perhaps frozen nitrogen, to reduce repeated
inflammation. States treatmenat was so painful, caused dif. breathing. Also had
breast inflammation frequently before  and  during pregnancy.

Baby latched-on well in football hold. observed  small milk transfer (only few
audible swallows, pre/post feed weight .25 oz after 10 min. at breast) I hooked
up lactina to  pump other side during feed,  to help initiate better letdown &
transfer. Only extracted approx 15 cc.  10-12 min. AT the time unsure whether
poor milk output 2ndry to inadequate stimulation ( pmping 3-4x/day) or possible
severing of mammary tissue in operation.  Encouraged mom to pump 6-7x/day and
put baby to breast  before giving bottle/ use skin-to-skin.

Current status:  per phone call mom leaking profusely; scar tissue is extremely
painful and purple in color. C/o lump in left breast  at  6:00 or 7:00 position.
still pumping 4 x/day but now getting  70ml/session. Formula suppl reduced to
2-4oz per day. When  feeds or pumps, feels excruciating " knife/back stabbing
pain", lasts for approx 2-5 minutes, sweats profusely, has dif. breathing. Could
it be that finally mom's milk supply came, having more let-downs, the scar
tissue has mammary glands with fluid accummualting with no  way to exit? Sounds
like  plugged duct on left breast.  Unfortunately mom is low-income no longer
qualifies for Medi-cal   & without insurance.  Who should I send her to for
evaluation and referral ( surgeon?) I hope for someone who supports BF'ing- or
they may just tell her to stop BF'ing to see if reduces inflam.  If  Mastitis is
developing,     which antibiotic is most suitable?

Public health nurse to see her today. Yesterday,  I recommended, tylenol to
reduce pain, swelling, warm compresses to  lump, gentle massage during
feeds/pumping. Will try to see her tomorrow. What should I do next?

Jeannette Newman-Velez, R.D. I.B.C.L.C
YWCA WIC Breastfeeding Promotion Coordinator
E-mail [log in to unmask]