Dear Lactnet friends,

I am just coming back on after being off a while.  A CNM friend of mine
has asked me to forward a copy of this post to you all for feedback on
this case.  I haven't encountered a situation quite like this one. I did
suggest culturing the milk from the other side.  She needs an answer
quickly so please email me privately in addition to posting to the list if
you have ideas so that I can forward the info to Gretchen ASAP.  If the
woman is not feeling better soon, she will switch antibiotics.  I also
suggested extra rest, echinacea and extra vitamin C. Gretchen has
suggested cabbage leaves for the inflammation. She says the woman is
pretty overwhelmed by parenting but seems to be good about resting and
isn't taking on other outside activities.  Binding clothing, tight bras,
etc have been investigated as contributing factors but don't seem to be. I
am puzzled, too.

Ione Sims, CNM
Community Nurse Midwife
[log in to unmask]

---------- Forwarded message ----------
 I have a client, g1p1, who is about
2-1/2 weeks PP after a really nice, normal, fast homebirth.  Baby went to
breast without problems - she had the usual tender nipples in the first
week, but no cracking, bleeding, or more severe problems.

Last week (6 days ago), they called to say that mom had noted that her left
breast was a little tender at an afternoon nursing - didin't think much of
it.  She went out to do a few errands, and within a couple of hours was
dizzy, chilling, and feeling completely awful.  She went home, went to bed,
and by evening had a temp of over 103 degrees and her breast was so sore she
couldn't touch it or hardly move the arm on that side of her body.  I had
them started warm soaks/packs, frequent nursing to empty the breast,
increased Vit C, lots of fluids, bedrest, acetaminophen for fever reduction,
etc.  The next morning she was still really sick and miserable and I talked
her into starting antibiotics.  She did, and within 12 hours her fever was
coming down.  By 24 hours after starting, her breast was improving (redness
became localized to the lower quadrant).  I had her continue all the other
measures until she felt everything was back to normal, which was by about
the third day.

Well, today she called again.  Her 7-day antibiotic course doesn't run out
until tomorrow and now she's got exactly the same thing going - on the OTHER
side.  Sore, red breast, chilling, etc, but no fever as yet.  I've never
before had someone develop a subsequent mastits while still being
successfully treated for an initial infection!

Question:  What should I do now?  Those of you who don't rx anitibiotics,
what do you do in cases like this where there is a fast, intense onset to
the infection with so many systemic symptoms?  Is there anything herbal one
can do to lower the threshhold for mastitis in women who are prone for
whatever reason?  Help - she feels terrible and I feel helpless....

Gretchen, CNM