-- [ From: Phyllis Kombol * EMC.Ver #2.5.3 ] --

        First a little reintroduction, since I've been mainly lurking for quite
awhile.  I am  the only full time IBCLC in an urban inpatient setting
with about 65% breastfeeding in our 5600 births per year and about 1000
babies through our intensive care nursery.  We have 3 full time
positions alotted but have been piecing together part time folks as we
can and usually only have about 1.5 IBCLC and .4 of a breastfeeding
educator nurse (who will  be sitting for the exam this year) to see the
worst problems of the 50-60 patients on our daily consult list.  We work
closely with WIC in our community and an IBCLC colleague asked for input
on the following case.  (She and the patient both agreed to me posting
it for your consideration.)
        The client is a 27 year old pregnant womsn.  This is her 3rd pregnancy
with EDC June 14, 1998.
Pregnancy/Breastfeeding History:  Initially unable to conceive.  Went to
a fertility specialist and was given "medicine" to help her conceive.
She can't remember what the medicine was, but believes it caused her to
develop an ovarian cyst which was surgically removed prior to her first
pregnancy.  On 9/5/92 her first child was born.  Experienced preterm
labor and was on Brethene during the later stages of the pregnancy.
Breasts increased in size from A to D cup size during the pregnancy.
Noticed a little blood in her colostrum after the birth of her son.  The
blood cleared within one day and she went on to breastfeed for 8 mos.
        She was on Depo for 6-12 mos. between '93 and late '94.  On 10/28/95
second child was born.  Was on Brethene from about 20th week gestation
for preterm labor.  Did not notice any change in breast size during this
pregnancy (stable at A).  Right after delivery, noticed blood had leaked
from her breasts onto her gown.  Was encouraged to pump in the hospital.
 Colostrum was "burgundy colored" according to client. Cont'd to pump
after discharge, first with manual pump and later with a battery
operated (G----r) pupmp.  Did not have pain with pumping.  Milk cont'd
to be burgundy colored.  Mom got discouraged and stopped pumping at
about 2 weks.
Rec'd no breast evaluation between this experience and current pregnancy
.  Her OB doctor is the same one.  She did use Depo again for 6-12 mos.
between pregnancies.
        Currently she is 37 weeks gestation.  She was on Brethene from 20th-
36th week gestation.  She is experiencing a "tingling, uncomfortable"
sensation in a localized area on the underside of her right breast.  She
does not have any swelling, redness or lumps.  Her breasts have
increased from an A to a B cup.
She is leaking a small amout of colostrum and blood from her right
breast and has expressed the same mixture from the left.  She asked her
OB and was advised to "wait and see if it clears up." Client is worried
and wants to know why this is happening.  She wants to breastfeed but
does not want her baby to get bloody milk.  At this time, she is seeking
 a second medical opionion, and is planning to pump and dump her milk if
it come in blood stained.  She hopes her milk will eventually be clear
of blood, so she can feel comfortable feeding her baby.
        In over 5 years as an LC, I don't ever recall a similar case.  Any
ideas, suggestions, recommendations are welcome....but since I often get
behind in digests, please email privately (as well as to the list):
TIA Phyl
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