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Subject:
From:
"Catherine Watson Genna, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 13 Feb 2001 20:30:07 -0500
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Hi Alicia,
Mastitis often reduces the metabolism of the affected breast, and
therefore decreases milk production.  Mom might feel engorged because of
the inflammation in the breast rather than pressure from milk storage.
Engorgement usually responds to ice, whereas inflammation responds to
NSAIDs and heat.  Your assessment of initial oversupply makes sense as
increased supply seems to predispose to mastitis.

During and after a course of mastitis, it can take quite a bit of work
to rebuild the milk supply.  As long as there is no abscess, it usually
seems to pick up with frequent nursing, but I have had women in my
practice who had much of their mammary gland obliterated by abscess, and
never did recover supply in the affected breast.  Perhaps manual
expression would be more effective than the pump until the breast is no
longer inflammed and indurated.  Laying the baby on a blanket on the
table and leaning down to nurse on the affected breast can be helpful in
increasing drainage while breastfeeding.

Could this be a nosocomial infection with a resistent bug?  I would
agree with you that the milk should be cultured, especially since
dicloxacillin did not even seem to dent the symptoms.  The only other
concern would be the rare possibilities of inflammatory carcinoma or
mastitis caused by candida.  You mentioned that the mom did not have
systemic symptoms of mastitis...

I'd also look at the baby at breast again.  There might be something
subtle going on in the baby's mouth that is causing nipple compression,
which can cause lack of drainage to areas of the breast, nipple
soreness, and shooting pains after feedings.  It's common for babies who
don't have perfect tongue mobility (or who aren't latched on deeply
enough to stabilize the tongue so it can perform the peristaltic
movements) to compensate with excessive compression instead.  The
chewing sensation is a clue that this is happening.

Good luck, this sounds like a real tough one.  And poor mom has to go
back to a grueling schedule.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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