Greetings all!  I would like to tap into the collective wisdom of this
group.  I just received a call from a mom who is pregnant with her third
baby.  I worked with her with her first two babies, who are now 2 and 4
years old.  This mom experienced frequent bouts of mastitis, which was at
times severe, with both her children.  She is now due in April, and is
wondering if there is anything she can do to prevent this again. (she says
she is more worried about mastitis than labor!)  With both babies, she
already had mastitis on her home visit, day 5.  She nursed both babies for
about one year, and developed many cases of mastitis over the entire year,
and frequently developed yeast infections due to the antibiotics.  She did
all the recommended things for mastitis, but it just kept coming back.

Now, my theory is that she has a structural problem (maybe a stricture) in
the affected breast, which prevents the milk from draining in a specific
duct.  The nipple appears to be dimpled, in that it kind of points upward,
where the other nipple looks fine.  (never mastitis on the other side).  The
nipple actually turns upward, and there is a crease approx 1.5 cm long that
becomes cracked immediately.  This crease is at the point where the tip of
the nipple meets the aerola.  I have felt that it is through this opening
that bacteria has been introduced.  Now, the clincher is that she makes more
milk on this side, so does want to use it.  She is also very committed to
breastfeeding and wants to nurse this baby, also.  Both babies were not easy
nursers either, by the way.  The second one was orally aversive, and is
still working with an OT.

Ok, any suggestions would be sincerely appreciated!  Her husband was
wondering about a prophylactic antibiotic, but I wouldn't recommend that
because she is very prone to yeast overgrowth.  Thank you in advance!  Linda





Linda J. Tandy, MSN, RN, CCM, IBCLC
Clinical Nurse Specialist
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