I am feeling discouraged today and I wanted to share this case. I wish I
could have done something different that would have helped the outcome. 
This mom has a 5 month old baby, her third child.  She nursed her other
children several years each and is very dedicated to breastfeeding.  When I
first saw her she was a patient in the hospital, had been admitted 3 days
before with severe mastitis.  She was pumping every few hours, intent on
continuing the breastfeeding, yet still spiking fevers.  Saw her two days
later, she was still pumping, encouraged her to get the baby in to nurse. 
He came in, she was thrilled when he nursed well and she noticed her milk
increased.  By the next day she noticed two large areas of redness on her
outer quadrant of her right breast, and increased tenderness.  We discussed
abcess, she said her doctor had told her it was NOT abcess and was a skin
infection which had come from her infected milk.  By the next day, the two
areas were indenting, getting worse, and MD says to her it is NOT an
abcess, changes her antibiotic and tells her to put Telfa pads on the area
to keep it from sticking.  I was off for 3 days, came back to a mom who had
abcessed and had to go in for major surgery on the breast to drain and
clean out the area. MD had told her to stop breastfeeding, bound the
breasts, put her on Parlodel  (yes I know its not recommended!)and a
stronger antibiotic.  Even the unaffected breast was bound and she had
stopped pumping.  MD told her that the milk protein was causing the
infection to continue, and that if she continued pumping she would be in
the hospital for weeks more. If she wanted to go home, the breast must be
allowed to involute and heal.  I asked her if I could talk a different
strategy to her Dr and she said okay.  I called surgeon and asked him about
his plan of action and he said that he felt it was imperative that she stop
nursing.  I asked him about continuing on the unaffected side, at least and
he said well it was up to her but he felt that she would be unable to make
sufficient milk with one breast.  Mom was feeling rotten and decided to
follow his plan so she could get home quicker.  Now it is 6 days later and
she is still in the hospital, had surgery again today to debride and clean
up the breast.  I shared with the doctor Ruth Lawrence's information, and
now feel just awful about this mom and her loss of breastfeeding and wonder
what I could have done more, and what may have helped this mom.  If you
have any suggestions please let me know because I am feeling so down about
this.  Thanks.
Ann Calandro, RNC, IBCLC