Alicia,
The "thickened" milk is an intriguing clue. That suggests to me 1)
"coagulation" from continued milk stasis; 2) high fat; 3) pus in milk, or 4)
yeast in ducts. Regardless of how this all started, I have seen "thickened"
milk, almost feathery in appearance, when there has been ductal yeast,
especially when it is more entrenched. Once you get this in the milk, it
does indeed plug the ducts easily, drain poorly, and can cause repeat
mastitis. If this is the case, diflucan is surely warranted, and delaying it
will not help any.

Did baby have or does baby have thrush? That can certainly contribute to
weird suckling and poor breast drainage along with mom's issues.

Has baby been able to thrive exclusively at breast throughout this ordeal,
and yet the pump has been ineffective in relieving leftover engorgement?
What kind of breast pump has mom been using?

Since your creative positioning helped relieved some of the engorged areas,
I'm wondering if mom might benefit from doing focused breast massage a
couple of times a day, especially before feeding. Gently working the plugged
areas towards the nipple, applying moist heat, etc., can help promote
drainage. It is possible that making this a part of her routine can help get
things moving again, in addition to whatever treatment is needed.

My armchair 2 cents.

Lisa Marasco IBCLC

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