Diane, I think we should continue to give moms the basic recommendations 
found in our textbooks for "plugged ducts" or "mastitis." We don't have 
crystal balls to know if something is on the worse side, like all the MRSA 
mastitis we are seeing here in Houston, TX. We can be more aggressive in 
suggesting that if things don't improve in 24-48 hours that mom go to her 
doctor. We can also suggest that moms go back to the doctor and ask for 
cultures when the antibiotic isn't helping (and it clearly is mastitis). But 
other than that, I don't see that anyone could have predicted this mom's 
situation.

You are right about the limits of phone helping or email helping. But even 
if you had seen her in person, you might not have known this was going to be 
a "bad one." You could use her example when you talk to moms in the future 
about being aggressive in getting medical treatment!

I have had 3 bad c-section infections among my WIC clients in the last 3 
weeks. These are only the tip of the iceberg because I only get certain 
referrals (as IBCLC). All of them were in the hospital for at least 10 days 
and came home very very sick. (All at different hospitals.)  We are also 
having moms with diagnosed mastitis not be cured by the initial antibiotic. 
It has all made me a bit paranoid.

Kathy Eng, BSW, IBCLC 

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