Dear Becky and Everyone,

We are just as intrigued with all the various items coming through from you.
It is really hard to restrain ourselves from spending more time than we have
sometimes to be part of it all! What a resource!

Just this morning we have had a client in deep trouble with a damaged nipple
(from one episode with a poorly attached 16 week old baby), engorged breast
and about half of the breast full of blocked (plugged) ducts. Over the
weekend this had gone from just sore to unbearable. Her midwife referred her
to us this morning. The baby had last fed (painfully) at 7am this morning
and the mother did not even want to touch the breast let alone feed from it.
She was crying on the phone when she rang at 9am. I asked her to soak the
breast in Epsoms Salts - about 2 heaped tablespoons in about 1-2 pints (or
4-5 litres) of very warm water, until the temperature of the solution
returns to about room temperature (about 10-15 minutes), then to go to a
local physiotherapist for ultrasound treatment. She then came to see us. The
affected breast is the one that usually leaks easily (when she undoes her
bra or feeds from the other side). It was very full and had not leaked all
morning, but did start to about an hour after the ultrasound.

I asked her to feed from the undamaged side first so that I could assess the
baby's feeding behaviour. She fed beautifully but I could see that she
didn't have quite as much breast in her mouth as she could have done. This
didn't hurt the mother, but when the baby came off after about 25 minutes,
there was a thin compression line across the top of the nipple. The mother
told me that she had noticed that this always happened after feeding.  After
an explanation that this meant that the baby normally fed with not quite
enough breast in her mouth so the nipple was not back quite as far in the
baby's mouth as it could be, she decided she wanted to try feeding from the
damaged side. It took three attempts before the baby took enough breast into
her mouth so that she didn't hurt her mother, and fortunately she didn't
release any of it till well into the feed. (Our arrangement was that if it
hurt, the baby was to come straight off!) Usually babies of this age have
well developed preferences for how much breast they like in their mouths! I
also explained that there is no need to change the baby's preferences unless
it's causing a problem, which it obviously hadn't until now and I expected
that this was just an accident that was not likely to happen again.

The breast felt a lot better after the feed, and she left feeling confident
that she could handle things from now on but will keep in touch as she needs
to. I expect that by about 3pm the last of the blocked ducts will have
resolved thanks to the ultrasound treatment and feeding will help drain off
the rest of the milk.

Anne is going to try to post the info on Lactnet re ultrasound dosages for
breasts after she talks to one of our physio friends. Epsoms Salts soaks can
be done more than once, but once is usually enough for these acute
situations. We also tend to feel that if a little is good, more is not
necessarily better!

Robyn Noble and Anne Bovey, Brisbane, Australia