Introduction
With the increase in numbers of mothers choosing to breastfeed and the knowledge of lactation consultants for assistance, the scope of problems that the lactation consultant will see is going to broaden. This case demonstrates the importance of the lactation consultant functioning both as a part of the team as well as being the initiator for bringing in other health care professionals.

Case Report
The mother is a G5P3 with 13 years between her second and third child. She is well prepared and knowledgeable about breastfeeding. She arranges for the rental of an electric breast pump two months postpartum in preparation for returning to work. At eight months postpartum, she asked for a consultation for what she described as a 'growth' on her right nipple. She had been advised to see a breast surgeon and have it surgically removed. Prior to taking what the mother felt was a drastic course of action, she sought the lactation consultant's advice.

The mother explained that the 'growth' had appeared on her nipple approximately one month prior to this appointment. She did not recall anything unusual happening before its appearance. The 'growth' was not interfering with her pumping or her son's breastfeeding. The only difficulty related to this growth was that her son would occasionally come off the breast and play with it. The 'growth' tended to crack and bleed at its tip which was uncomfortable.

Upon examination, the 'growth' was not a 'growth' but a localized inflammation of the nipple tissue, approximately 1cm diameter and 1cm long. It was lighter in colour than the surrounding nipple tissue with spots pigmented similar to the rest of her nipple. The tip was red and the edges were rounded.

The lactation consultant called a local dermatologist. He suggested that it sounded like a staph infection and offered to see the mother. A full consultation was arranged. After taking a history, and examining the 'growth', the diagnosis by the dermatologist was "an inflammation secondary to a staph infection of unknown aetiology".1 The recommended treatment was topical Bactroban twice a day for one week with oral Zithromax for five days. If there was no change in that time, a skin biopsy would be recommended.

This medication choice was discussed between the dermatologist and the lactation consultant. The dermatologist was uncertain of the compatibility of these medications and he questioned whether pumped milk from this breast should be given to the infant.. However, the dermatologist was comfortable leaving the breastfeeding management decisions to the lactation consultant. Neither topical Bactroban nor Zithromax are contra-indicated for breastfeeding.²

The mother chose to pump the breast with the inflammation with a hospital grade electric pump and not breastfeed on that side until it had healed. This choice was made for her comfort. The pumped milk was given to her infant. Her thinking was that, as the 'growth' had been there for so long, it was unrealistic to expect it to heal in a week. The mother continued to pump at work and breastfeed when she was with her infant.

Summary
Lactation Consultants working with breastfeeding mothers will see more 'unusual' situations. As breastfeeding advocates and health care professionals, it is in our best interest and that of the families with whom we work, that we develop a wide rage of breastfeeding friendly health care practitioners.

We need them for consultations with problems outside our sphere and when we do need to refer, it is important that the automatic response from health care practitioners to whom we do refer, is not advice prefaced with 'you just wean'.

References

1. Scheman Andrew MD. Personal conimunication.
2. Hale Thomas. Medications and Mother's Milk. Amarillo, Texas: Pharmasoft Medical
Publishing, 1996.

Patricia B Drazin is a lactation consultant in private practice in Wilmette, Illinois USA. The editor met Patricia in New Orleans at the 1997 ILCA Conference and Patricia offered to contribute to the journal.

We welcome Case Study contributions from practitioners in any field. The material does not go through the normal rigorous review process, but is sent to one reviewer. 
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from Birth Issues Vol 6 No 3 September - October 1997