Dear 'Netters:  I would appreciate any helpful comments regarding this
situation.  A colleague of mine has a 10-week-old baby, the happy result
of a long infertility struggle (she's 46).  She was very determined to
bf, but due to some early problems including Caesarean birth, ABO
incompatibility with early jaundice mishandled by a nurse who in her
hurry to get the baby fed repeatedly shoved his face into her breast,
then bottle supplements with resulting nipple confusion which did not
improve despite various frustrating attempts with SNS, shield, etc., she
finally gave up about a month ago but continued to pump and feed her milk
by bottle, with abm as extra supplements.  Apparently she didn't give up
completely, but kept on offering the breast occasionally.  About a week
ago, she had gotten engorged after noting that the pump was not as
effective, so she put the baby to the breast and the little guy just
started nursing!  She asked my advice, since she was having soreness
initially at latch-on, and she was still complementing with a bottle
after some feedings because he would suck for a few minutes, then "pop
off", sometimes pulling her nipple with him, which she interpreted as
frustration at not getting enough (which was reinforced in her mind by his
taking a few ounces by bottle right after).  I advised that she nurse
exclusively and just watch his diaper count to tell her that he's getting
enough, and to nurse before he's crying from hunger.  I reassured her
that the soreness at latch-on was probably like a new mother's soreness
in the first week, but if it persists beyond latch-on, we would need to
further evaluate.  After two days, she stated that he nurses about 30
minutes on one side, falls asleep for about 1/2 hour then nurses on the
other side, and keeps this up all morning, which has resulted in
increasing soreness and a deeper burning pain in the medial aspect of her
breast, sometimes lasting a 1/2 hour after a feeding.  In the afternoons, he
doesn't seem to nurse as often or for as
long.  She has given him one 4 oz bottle on each of the two days, but
otherwise has just nursed him.  She repositions him, and notes towards the
latter part of a
feeding, he seems to be closer to the nipple, but she's afraid to take
him off because he may not want to go back on the breast.  She saw no
thrush and baby has no diaper rash.  She has tried supporting her breast
better, and tucking him in closer, with some improvement.  I'll be going
out to see her tomorrow to better assess, but in the meantime I advised
that she never let him continue in a bad position and if she's sore to
try switching to the other side.  She has back problems and will be
taking motrin, so I'm hoping that will also help her deep breast pain (by
the way, she checked for lumps and found none).
A couple of questions:  If there's no evidence of thrush, what are some
other possible causes for her pain besides the obvious?  She's wondering
whether it's her "old breasts", with less support, causing some
ligamentous pain (since it feels better when she supports it).  Anybody
ever heard of such a thing?  Anybody have any experience with a baby that
bottlefed for 2 months and then went to breast in this way?
Sorry for the long rambling post, but I really want to help this
persevering, committed mother.  TIA, Alicia.  [log in to unmask]