>>Mom has some confidence issues in terms of her role as a
mother, but has been very committed to breastfeeding.  Since day 4 she
has had a cracked nipple on the right side.  Mom has a HUGE (like I am
frightened by it) crack on her right nipple.  I have checked her
latch, an IBCLC whom I trust completely has checked her latch-- can't
see anything to correct.  Tried topical treatments, etc.  No evidence
of yeast.  Baby sucks normally on fingers, no hint of tongue or other
problems.  Mom has been nursing on left side only, pumping and
bottlefeeding on right side.  Suggested the bottle might be altering
latch, mom will stop bottles if she must, BUT has to return to work in
a few weeks anyway.  Any suggestions?<<

This sounds exactly like me about 3 years ago!   Finally the LC suggested I
try an antifungal in spite of having no visible signs of thrush.  Is this
what you were referring to when you mentioned "topical treatment"?  For me,
it helped with a lot of the pain, but the cracks still didn't heal.  My CNM
finally did a culture of my breastmilk and found evidence of a staph
infection.  Treatment with a topical antibiotic (a couple times a day was all
it took) alternated with a topical antifungal finally did the trick for me.
Prior to the topical antibiotic the midwife prescribed an oral antibiotic,
but that really didn't seem to help with healing that huge, persistent crack.
 I used the topicals for about 3 weeks (felt better after about 2) and then
quit.  This was probably not a complete cure (I still get little blisters
starting every now and then--my son is still nursing--betadine soap gets rid
of them) but it healed the major wound and made continued nursing possible
and even comfortable!  I also followed LC's advice to use "the longest bottle
nipple you can find" for bottle feedings and avoid all other artificial
nipples--don't know as that was really an issue though in my case or in
yours.  I do think it can make a difference to some babies and offer the same
recommendation to the moms I work with when they are planning to return to
work.

If mom has correct latch-on and baby has a good suck and mom still has huge
cracks that aren't healing, it sounds like something else (not the
breastfeeding) may be the problem.  Perhaps you could suggest she see a
dermatologist or her OB to check for other causes.

Catherine Alqallaf, LLLL
Centerville, TN

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