Hi Julie,
In my opinion, yeast get treated for more than is necessary, moms often
receiving months of treatment with no results. I think of myself having a
vaginal yeast infection, and with the first application of a topical
treatment, there is relief, even if not a cure at that moment.
You didn't say if this mom has bilateral or one-sided symptoms. That may
tell you something too.
What I am wondering is if the mom has oversupply symptoms, that maybe baby
is clamping and has caused some repeated trauma, and/or circulation
compromise, maybe even vasospasm. I would also be wondering about contact
dermatitis or allergy to some of the treatments.
I would definitely want a thorough history, what makes it worse, etc. I
would also want to see the way they nurse, positions, latch, a typical
feeding, the way the nipples look when released, the way the skin looks.
Also how she pumps, the suction level, the flange fit.
What could help is to perfect the techniques of position/latch, manage
oversupply if still a factor, use some topical cortisone sparingly and for a
short treatment period, and take some pain meds or anti-inflammatory for a
short treatment period (1 week) and see what happens. With the topical
cream, I would ask mom to rinse with warm water and gently pat dry prior to
feeding baby, I do not know how much would be on skin, but would not want
baby ingesting steroid.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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