I have a mom-baby that I'm caring for that are a puzzle. Mom delivered
11/30/04. Baby was 7 lbs 4 oz. Baby latched and nursed starting a few
minutes after birth. Mom had a lot of trouble with latch initially, mostly
due to allowing the baby to sort of slurp up the nipple to become deeply
latched. She has flatter nipples, although not bad, just not as protruding
as some. We finally had some success with having mom firmly compress the
areola, aim the nipple up, and tip the "breast sandwich" into the baby's
mouth when she gaped. Meanwhile, her nipples suffered some scabbing, which
cleared after finally getting the latch corrected. Baby was slow to start
to gain, but always looked well hydrated, and gained averagely once she
started to gain. She did get some bottles of ebm during this time as mom
was so sore she could not always tolerate latching the baby. At 2 weeks of
age, mom complained of deep breast pain, not resolving after latch, sharp
and shooting, worse in the lower outer quadrants of the breast. She also
noticed redness of the nipples and areolas. I examined her and baby, and
found baby to have thrush, and her nipples to be bright red. I started mom
and baby on diflucan for 2 weeks. Pain improved a little. At 5 1/2 weeks,
she returned with complaint of persistent pain, especially in the lower,
outer quadrant of the right breast. I could feel a firm cord-like mass,
mobile, mildly tender. The right breast was also firm and full, and mom
reported favoring the other breast for a while due to the pain. Nipples
were still red and sore, but no obvious skin damage. Baby appeared to have
a small amount of thrush again. I restarted diflucan in both, and suspected
a plugged duct. Had her massage, use heat, and empty the breast as well as
possible with baby or pump (she has a PIS) Saw her again yesterday, and the
breast is still sore, but no palpable mass now, and the breast is soft.
There was never any redness or fever or other signs of mastitis. Nipples
are pink, and still a little tender. There are no signs of Raynaud's. The
baby is thriving now, growing an average amount, and generally seems happy.
I could not see any more thrush on baby (she's on day 8 of diflucan.)
This mother nursed her last child 10 mos, and had various boughts with pain
most of that nursing experience, too. She's kind of sensitive and anxious
in general in life (I've taken care of her several years, and been through a
divorce, remarriage, and 2 pregnancies with her, so know her well.) This is
her 4th child. First was breastfed just in hospital, and stopped due to
poor latch and nipple trauma. Second was breastfed about 6 weeks, and again
stopped due to nipple pain and damage. Third was the one nursed 10 mos,
including after she returned to work as a prison guard at 8 weeks and pumped
at the prison all that time! She is pretty dedicated, but would like to be
pain free. She has the above mentioned 4 children, plus 3 step-children at
home so is obviously busy. All the children are 8 and under. Any ideas?
Jennifer Tieman
Family Physician
Mom to 4 including my toddler nursling Caroline Rose
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