Hi all, yesterday I saw something I've never seen before and wonder if
anyone has any answers.  A mom phoned me from the labour ward to say she had
"cracked" nipples and everyone was concerned about breastfeeding (whether
the nipples would worsen, whether breastfeeding would be safe for the baby).
By the time I arrived in the afternoon, the staff had already scrubbed the
nipples!

Mom is Caucasian.  This is a first baby. The nipples are normally
protruberant, normal shape and size, but there is what appears to be hard,
dried, browny-yellow, thickened skin on the tip of each, in little pointy
protruberances corresponding to the normal ups and downs of the nipple-face,
between the pores, not *in* the pores, which are not occluded. The skin
looks exactly as if someone had dried it out or burned it with a match-flame
(without the blistering that would subsequently occur if this had really
happened). The L nipple is worse than the right. It doesn't look infected,
cracked or sore, and mom confirms that it doesn't itch and there is no pain.
The condition commenced shortly before pregnancy, she thinks, and she did
*not* do any nipple-toughening, or use any type of nipple creams or
ointments during the pregnancy.

The baby was anxious to eat.  In the absence of any info at all I suggested
we try the baby at breast and see what happened.  He raised no objection to
the condition of the L nipple, sucked easily and there was swallowing
(obviously a good quantity of colostrum being produced already). Mom found
the whole feed very comfortable and at the end the nipple looked better, if
anything, being moist.  I suggested leaving a little expressed
colostrum/milk on each nipple after feeding, and after it dried, using a
tiny smear of pure lanolin to soften the hard skin, no soap, and not to
attempt to loosen the hard skin in any way.

Does anyone have any ideas?  Seen anything similar?  Cause? Tx?  Anything????
I have mom's grateful permission to ask you all.  Thanks if you can help.

Pamela Morrison IBCLC, Zimbabwe
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