PTP

Been working with a mother of a an almost 11 week old. After a rough
1st week, BF was great until she returned to work at 8 weeks pp. She
has complained of her nipples cracking whenever pumping. When she goes
back to bf on days off, there is improvement.

She has large nipples, at the base the areola is very wrinkled which
makes me suspect that it is actually nipple tissue. She was using the
27mm and experienced pain w/every pumping. She went up to the 30mm and
then 36mm. She stated it felt better but they continued to crack open
when pumping. I saw her nipples and they had small cracks at the base.
She was using lanolin and/or soothies regularly and started using
olive oil when pumping. A week later baby was diagnosed w/thrush and
treatment started. Mom was not being treated so we discussed how to
handle thrush. I saw her nipples at that time and they had a thrush
rash that was not visible the week before.

Mom finds all the tips for managing thrush to be overwhelming. I am
not confident she will be diligent in the treatment. A week later, mom
has some improvement but as soon as she went back to work one nipple
cracked all around the base. She complained yesterday that her nipples
are so dry that they crack when she pumps. This is the first complaint
of dryness I've had from her since problems started as she was using
lanolin almost constantly. I have not seen her pump yet, I'm trying to
arrange that.

She is using low suction due to the pain which lowers how much she can
get when pumping. Massage helps but she doesn't feel she is emptying
her breasts.

I've suggested she experiment with the different size flanges. She is
using a Lactina at home and an old pump and style at work. There is no
difference in pain between the two.

She started Gentian Violet last night. I want to see mom pump but our
schedules don't mesh well. I keep going back to the flange size in my
head.

I would welcome any tips or suggestions. Most of our communication is
via text and phone.

Thank you,

Allison Laverty Montag RLC, IBCLC
Green Lake, WI USA


-- 
"Our doubts are traitors and make us lose the good we often might win,
by fearing to attempt."
William Shakespeare
Measure for Measure

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