I saw a mother yesterday, her fourth day post-partum. They stopped by quickly
on their way to see the pediatrician.  I only spent about 15 minutes with
them, I thought it was going to be a quick positioning fix.  The mother was
in excruciating pain the second the baby latched on.  Having her deep breathe
while I positioned the baby a little better made minimal difference.  She was
miserable the entire 5 minutes the baby was on the breast, but she had been
pumping last 24 hours and the breast quite full and hardening needed to be
'emptied' well, so I encouraged her to hang in there.  Her nipples were
cracked and there was definite impairment of the skin integrity, but the kind
of soreness she was experiencing, I would expect to see at two weeks out from
damaged nipples.There is no questioning she has nipple damage from initial
poor positioning, but her pain seems abnormal.  She did not react like she
had hypersensitive nipples, but she was extremely uncomfortable with the baby
at her breast. Pain "10" on 1-10 scale. She described the pain as hurting,
burning, aching, terrible...when asked if she felt deep, knife-like pain, she
said "all of it"!  She received 4 doses of IV Ampicillin for treatment of
positive beta-strep, day of delivery.  She also told me she has a history of
vaginal yeast infections and she thought she had one at the time of delivery
with a yellow discharge, but the OB told her he did not see anything...Pink,
shiny nipples, fair skin...I saw the OB later that day and he said she acted
that way the first time the baby latched on, he wasn't too impressed...She
appears to be a very 'normal' mother, eager to do what is best, has a
supportive husband, who has been finger feeding pumped breastmilk.  Right
before the mom and baby rushed out to the doctor's office, I assessed the
baby's suckle, now the baby had eaten, but the suck was a 'medium' in regards
to 'pull', with regular rhythm, I was surprised the suck was so 'mild', based
on the mother's complaints.  I have never seen a mother with yeast this soon
after delivery, but I think it is possible she had systemic yeast before the
Ampicillin...I called the one most experienced LC in our area, she said she
had never seen it this early either...Have any of you seen ductal yeast this
soon after delivery? I would appreciate any and all comments, thoughts,
suggestions...
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Anne Williams RN BSN IBCLC

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