I will have a good weekend thinking about how happy this mom was today!  :-)
This mother delivered 5 days ago.  It is her second child and was complaining
of sore nipples almost right away.  She nursed her first child for a year and
said that she had sore/cracked nipples for 2 weeks with her.  She just hung
in there until they healed.
What I observed was long (around 2 cm) nipples.  I was seeing her around 48
hours postpartum.  There were cracks horizontally on both tips and a crack on
the left nipple at the juncture of the nipple/areola from 10 o'clock to 2
o'clock.  The baby had a slight recessed chin, normal tongue, palate and suck but a
very tight, short labial frenulum, which caused a very noticeable notch in
the upper gum line.  I had made some adjustment in the latch to a more
asymmetrical approach with not much improvement in pain relief.
I called her today and the nipples were worse.  I had her come in.  The
breast were engorged.  The cracks were slightly larger but the one at the
nipple/areloa junction was healed.  I had her hand pump for a couple minutes, to get
the milk flowing and soften the areola and then had her put on the regular
nipple shield.  The nipple was compacted in the shield.  She latched the baby - NO
PAIN!!  Before she was having latch pain of "8" with slight decrease to "6"
(this is with a 1-10 scale).  The baby went on to nurse beautifully into a
drunken satisfaction and the breast softened.
The plan was to continue the shield use until the nipples healed then try
without the shield.
Has anyone ever seen a tight, short labial frenulum cause sore nipples?  I
advised her to have the pediatrician look at this and maybe a dentist.
Ann Perry, RN IBCLC
Boston, MA
The

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