I am frustrated by a case that I think I should be able to solve, but for whatever reason, the answer isn't coming to me.

First time mother, now six weeks postpartum. Long but fairly uneventful homebirth and after some good rest for mom and baby, breastfeeding initiated fairly smoothly. Both mom and baby have had chiropractic and cranio-sacral work. The issue we're having are these creases along the lateral diagonal corners of her nipples, symmetrical bilaterally. Mom feeds almost always in the cradle hold and creases are from 2 o'clock to 4 o'clock. 

Baby has a lengthy and free tongue. Latch looks quite fabulous. Gaining exceptionally well, appropriate. Mom's only complaint of pain is upon initial latch "when the scab is ripped off." Then she does well, but initial latch is rather excruciating. While I think we might have had a few poor latches during the first few exhausted days, baby really seems to have mastered the latch-suck-swallow routine, and mom gives great support. I suspected we just needed a day or two to recover, and when that didn't happen by our two week visit, I offered her 30 grams of APNO to boost healing. We discussed alternating positions and I've stressed not allowing baby to slip, but honestly the crease is along the upper portion of baby's latch so not typical of a poor latch for baby's positioning. 

At her six week visit, mom said she was doing better, "I don't hate it, but I'll admit I am not in love either." She is really experiencing a great deal of pain upon latch on and said she used the entire tube of APNO and filled it again! I haven't a clue why I even offered a refill this time, as I've never had a mother need it. I was surprised, and rather stumped.


Thoughts?

 
Penny Lane MSN, CNM, IBCLC
Believe Midwifery Services.com

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