My long-distance arm chair 2 cents worth:

>>1.  She does not have this pain  when she pumps.  Would it be a good idea
for
her to pump for a while in hopes that this nerve sensitivity gets
better...she has no history of Reynaud's.  <<

What does the nipple look like coming out of the baby's mouth? Any
particular sensations while baby nurses? Does baby possibly nurse
differently on this breast than the non-affected one? It sounds like a
traumatic vasospasm, especially when it is unilateral and pumping does not
hurt. In my limited experience, nifedipine does not resolve trauma-related
nipple spasms.

If baby is nursing differently on the affected side and the receding chin is
an issue, teach this mom how to do breast sandwiching (ala Diane Wiessinger)
with the cross-cradle ("U" sandwich) or football hold ("C" or "X"), starting
with baby's nose lined up with nipple and head tilted slightly back. When
baby opens wide, mom needs to land the lower lip/jaw just a bit ahead of the
top; this causes the jaw to plant and uses the breast to gently open the
mouth wider, as opposed to a straight-on latch where the lower receded jaw
can slip up to the bottom of the nipple. Though baby is started off-center,
they end up centered.

If positioning adjustments such as above do not stop the sharp pains, mom
probably would benefit from a short break on that side. I do agree that two
episodes of mastitis might have heightened nerve sensitivity. Given the
variable experience of nipple pain, I'm not sure if there would be any
infections going on, however. If you decide this is a possibility, maybe try
Jack's all-purpose ointment, or treat as per the article for latent
infection? Sometimes I think we just prioritize our best guesses and knock
them off one by one.

I'll be interested in what happens with this case.

Lisa Marasco IBCLC
Santa Maria, CA

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