I am grateful to Lisa Amir for helping me refine my terms as I grapple with
understanding chronic, debilitating breast/nipple pain in afebrile nursing
mothers.  She is absolutely right that "sub-clinical" is  not the best way
to describe what I'm seeing.  "Low grade infection" is a much more precise
terminology.  I'm going to add the word "chronic" to this.  Chronic
low-grade infection of the breast or nipple is, in my experience, common,
under-treated, poorly understood, and a real reason that women wean in
total frustration.  They blame themselves for not being able to get well,
and because the pain is coincidental with breastfeeding, their health care
providers dismiss their concerns/problem as trivial.  The problem is easily
"solved" with no work to them by telling the mothers to wean.  If the same
pain, broken skin, rash, or redness were on the tip of their noses, no
expense would be spared to rule out/resolve the problem, and no one would
shrug and say "live with it; this is normal."

I have another mother, 8 weeks pp, whom I just began working with 2 weeks
ago.  She worked with the hospt. LCs for 6 weeks trying to resolve chronic
pain.  When she goes outside in hot weather (and its over 100 here) her
breasts throb.  She can't lay the baby on her breast without pressure
sensitivity.  She has been only pumping for a week to try to heal her
nipples.  21 days of diflucan and this is right where she was when she
began.  I had to throw a fit to get someone to culture her milk, and she
really ought to have an ultrasound to rule out abscess (which is what I
suspect).

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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