Hi all - just thought I'd share a tough case with you of a mother with
extreme breast pain who I'm working with at the moment.

The mother is in her late thirties, first pregnancy - twins.  The babies
were born at just a day or two short of 36 weeks gestation.  Lovely birth -
first twin underwater in the bath, second twin followed naturally some 20
mins later (out of bath by now).  No intrapartum drugs, physiological 3rd
stage.  Yes Lactnetters from the US this is a hospital birth I am
describing.  Babies weighed 2.3 - 2.5 kg approx, can't remember (multiply
by 2.2 to get pounds).  The smaller twin needed oxygen for 6 hours.

Mother was prepared for preterm birth and was adamant that her babies would
receive nothing but breastmilk so had some donor breastmilk from a friend
ready for them (no milk banks in Aus :-(  ).  Neither baby was NG tubed or
dripped - the smaller twin has finger feeds for 5 out of 8 feeds a day
(other 3 at the breast).  The bigger twin has been only breastfed.

The problem:  from the very first feed the mother has experienced extreme
shooting breast pain.  She has never had thrush (yeast) and has no risk
factors for it - plus the pain isn't typical.  I first saw her yesterday
when the boys were 4 days old.  Her latch was good - there's no nipple
damage evident and the nipple exits the mouth looking pretty close to the
way it went in (one of my major criteria for assessing latch).  The pain
starts at the nipple and shoots (stabs!) laterally on the left side of both
breasts to the central chest wall on the right breast and the underarm on
the left breast - only there, no where else.  She only feels the pain when
the baby is actually suckling ie. when his jaw is working - the second he
stops, so does the pain (still latched with negative pressure)

Now this pain is really severe - the mother is literally jumping up and
down on the spot as the baby feeds and is really distressed.  Massaging the
affected area as he feeds makes no difference (other than distraction -
mother said);  it's not affected at all by the milk ejection;  it's
absolutely no different if you change the baby's position; heat is
difficult to apply during a feed but is really soothing to the dull ache
which is left in the breast after the end of the feed.  The baby's suckling
action looks wonderful and lots of nutritive suckling occurs.  Both breasts
were very full when I saw her and significantly softer after the feed (the
side fed from) - but this pain began with the very first feed, so not
related to breast fullness.

On inspection her nipples are normal, areola is average to small size but
thicker than usual - kind of blends up to the nipple.  She has small
breasts.  She experiences the exact same pain when pumping (Medela
Lactina).  She reported hand expressing was less painful but she wasn't
getting much - I watched her technique and it was less than effective -
when I showed her how to do it properly she found it painful again, but not
as bad as the pump or baby.  When I hand expressed her the lactiferous
ducts and whatever else surrounded them was thicker and firmer than I
expected (am used to feeling) - but I was able to get much more milk with
the improved technique.

I worked on her attachment technique - changed it from 'really very good
that I wouldn't usually modify' to brilliantly excellent  (do you like
those technical descriptions?).  This did reduce the pain to bearable, but
still there.  I suggested Nurofen (ibuprofen) 45 mins before feeding, a
warm pack to put on the breast immediately the feed concluded, and Rescue
Remedy which she'd never heard of and i doubt she'll try.  We also
discussed distraction techniques, relaxation techniques - baby was actually
getting distressed with mother's leaping around while feeding.

I rang her today to see how she was going and she said it was still there
but very much improved with those measures - she's taking the Nurofen
regularly as often as recommended on the pack and will continue to for 48
hours, then see how it goes without.

I'll keep you informed about the progress.

Denise

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Denise Fisher BN, RN, RM, IBCLC
BreastEd Online Lactation Studies
++++++ earn 120 L CERPs +++++++++
mailto:[log in to unmask]
http://www.BreastEd.com.au

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