>Everything looked normal except
>for a small shiny line where she indicated the pain was. She thinks it's
>the same location as the crack with her first.
Winnie -
Some years ago I had a client the shafts of whose extremely painful nipples
were ringed with fissures, sort of like stretch marks. When she pumped,
there were gelatinous blobs in the milk. She ultimately, over several
months, healed one side and weaned from the other.
Two years later she had a second child, *immediately* had the same problem
of extreme pain and nipple shafts fissured "circumferentially", and she
began pumping blobs as soon as she started pumping. This time, she had the
milk cultured and was treated with appropriate antibiotics. The blobs, I
learned, were symptomatic of Staph aureus (and maybe other bugs? Like the
woman described in The Breastfeeding Atlas, she found that the blobs
dissolved after the milk had stood a while.)
I've since seen other mothers whose not-quite-healing nipples responded
dramatically to systemic antibiotics, a la Verity Livingstone, JHL 1999
15(3): 241-6. And I've wondered if perhaps that first mother never entirely
cleared her first infection, allowing it to flare up again with the birth of
her second child.
I've also seen mothers whose nipple shafts split open, leaving painful
gaping wounds that would stick together between feedings and rip open during
feedings. Once the wounds were allowed to heal "open," the moms had no
further trouble. Their nipples were differently shaped thereafter, and
caused no problems at all with subsequent babies, which makes me suspect
that's not the problem with your current client. I'd vote for a bacterial
infection.
--
Diane Wiessinger, MS, IBCLC, LLLL Ithaca, NY
www.wiessinger.baka.com
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