Ok...so now I'm dealing with a mom whose symptoms have me puzzled.

Mom is an experienced breastfeeding mom - 2 other kids, one had tongue-tie
and she had the clipping done and continued to breastfeed x 1 year.

The call I got was to rule out Raynaud's or Thrush.  Mom reported pain in
the breast and nipple not only during breastfeeding, but also after feeding.
This would last for hours after, so that she was never pain-less, as the
breastfeeding was also painful.  She describes the pain as radiating from
nipple to the back covering her whole breast and chest region.

Between baby 2 and 3 (this one) she had a back injury and has discs that are
ruptured in the thoracic region.  She has been going to a chiropractor and
an orthopedist and may be facing surgery.

She also reports strong let-down pain - much more than with her previous
kids.

My observations include:

1. Baby has a slightly elevated palate and we have been working hard on
positioning - expecially getting the breast deeply in and the nipple beyond
the slightly projecting hard palate just before it stops and the soft palate
begins.

2. No signs of thrush in either the baby's mouth or the mom's nipple.

3. No signs of the classic color changes in the nipple that show up when
I've seen Raynaud's.

4. Excellent milk supply, baby, gaining by leaps and bounds.

5. Some positioning issues including mom (short mom) not propping her legs
so she was in what I thought looked like a very uncomfortable position -
especially knowing about her back injury.  We added a footrest and better
support for baby's weight.

6. Baby does have a habit of bunching up the tongue in the back (for a while
the mom was sure her tongue was too short - but with suck training and
tongue massage she saw that the tongue DID cover the lower gumline).  She
also "flicks" her tongue, mom reports, at times during breastfeeding, which
mom finds very uncomfortable.

Despite my assistance in positioning, she still reported some pain during
breastfeeding and a great deal of pain after breastfeeding.

I began to wonder if this may not be referred pain, (from her back injury)
as even when she used a nipple shield (I know, many of you would never have
tried this - but it was an EXPERIMENT as I wanted to see what happened), she
reported pain on her nipple when clearly the baby was not pressing (but WAS
suckling) on the nipple.  She was the one who realized that there was still
pain with the nipple shield even though she could feel that the baby was NOT
pressing or pushing or pinching it.

I then tried the breast pump (again, not a treatment but rather to try to
see if suction was the cause of the pain) and she reported no pain with
pumping, but pain does occur on the nipple AFTER breastfeeding or pumping -
especially sensitive on the tip of the nipple.

She reports some improvement (since I saw her 4 days ago) and is now
breastfeeding (with little pain during, but with pain in the breast and
chest radiating to the back at times after breastfeeding and a lot of
sensitivity of the tip of the nipple - which causes her to want to put
pressure on her nipple to stop it -  after breastfeeding) most of the time,
but every once in a while she pumps to give herself a break from the pain,
because it is much less then.

Any suggestions on other ways I could help this mom?

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA

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