Wise Ones,

Permission to post:  Mom is pregnant for second time.  Successfully
breastfed last time, even tho had some breast "aching" during pregnancy.
Her breastfeeding course was painless and uneventful, weaned before 1 year.
She is now about 27 weeks pregnant and for the last month has had
stinging/burning nipple pain and shooting breast pain (which is completely
different than the breast pain she had last pregnancy, she says).  The pain
is mostly constant, with occasional 30 minute respites.  The pain is so
severe that it makes her cry during the day and it awakens her multiple
times at night.  I have not seen her nipples, but she describes them as
"sometimes a little pink under the brown and sometimes feel a little warm".
No redness, lumps etc. in the breast itself, she says.  She denies scaling,
rash, breakdown, etc.  She does have some small patches of eczema on her
hands (normal for her) per her report.  She is leaking colostrum.  Has had
a recent vaginal yeast infection.   Treatment so far by her CNM and her
primary care doc:  Tylenol, ibuprofen, nystatin to nipples, keflex, and
hydrocordone for pain.  She reports none of the meds has helped; hot/cold
do not help.  She did have a massage and says the massage therapist told
her that her chest muscles felt "inflammed"---she had brief relief after
massage, but can not repeat the results with self-massage.  She is feeling
frustrated and overwhelmed by the constant pain.  My thoughts:  Ductal
yeast?  Diflucan is Category C in pregnancy.......Also, maybe a dermatology
consult?  Would love to hear your suggestions so that I might share them
with mom and her nurse midwife.   Is there something else I should be
asking?  How can I help this lovely young mommy?

Thanks so much for your help and support.

Carolyn Jacobson, BSN, RNC, IBCLC
(who was not only fed evap. milk and karo, but was put on SKIM milk at one
month d/t being so fat!  Still drinking skim milk--it hasn't worked yet!)

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