Hi all,
I am an LLL Leader and a PPLC. I went into business just under a year ago.  But I have been an LLL Leader for 13 years.  I have seen a lot of situations but I am always learning more about breastfeeing.
Currently I am working with a mum who is having serious problems with a cracked nipple.  I saw her once as a paying client,  then I went to see her for free and we are in touch at least once a week by text and phone – she is hard to get hold of to speak to but if I leave a message she usually phones me back.
When I first saw her she had badly cracked nipples.  The baby was attaching pretty well from outside but nipple came out with typical vertical ridge.  One side the nipple points down towards the floor (the right side),  the other side is more ‘normal’ looking.  I suspected an infection as well as positioning.  Baby was a week old.  She also handled the baby quite awkwardly despite this being baby no. 5.  She used a pillow and I decided against trying skin-to-skin as she seemed so ‘finger and thumbs’.  I know that may have been wrong.  I made some suggestions for positioning and sold her ‘breastfeeding made simple 7 laws etc’ as she seemed to read a lot (very internet savvy) and I felt she would benefit from the book.  She has had a lot of other support from 2 breastfeeding support groups.  After 6 weeks I went to see her again.  She had been expressing a lot from the right side as it still wasn’t healing.  Doctor had prescribed flucoxacillin without swabbing.  She was reluctant to take them but did start and finish course.  On left side baby had good feed and nipple came out looking perfect although she still had painful feeds on left.  I did not see feed on right (worst ) side. She had been treating for thrush to little avail, as HP’s thought thrush more likely than infection.  She was then swabbed by nurse after first course of antibiotics. Swab negative.  Dr then swabbed deeper – she was sore for 1 ½ hours after.  Positive for staph A.  Took 2nd course antibiotics.  Wound healed significantly and she expressed from right side for a week while taking antibiotics.  Had 2 good weeks sounded more confident.  Feeding out and about with baby and learning how to get baby on comfortably.  Now wound has opened up again and she is back to expressing on right.  She is considering just feeding from left.  Doctor has referred her to breast clinic.  I so want it to work for her.  She also has symptoms of Raynauds on nipples after feeding.  And baby number 4 died just over a year ago from a brain tumour at about 14 months old – we have talked a bit about it and she is obviously still grieving. None of her previous breastfeeding experiences were easy due to pain in early weeks.  One she fed about 10 months but was sore for weeks.   Baby no 4 she only fed for 10 weeks due to pain.  
Any ideas?
Could her breastfeeding history suggest something anatomical with babies mouths?
I have talked with her about making sure baby feels stable in case he is clamping down on nipple.
At 2nd visit I showed her a skin-to-skin dvd which she found helpful and she was doing a lot more lying back and letting baby find nipple since then.
Is grief and running after 3 school age children causing her problems?
She seems amazingly strong given all she has had to deal with.
Could it be very persistent infection?
Weight gain at start was fine. Then slowed a bit - I guess due to putting off feeding due to pain.
Thanks in advance for any ideas,
Sarah McCann.
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