How about having her do some prolonged reverse pressure softening, deep areolar expression until the areola softens a bit?   

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Terri Klein
Sent: Thursday, September 10, 2009 4:04 PM
Subject: painful latch

Dear Lactnetters,
Need help with a mom. Baby is now one month of age. Mom continues to have pain during feeding. Worse at latch but some discomfort throughout feeding. Mom has inverted nipple on right side and flat on bottom of nipple with raised at top of left side. Shaped somewhat like a pacifier.
This is the shape of the nipple prior to even nursing. Areola is very firm. I suspect some adhesions and that it is painful when baby latches because she latches well and nipple is everted at end of feeding on right side and more round on left. Did not have good luck with nipple shield. I felt the baby had a much better latch without. Tough to get a decent seal.
First baby she pumped for 10 months because that baby would never latch. 
Mom has tried pumping first then latch but remains painful. Ruled out tongue tie. Pediatrician evaluated at birth and again today. Doesn't seem to have a short tongue. Have given mom some suck training exercises to see if she is holding tongue back. Couldn't see her today just over the phone today. 
Any further ideas that I can suggest to this mom?
Warm regards,
Theresa Klein RN, IBCLC, RLC

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