Jennifer asks:

<Miraculously, she has lots of milk so far, and a MER that is functioning beautifully.  But, she has massive pain due to the cracks that began in pregnancy.  What would cause cracks to begin during pregnancy?  I suspect it has something to due with the surgery (excess tension on the skin, maybe blood and other circulation in the skin is disrupted, therefore skin integrety is affected, or ???)  Could cracks during pregnancy be caused by anything else?>


Just a couple of wild guesses here:


Prenatally, the nipples were probably in direct contact with the bra itself, as most moms don't need leakage pads at that stage. I have known some folks, even in my own family, to have some pretty intense skin reactions to any laundry products left in garments, including the residue of dryer sheets. A second rinse with 1/2 cup of white vinegar is always a good trick to try (I still treat every load of my wash that way) and of course, nothing added in the dryer. Postpartum that would probably not apply if she is using disposable nursing pads, but allergic reaction is still possible. (Some babies are allergic to certain brands of disposable diapers, for instance.


However, her postpartum situation sounds much more than skin deep. It sounds like the nipple button is being pinched either by the baby's jaws or between the tongue and hard palate, deformed like a new lipstick, and the leading edge of the "lipstick"the only portion of the nipple exposed to the vacuum, soon being damaged. This is often a straight line, as in "positional nipple damage" described by Mavis Gunther, and the skin being the only tissue free to move toward the baby's vacuum. 


As far as nipple pain of the intensity you describe, she has my sympathy. I once had a client (now friend, permission to post) who had such a traumatic history with her first baby that she switched to exclusive pumping rather than direct breastfeeding. She came in between pregnancies to have her nipples evaluated for possible abnormalities/suggestions to avoid such intense nipple pain. She had rapid vaginal deliveries, and this phenomenon has been attributed to cranial nerves being effected by molding/overlap of neonatal skull bones. (Smith L, Kroeger M, Impact of Birthing Practices on Breastfeeding, 2nd ed. 2010)


A few hours after the birth of her second child, I visited her in the hospital-same discomfort as with first baby. Digital exam revealed what seemed like a tonic bite reflex, and I found that my finger began to hurt quickly during a digital exam! Two gentle sessions of craniosacral treatment from an osteopath completely solved the problem. With the third baby, the couple went straight to the osteopath's office upon discharge from the hospital!


I have seen this with more than one mom.  No wonder the nipple pain is enough for some mothers to call a complete halt in short order to direct breastfeeding- or ANY breastfeeding!


For her sake, I hope this is helpful.

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC  Dayton OH

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