This is a tough case and mother is in high danger of weaning. This is sounding mostly like vasospasm due to nipple pinching. It seems the warmth helped so I would emphasize the strategies for vasospasm prevention/relief. I believe a med in the NSAID family like ibuprofen or Aleve (BRAND name) would help if taken around the clock per label directions or per doctor if she's not allergic.
This next suggestion is an iffy one but mother may indeed need a break for her nipples to heal. Sometimes when mother resumes bf (if she will) the pain is much better if she has done the above for a day or two. Advise her to use a 'good' pump, not just any pump, or hand express, and if pumping short frequent sessions on low, if possible. Baby can be alternate fed, even bottle feeding in a bf-friendly way e.g. paced bottle feeding on a slow-flow tapered nipple. I would not have her use lanolin or yeast treatment for now. During the bf break, baby's face and jaw can be gently massaged and mother can mimic "open" with wide open mouth. Baby could probably benefit from chiropractic or craniosacral therapy, however this may be too much for mom to handle at this point.
I am not sure if she had an actual open sore on her nipples in her history, if so she may actually have a bacterial infection, which is often mistaken for thrush. She may benefit from antibiotic treatment by mouth.

Laurie Wheeler RN MN IBCLC
BMH-UC Breastfeeding Resource Center
 "Opinions expressed above are not necessarily those of BMH-Union County or Baptist Memorial Healthcare Corporation."



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