Hi Cher,

My differential diagnosis for a mother like this is latch/pump trauma and/or mammary dysbiosis and or vasospasm and or hyperlactation. (in other words, one, all, or several of these)

Assuming that latch, suck/swallow, and pumping are not traumatic:

I would do a thorough history to determine if she still needs a reduction in her supply.

In other words, if she is still block feeding, and still struggling with fullness, she needs to decrease her supply. I often use sage or the birth control pill with estrogen (the latter after 6 weeks)

If she no longer needs a reduction in supply, I would perform a thorough history and physical to evaluate the possibility of vasospasm, and dysbiosis.

I would also do a breastmilk culture. BTW, I almost never isolate yeast- less than 10 times in more than 20 years.

If it appears to be a dysbiosis, I use antibiotics based on culture results.

With this approach, I most often can resolve their pain.

Anne





Anne Eglash MD, IBCLC, FABM

Clinical Professor, Department of Family and Community Medicine

University of Wisconsin School of Medicine and Public Health

Medical Director, UW Lactation Services

Medical Director, Mothers Milk Bank of the Western Great Lakes

Founder and President of The Milk Mob, dedicated to building Breastfeeding Friendly Medical Systems and Communities







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Date:    Sat, 12 Aug 2017 18:12:59 -0500

From:    Cher Sealy <[log in to unmask]>

Subject: Help Needed for Mom in Terrible Pain



Hi Everyone.  I haven't posted on Lactnet in a long time, but I continue to read and learn from all of the amazing people who are part of this group.

Working with a mom who gave me permission to post. She took my breastfeeding class and told everyone that her first experience with both birth and breastfeeding was "a nightmare." Unfortunately, it seems to be happening all over again. Baby girl born vaginally July 17, weight 7 lb 5 oz. She had a doula this time and a much better uneventful birth experience. Her first baby had a tongue-tie so she expected it again, and it did happen again. Pain with first feeding. Both tongue and lip procedures done by laser at day 4 by a well-known and well-thought-of dentist in our state. Mom told me her biggest difficulty with first breastfeeding experience was oversupply and strong MER, and constant feeling of engorgement for weeks until she eventually quit. This time has been no different. Mom contacted me at one week complaining of nipple pain, strong MER several times each feeding, and constant full feeling in her breast. I observed a feeding. Latch looked great, but baby had difficulty maintaining. Constant coming off the breast and then chomping back on.

Suggested laid-back breastfeeding and it has helped a lot. I also suggested a nipple shield.  Mother used it for about a week. It also helped baby to maintain latch, but mom felt like it was not helping her pain and "just didn't like it", so she quit using.  At my suggestion she started block feeding around two weeks. Baby from birth had been eating q 3-4 hours and sleeping 5-6 hrs at night with plenty of wet/dirty diapers and excellent weight gain. Blocked feedings helped because mom said baby started eating q

2-3 hours after about 5 days, and she didn't feel as full, but her breasts still felt "uncomfortable". Around 2 weeks, baby started experiencing reflux, where mom felt like baby was "losing half the feeding" every time.

Also about this time nipple pain started getting worse. Mom using hydrogel pads from the beginning.  Suggested she try APNO which she has been using, but states it doesn't feel like it does any good. Uncomfortable full feeling in breasts changed to pain at 3 weeks.  When she told me she was experienced burning sharp stabbing pain, we started talking about yeast. At that time also she told me she was seeing white stripe on the tip of her nipples when baby came off.  She believes lip tie has grown back and has sent a picture to the dentist, and is awaiting a response.  She started Dr.

Jack's candida protocol 4 days ago. Pain in both nipples and breasts has gotten incrementally worse each day. She added topical grapefruit seed extract yesterday.  Today she called, crying, and says breast pain is excruciating and she dreads feeding. I told her sometimes it gets worse before it gets better (but haven't heard of that by day 4). Interesting that she reports baby is doing better and has had no more reflux since starting g.v.  It seems like mom is hyper-aware of her MER's. Can anything be done to decrease that without further decreasing milk supply?  Any thoughts on what else could be going on? Mom frustrated with me because she said "it seems like we're just guessing."  Thanks so much for any thoughts or advice!

Cher Sealy, RN, BSN, IBCLC

Private Practice Lactation Consultant

Montgomery, AL



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End of LACTNET Digest - 11 Aug 2017 to 12 Aug 2017 (#2017-208)

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