I'd like your thoughts, Lactnetters, on a mom with sore nipples.  First, a
brief intro: I'm an RN, ASPO/Certified Childbirth Educator x 25 years, IBCLC x
10 years, actively teaching Lamaze classes full time.  My LC work is limited
to teaching prenatal breastfeeding classes and phone consults and support to
my newly delivered Lamaze moms.  I refer out to IBCLC's when clients clearly
require a home or office visit (until I learn to clone myself there just isn't
enough time in the day to do it all).
        Here's the history on my client:  She had an uneventful pregnancy with this,
her 2nd child.  First birth 2 yrs. ago was textbook, unmedicated, breastfed
for over a year after taking a prenatal breastfeeding class with me.  Nine
days ago she had a normal, spontaneous, totally unmedicated vaginal delivery
again, and put baby to breast immediately.  She did not take the breastfeeding
class this time.  She called immediately after delivery with birth details,
and then again today for help with sore nipples.  On post-partum day 1 (PP1)
she noticed a small crack on one nipple. PP2 she decided to pump until it
healed, giving the baby expressed milk. PP3 she noticed a vaginal itch and
severe dryness of her mouth. On PP4 she saw her ob who prescribed diflucan.
Continued to pump and feed baby expressed milk and on PP6, she took the
diflucan once, as prescribed by her ob and did a "pump and dump" until PP8
when she put baby back to the breast.  By today, PP9, the nipple pain had
increased significantly.  She has no vaginal itching, crack on nipple  is well
healed and she does not (nor did she ever) have redness or blistering on
nipple.  Baby has a few small white patches inside mouth.  Mom reports dry,
"seared" feeling inside of mouth has persisted and she has tight,
dry-skin-like sensation which has traveled from PP3-9 from one ear, across
chin, to other ear, externally.  Says it feels like she's burned inside of
mouth as if she drank too hot tea.
        My thoughts:  yeast?  Shouldn't mom and baby both have been treated?  Are
they passing it back and forth?  Why didn't she start diflucan as soon as it
was prescribed?  WHY didn't she call sooner?  She's seeing ob today,
pediatrician tomorrow.......I've heard Kay Hoover's thrush sheet mentioned on
Lactnet a few times.  Where can I get a copy?  If any of you would share your
thoughts on this with me, please e-mail me directly.  Thanks so much!  I
appreciate your input, and so does she.

Joyce Blangiardo RN, FACCE, IBCLC
([log in to unmask]) here in windy, warm Long Island, NY