Robin,

If mom has no pain when baby is at the breast (due to sore nipples) and the baby
is gaining weight, I have found some babies do breastfeed with all sorts of
sounds which, if mom had pain, we would try to correct.  Just had that happen
yesterday with a baby who is growing and gaining well.  She does swallow a lot
of gas, though, so mom has learned to interrupt the feeds to burp her often.
She only does this on the right breast - which also has the strongest let-down.

I think you are on the right track with antifungals and the one-sided nursing.
She will need to express _thoroughly_ the opposite side after using warm
compresses.  As she is so busy and overwhelmed with time constraints, perhaps if
she heard only two suggestions right now:
        Use antifungals conscienciously (oral, I hope)
        Breastfeed on one side  while breastpumping on the other side to avoid
mastitis.

 If she pumps while breastfeeding perhaps she will feel less "tied down" in
terms of time spent on baby - and often the let-down will allow her to empty the
breast better.

Moms who come see me alone  can only take one or two "jobs" at a time, I find.
Unless Dad or Grandma are present and willing and able, I find that giving more
than 2 suggestions creates a great barrier which some moms feel too overwhelmed
to overcome.  (Remember our brain is delivered with our placenta and it takes
about 6 weeks to grow a new one!)  I do let them know I have other "tricks" up
my sleeve if these 2 don't work, but if I try to teach them all in one visit,
they get forgotten - or what is worse, they follow the one or two  which weren't
as important.

Good luck - sounds like she is very determined even if she hasn't followed all
your suggestions or she would have quit at day 10!

Jeanette Panchula, BSW, LLLL, IBCLC, RN
Puerto Rico
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