Hi Janaki,

A few things come to mind -

 Don't underestimate a palatal variation as a hidden breastfeeding problem.

If the palatal arch is high and the mother's nipple/areola tissue is not
properly filling baby's oral cavity then trauma can occur.  It can also
cause uneven intra oral pressure and secondary trauma.  In these situations
latch and positioning look fine.

Of course nipple candidiasis will break down tissue this way also.  Sounds
as if the mother is moving from remedy to remedy very quickly.   I'd try
Lotrimin AF on her nipples for 2-4 days then assess any improvement.  If a
positive change occurs, then I would begin a "full yeast" treatment.
Sometimes using an antibiotic ointment in addition addresses staph in the
cracks.

In severe cases especially where there is a sucking problem or palatal
variation,  I will have the mother pump and finger feed with a p-syringe
for 24-48 hours and not put baby to breast.  This give the nipples a chance
to heal and baby some appropriate re training.  I like breast shells if
the mother has to wear a bra or cover-up.

Alternative feeding positions can help with the palatal variation.  A deep
latch isn't deep enough.  Try positions where the baby is prone to the
mother in a reclined or supine position.  I'd experiment with positions
until I found one where the mother no longer feels any pain with baby at
breast.

Lastly, slow healing (once the trauma cause is identified and treated) is a
sign of a depressed immune system.  This Mom may benefit from some
nutritional counseling.

I loved the recent posts on moist healing.  I have used saline and epsom
salt soaks as well for nipples where the trauma was discharging various
colors.  It works
so well in some cases.

Joanne Burke Snyder, MA, CLE, IBCLC
Latch-On Services,  A Private Practice in Indianola, Iowa