I would be thinking tongue-tie or large nipples. Usually, if the latch is poor, then pumping is less painful. However, if nipples are already damaged, and if the pump size is too tight, then the pumping may be painful too. I would not put alot of trust in the nurses' assessments that the baby was well attached (no offense intended) because in my experience, these assessments are not often accurate. I would also wonder about the latch if the baby had high bilirubin levels requiring phototherapy. This could have occurred due to inadequate milk transfer. Have you done a breast assessment? I would just follow this dyad closely, making sure she gets good help from the start with position, latch, and check the baby's tongue. Have you seen the first child and noticed any tongue restriction?

<<She stopped feeding her first baby after 3-4 weeks due to severe pain ...approximately 1 hour after every feed. The painstarted on the 3rd day after delivery & she describes it as a throbbing painfrom the nipple through to her back. ....Avent Isis pump butexperienced the same pain.The baby was delivered by vaccuum & did have phototherapy for raisedbilirubin levels. ...assured by thenursing staff that her baby was well attached. >>

Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

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