Hi -

I'm back on Lactnet after about a year and a half hiatus - I'm Morgan
Kennedy Henderson, and I'm a (relatively) new LLL leader and a
childbirth educator just outside of Boston.  It's wonderful to be
learning so much!

I have a woman with a five week old baby who says that nursing has
always been painful.  Her nipples very quickly cracked, and are now
essentially open wounds that bleed whenever the baby latches on.  She
says that her milk comes out of one point in the center of each wound
rather than out of several points around the nipple...

She has met with three different lactation consultants (I know two out
of the three are IBCLC and have great reputations; I don't know who the
third is) who are all associated with her HMO; so far she is pumping and
bottle feeding for some feedings to give herself a little bit of a break
(she says pumping is slightly less painful than nursing...), she uses a
nipple shield for some feedings, and will just nurse for others.  Both
the pump and the baby break the wounds open again (he's eating about
every two hours right now), so she's beginning to think she has to wean
to heal.
I won't be able to see her until tomorrow at the earliest, but we've
gone over basic latch-on and her description of what they're doing
sounds OK.  The baby sounds like he's a little confused, but adapts well
to each "medium' (breast, nipple shield or bottle) with a little
prompting - of course his initial latch-on is worse after his using the
bottle or shield, but she feels like she corrects it quickly and can
often anticipate him (not opening his mouth wide enough, for example).
The baby is gaining well, great number of diapers, alert and responsive,
etc.

She was told prior to his birth that she has flat nipples (definitely
not inverted), but the LC didn't think she'd have trouble nursing.  She
does feel he latches on a little better with the nipple shield because
it pulls her nipple out further...   The Breastfeeding Answer Book talks
about the possibility of adhesions making nursing more painful and
taking several weeks to "break" as the baby nurses, often resulting in
cracked nipples...

Any suggestions?  Would it help if she were to not nurse for a while to
let her nipples heal to the point of not opening up whenever he latched
on (the Breastfeeding Answer Book suggests a "short while" - can anyone
recommend something more specific)?  Could manual expression possibly be
more comfortable?  What questions could she ask to get a more complete
evaluation if she went back to her LCs or to another specialist?  (i.e.
palate issues, frenulum, pursuing the issue  of flat nipples, etc).
She's in so much pain, I can't believe she's stuck it out, and it sounds
like the people around her (while supportive of nursing) are starting to
say that nursing isn't worth this.

Thanks very much -

Morgan Kennedy Henderson