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Subject:
From:
Jennifer tieman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 4 Apr 2005 21:33:23 -0400
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I saw a mom/baby couple today at mom's six week postpartum check up.  Babe
was born 2/23/05 at 36 1/7 weeks.  Mom was induced due to severe
pre-eclampsia, and baby was born vaginally.  Baby was small, 5 lbs 11 oz,
but fairly aggressive from birth.  However, she tended to fatigue easily
with feeds (not surprisingly) and mom initially pumped to maintain supply
and fed some expressed milk as supplement.  Even with that, baby had an
inital large weight loss of about 1 lb, then started to gain.  At six weeks
she is about a pound over birth weight (6 lbs 12 oz) but really her weight
gain has been adequate since she started to gain, averaging just under 1 oz
a day.  Baby initially also did some feeding at breast with a nipple shield,
which did improve her transfer, but she wasn't crazy about it.
The problem now is that mom has developed very sore nipples.  She had some
initial nipple soreness which disappeared at about 1 week of age.  Around 3
1/2 weeks she noticed return of soreness.  The pain is in both nipples,
right more than left, and does not get better throughout a feeding.  Pain is
a little better with pumping, but mostly mom thinks this is because pumping
is faster.  She describes a feeling like the skin around the base of the
nipple is cracking open with each feed.  She has no deep breast pain.  On
exam, her skin appears undamaged, but her nipples are bright pink, and
especially around the base are sore to touch.  Her nipples are on the
flatter side, but certainly not inverted.  Baby has no evidence of thrush,
and mom also with no complaint of vaginal yeast symptoms.  Mom was treated
for a vaginal yeast infection during late pregnancy.
Initially, we tried some APNO, and she thought it got a little better, but
the last week it has been getting worse again.  Mom is getting frustrated
and thinking about weaning if the pain doesn't get better soon.  I have her
trying ibuprofen, continuing the APNO, and started her and the baby on
Diflucan today.
The baby was sound asleep at today's appt. and would not awaken to latch
properly.  She did latch briefly, and mom is using football hold with a nice
looking assymetric latch.  However, since baby would not really suck, I'm
not sure she's not slipping down once she starts to feed effectively.  Mom
has been almost exclusively pumping and feeding pumped milk in the last 3 days.
What do you think?  Yeast?  Something else?  What else can I recommend?

Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose

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