Hi.  I'm a LLLL, trying to help a mother with nipple and breast pain
which we can't quite figure out.  Any suggestions of cause or possible
relief measures would be greatly appreciated.

The baby, now 7 weeks, was born by emergency c-section during his
mother's violent bout of the flu.  She had antibiotics after the surgery
as would be expected.  She had painful nipples during the first two
weeks, but this appeared to be within the normal course of things as
many people checked positioning/latch and it looked good.

At two weeks, she was engorged and developed mastitis.  She is a
homeopath and self-treated with a colleague's help.  The mastitis
retreated but the nipples remained sore.

Her midwife suggested thrush after looking at her nipples and finding
small patches in the baby's cheeks.  Since then, she has used three
different topical treatments including nystatin and gentian violet.  The
very strange thing is that she has had no noticeable relief during
treatment, not even a little bit.  It is my experience that there is
quick relief with treatment, but that the thrush is quick to return if
not entirely eradicated.  She has a prescription for systemic remedy,
but is hesitant to take it as she is now uncertain that she had (or
still has) thrush.

The mastitis reoccurred at six weeks which is when she contacted me.
Once again, she self-treated and the mastitis retreated within 3 days.
She believes that it is gone, although she has some residual sensation
(not even really discomfort) along the outer left breast and into the
arm pit.  The way she describes it is as feeling the milk drawn along
the ducts.

She continues to have pain around the left nipple/areola, sometimes very
severe at latch-on, sometimes less so.  On the left breast, she has pain
during the entire feed, although she finds it is manageable relative to
latch on.  Her right nipple is mildly painful at latch and comfortable
during the feed.  She describes the pain as a sharp or biting sensation,
although her baby does not appear to be clamping down on her.  Her latch
& positioning are good, although the baby occasionally breaks
suction/clicks.  He appears to be nursing well and is gaining very
well.  His tongue is normal.  Her nipples were not flat or inverted.
The tips appear pink and slightly irritated, but otherwise normal.  The
left nipple may have a slight fissure, but there has been no obvious
cracking/bleeding/scabbing at any point.  The areolas look normal.

Baby does use a soother.  I suggested that this can lead to suck
problems, but none are apparent.  I taught her a suck-training exercise
just in case it helps.

I really don't have any more ideas as to why she is still experiencing
pain.  I tend to believe that it is not thrush, but am at a loss for
other suggestions.  She is considering abandoning nursing on her left
breast altogether.

Leslie White, LLLL
Deep River  Ontario

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