Hi All,

 

First I want to thank everyone who has responded to my head-banging
frustration.  After reading everyone's suggestions and thoughts I have
decided to write a 'politically correct' letter and make it more of a Dr
report type of thing.  I will not say anything about how the mother heard
'this' and it 'couldn't possibly be right' or must have misunderstood
because I feel that would completely dismiss the mother, her feelings and
intelligence.  I know this mom - I know these midwives - if I didn't I would
be responding differently.  Thank you to those who took the time to note
that they trust me and my observations.  The topic of the 'mom brain' and
how dismissive it can be is certainly eye-opening isn't it?  It will take me
time to write the letter.  I am still angry - but have cooled off some.
Hard for me to do under these particular circumstances.

 

At any rate - I have a new question for a new mommy.  Baby is 6 wks old.
She has had chronic pain the entire time.  When she called me 2 weeks ago
she told me she had been diagnosed with Thrush by her Dr and baby had also
been diagnosed.  She had been given nystatin it wasn't working what else
could she do.  She had told me that she had had burning pain for a couple
weeks prior, that it was getting worse.  (Silly me) I took the Dr's
diagnosis and gave her other options for treating thrush.  Well, after 2
weeks of trying this and that (Gentian Violet, APNO, Diflucan) there was
still NO improvement.  She asked me to come see her which I agreed to - it
was time to look at this in person.  Probably should have seen her 2 weeks
ago, but I never got from mom that the pain had started on day 1.I'm sure I
asked, but somehow it got lost in the whole thrush debate.  At any rate now
I am at a loss.

 

Mom's nipples come out compressed after nursing - obvious minor trauma to
nipples.  Nipples BURN - areola's BURN - the area around the areola's BURN
now.  She is also having excruciating vasospasms in between nursing's.  Baby
nurses frequently and was gaining weight well up until 2 weeks ago when that
dropped off sharply (only 4 oz in 2 weeks).  Nipples are pink/red.  Baby
does have white 'stuff' on her tongue - but has been thoroughly treated for
thrush so I am not sure if this is still thrush and just a bad case of it or
if it is just a layer of milk.  Some of it does wipe off - some does not.
Bottom line:  mom's nipples hurt 24/7, the burning is always there and seems
to be getting worse, and nursing is very painful.  Milk supply is low.  Baby
appears to have a possible posterior tongue tie - but there is no frenulum
to clip - tongue notches to a degree, just behind the tip is always pulled
down when baby lifts her tongue and suck eval showed some back and forth
movement but not consistent, but also very tight strong suction at juncture
of soft and hard palate - my finger felt like it was being rubbed raw!
Tongue motion was sometimes good and sometimes not - but the tightness of
suction was amazing.  Now I know how to work with lack of suction how do you
relax that suction a bit?  No noticeable body issues or tightness in jaws or
neck areas.  Baby 'chews' at the breast using upper and lower lips
excessively to help with milking - lower lip looks 'chapped' when baby comes
off the breast.  Tired a nipple shield to see if that would help pain level
- baby did fine with it - latched deeply, got milk but pain was the same if
not worse for mom.  She won't be using that.

 

So:  I fixed the latch which allowed the nipple to come out of baby's mouth
looking normal.  But it still hurt her.  My thoughts:  Thrush still a
possibility.  6 weeks of nipple trauma led to nerve trauma leaving the
nipple and areola.  Something is going on with this baby's ability to suckle
correctly but I am at a loss as to how to fix it.  Possible posterior T-T -
but looks like it will require surgical correction as there is NO webbing to
speak of - but the frenulum is easy to see as a noticeable white band and is
tight to touch and shows other signs of being tight.  I did refer to ENT who
is good in this area for evaluation.  I advised to stay on APNO, wear breast
shells to keep everything off nipples, warm compresses for vasospasms, talk
to her HCP about possible Raynauds and nifedipine, take herbs to increase
milk supply (it is low now) and supplement with ABM to ensure appropriate
weight gain in baby, and start supplements of fish oil or flax oil to help
with nerve repair.


So - thoughts?  What am I missing?  Any other ideas to help me help this
gal?  All input is greatly appreciated!

 

Warmly,

Jaye

 

 

 

 

 

 

 

 

 


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