I appreciated all the comments on received on several moms I've seen who
seem to have an aversion to breastfeeding.  I'm not sure that at least with
the current mom I'm seeing I'll be able to change her mind, but I am working
on understanding where she's coming from and providing "positive propaganda."

Now I have another question.  I have a mom with 7 week old infant.  Mom and
baby had a rough start, baby is #3, mom planned 2nd VBAC with this one.  Had
prolonged rupture of membranes, developed chorioamnionitis and fetal
distress, we decided on emergency c-section, but baby decided to come
vaginally on the OR table, just before starting anesthesia.  Baby was
initially sleepy, had several apneic episodes, poor latch.  Mom and baby
were treated with IV antibiotics due to chorioamnionitis.  Mom's first two
breastfeeding experiences complicated by inverted nipple on one side, and
used nipple shields.  After first couple of days, baby latching very well
and started to gain appropriately.  Mom was thrilled to not have to use a
shield with this baby.
Shortly after discharge, mom and baby developed thrush, fortunately picked
up right away by our IBCLC doing a home visit.  I treated with long course
of Diflucan and symptoms resolved.  Meanwhile baby gains very well.
Now for the last 2 weeks, mom complains of pain with letdown only.  No
nipple soreness, no pain throughout feeding, but she describes letdown as
being painful enough to bring tears to her eyes.  She has noticed less pain
when breast is less full, but does not have any engorgement.  Breast exam at
this point appears normal, baby is 3 lbs over birth weight and has no
evidence of thrush.  The pain on letdown is throughout both breasts, worse
in the upper areas of both breasts.  Any ideas?  Mom is very dedicated and
did not make it this long with exclusive bfing with her other 2, but she
would prefer to be comfortable if possible!

Jennifer Tieman, MD
Family Physician
Mom to 3, and new baby #4 expected 5/31/03

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