OnWed, 26 Mar 2003  Sara Macy wrote about a mother with twins born at 37 weeks, boht wiht tight frenula.  She still has a nipple pain 6 weeks later.  She wrote:  Pain continues with pumping at a 5-6 pain with
babies latch is a 6-7 on pain scale of 10. Mother reports edema of nipples,
pump placement can be observed 30 minutes after. Continues to rate nipple
pain at a 5-6 on pain scale of 10. This same mother states that this is
more pain than the cracked nipples experienced on day 3 postpartum. Mother
has continued to pump throughout this lactation period. Does anybody have
any suggesstion? Could this be a latex allergy to pump? Mother is very
determined not to stop lactation. 
Hi Paula,
     I wonder if there is some other subtle anatomical factor riding with the tongue tie.  What about the labial frenulum?  There was a case report in JHL a few years ago about a baby whose feeding improved immediately after the lingual frenulum was clipped, but then gains went down again, until the labial frenulum was clipped.  Another thought would be even slight abnormalities of other oral structures, e.g. an incomplete cleft of the soft palate, or distortion of the epiglottis and larynx.  Most of us don't have the training and background to pick up these, and most of us on this list can't diagnose, and an appropriate referral would be in order.  If it turns out that there are none of these problems, at least you'd have eliminated them as possibilities.
   Is the oedema only in  the nipples, or is it in the areola, too?  If so, have you thought of trying Jean Cotterman's reverse pressure softing technique?  I realise this would be treating a symptom, and that finding the underlying cause is what the mother most needs, but it may bring some relief.
    Virginia

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