Hi Amy.  I feel for these moms you describe, especially having experienced SO much nipple pain, myself.  Where you have all ready checked out the possibility of any problems with latch and positioning, I wonder if some things I've found from experience, both from nursing my own kids, and with other moms, may help reduce the pain in some of your clients.  I have no scientific sources to support them, but none of them have any possible adverse effects.


Keeping nipple tissue relaxed, as much as possible, so that the blood can flow freely, aids healing of any kind of injury.  As someone else suggested, there could be some amount of vasospasm present.  Severe vasospasm, where the nipple turns white, then purple, as the circulation returns, can injure the tissue, but if there is all ready some amount of injury, vasospasm that is less severe can impede healing.  This can happen, to some extent, from any kind of tactile stimulation, like something brushing up against the chest, or going out in cold weather.  Between feedings, wearing a thick layer of padding inside of a nursing bra is very helpful to keep that tissue relaxed.  What I used were nursing pads that I made of diaper flannel, two at a time, which totaled 8 layers of thick flannel.  If the padding results in a bra being too tight, either a larger sized bra should be worn, or with many bra styles the flaps can be lifted up, to hold the padding in place, but not fastened.  It's also important, in general, to remind moms to wear the right size of bra, which does not restrict circulation to the nipples.  In this day and age where cleavage is so fashionable, many women wear bras that are too tight.


To avoid the reaction when the air hits a wet nipple, especially when the baby unlatches, keeping a flannel pad inside of mom's clothing, to keep it warm while baby was nursing, and applying it immediately when the baby unlatched, can prevent a lot of pain!


Having any kind of skin irritation can increase overall nipple discomfort, too.  Moms with hypersensitive skin can have some amount of irritation, even if it doesn't look like eczema. I've found it helpful to always rinse off with warm water, after feedings, and either air dry, or pat dry with a scrupulously clean, double rinsed, towel. Treating all clothing that comes in contact with the breasts to get out all detergent, and using no fabric softener, can help, too.   The parts of nursing bras that touch the breasts should always be cotton (except in the rare case where the mom is allergic to cotton).  The same thing can be said of a low-grade thrush infection, which can be hard to see, and doesn't necessarily result in any symptoms in the baby.  Any time thrush is at all suspected, it's good to always have a clean surface against the nipples.  My pads were 9 inch squares of cotton flannel, that I folded twice.  By altering the layer touching my breasts, I could use one pad for four feedings.  And, of course, any clothing that touches the breasts where thrush is even suspected should be washed in hot water, with detergent, and a little bit of bleach, or I have heard that adding some borax or vinegar to the wash will also kill it.


Doing one of these things only once or twice probably wouldn't help but, since the moms you refer to are about at their wits' end, and nothing else has helped, I'd suggest trying these on a regular basis, for at least several days, and see if they don't see improvement.  None of them cost anything or have any possible adverse effects, so what do they have to lose?   I'd like to hear about whatever ends up working for them!  Is SO important for suckling to be a nice experience, not one they dread!

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