Hi Everyone.  I haven't posted on Lactnet in a long time, but I continue to
read and learn from all of the amazing people who are part of this group.
Working with a mom who gave me permission to post. She took my
breastfeeding class and told everyone that her first experience with both
birth and breastfeeding was "a nightmare." Unfortunately, it seems to be
happening all over again. Baby girl born vaginally July 17, weight 7 lb 5
oz. She had a doula this time and a much better uneventful birth
experience. Her first baby had a tongue-tie so she expected it again, and
it did happen again. Pain with first feeding. Both tongue and lip
procedures done by laser at day 4 by a well-known and well-thought-of
dentist in our state. Mom told me her biggest difficulty with first
breastfeeding experience was oversupply and strong MER, and constant
feeling of engorgement for weeks until she eventually quit. This time has
been no different. Mom contacted me at one week complaining of nipple pain,
strong MER several times each feeding, and constant full feeling in her
breast. I observed a feeding. Latch looked great, but baby had difficulty
maintaining. Constant coming off the breast and then chomping back on.
Suggested laid-back breastfeeding and it has helped a lot. I also suggested
a nipple shield.  Mother used it for about a week. It also helped baby to
maintain latch, but mom felt like it was not helping her pain and "just
didn't like it", so she quit using.  At my suggestion she started block
feeding around two weeks. Baby from birth had been eating q 3-4 hours and
sleeping 5-6 hrs at night with plenty of wet/dirty diapers and excellent
weight gain. Blocked feedings helped because mom said baby started eating q
2-3 hours after about 5 days, and she didn't feel as full, but her breasts
still felt "uncomfortable". Around 2 weeks, baby started experiencing
reflux, where mom felt like baby was "losing half the feeding" every time.
Also about this time nipple pain started getting worse. Mom using hydrogel
pads from the beginning.  Suggested she try APNO which she has been using,
but states it doesn't feel like it does any good. Uncomfortable full
feeling in breasts changed to pain at 3 weeks.  When she told me she was
experienced burning sharp stabbing pain, we started talking about yeast. At
that time also she told me she was seeing white stripe on the tip of her
nipples when baby came off.  She believes lip tie has grown back and has
sent a picture to the dentist, and is awaiting a response.  She started Dr.
Jack's candida protocol 4 days ago. Pain in both nipples and breasts has
gotten incrementally worse each day. She added topical grapefruit seed
extract yesterday.  Today she called, crying, and says breast pain is
excruciating and she dreads feeding. I told her sometimes it gets worse
before it gets better (but haven't heard of that by day 4). Interesting
that she reports baby is doing better and has had no more reflux since
starting g.v.  It seems like mom is hyper-aware of her MER's. Can anything
be done to decrease that without further decreasing milk supply?  Any
thoughts on what else could be going on? Mom frustrated with me because she
said "it seems like we're just guessing."  Thanks so much for any thoughts
or advice!
Cher Sealy, RN, BSN, IBCLC
Private Practice Lactation Consultant
Montgomery, AL

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