I hope that you will be able to help with this mother I have been working
with.  She had a vaginal birth 7/22/01 with epidural and antibiotics.  Son
had good apgars (9) and immediately went to breast well.  Roomed in with
mom, no bottles, supplementation or pacifyers.  I saw mom 8/18/2001 for c/o
sore nipples.  She states she has never had a nursing session without pain.
She has seen the Lactation Counsellors at the hospital as well as one other
private practise IBCLC for her c/o sore nipples.  Upon examination, her son
appeared in good health, no tight frenulum, but does have a receding chin
and a higher palate.  His weight gain has been excellent and he appears to
be thriving.  It is the mom, that has nipple pain with every feeding, who
is getting so frustrated.  We maximized the assymetrical latch technique and
mom did say the pain was a little better.  However, no matter the position
or excellent latch, her nipple was still somewhat pinched after the nursing.
 It is along this pinched line where she is sore with some tissue breakdown.
 She has been using Newman's APNO for a week now, but not after every
feeding.  The baby still has had no bottles or pacifyer.  I was able to see
the baby's tongue under the nipple while he was nursing and he had a
wonderful wide open latch.  The mom states it feels like he is chewing her
nipple.  It appears that this may be a combination of things:  receding
chin, higher palate, ??tongue bunching or sucking.  There is definitely
nipple pinching, but no clicking or other signs of suction loss.  When the
mom uses her Pump In Style, it does not hurt at all and there is no
compression of the nipple. (I would think that if it was yeast, the pump
would hurt as well)   She has been taught both of the tongue exercises in
the BAB and says that he does keep his tongue down well when latching.  I
will be seeing her tomorrow again and am not sure what else to do??  What
have I missed??  This is a very committed mom but she is in tears with each
nursing.  Thanks for your thoughts.
Hilary Black  RN BSN IBCLC

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