If she is feeling the pain "deep" inside the breast she may simply be
experiencing a "painful" let down. If this is the case, in my experience this
usually resolves itself by the time baby reaches 8 weeks. It's unclear whether
the pain actually stops or mom becomes accustomed.
However, you are probably right about the thrush. Unless you have a good
relationship with the DR there isn't likely much you can do at this point. I
would have the mother call the DR anyway and complain about the thrush. That
way, as soon as the very first outward apprearance occurs on her or the baby she
will have documented her suspicion and will likely get treated more quickly.
Tammy Schilling
LLL Salisbury
Kathy Rubin wrote:
> I saw a mom in support group today who has been nursing a 5 week old baby.
> She is complaining of a pain that she describes as sharp and shooting, more
> so in one breast over the other. She says that the pain occurs when the baby
> is feeding, at the beginning and often throughout the feeding. She says that
> warm compresses before feeding make it worse. When she pumps, she does not
> experience the pain.
>
> I observed the baby, who has a long, flexible tongue that extends well over
> the gumline. I watched the baby latch, and after several attempts where mom
> removed her (correctly by breaking the seal) when she felt that the latch was
> not deep enough, the baby got on well, with a real wide angle between top and
> bottom lips. Lips were nicely flanged; I could not see if the tongue was
> coming forward well without disrupting the baby. Swallowing was evident, with
> an episode about 10 minutes into the feeding where you could see that the MER
> had given the baby a big burst of milk, to which the baby pulled off, and
> then relatched.
>
> Mom's nipples have intact skin without any visible cracking; you might say
> they were a little pink, (but not cherry red) but mom did not feel that they
> were reddened unusually when I questioned her. There are no signs of visible
> thrush in the baby's mouth, nor on the nipples. No itching of the nipples. No
> diaper rash. No vaginal itch nor cheesy discharge noted by the mom. Mom did
> have the usual antibiotic IV right after c/section, but baby has not had any
> antibiotics. When asked, mom says that occasionally the baby bites down, mom
> feels it is in response to a good letdown, but this is only occasional. There
> was no nipple blanching after the feeding.
>
> When mom called her doctor's office about the soreness, she was told that she
> should be wearing her bra all of the time (she was not) b/c it might be due
> to muscle pain. The breast is larger than the baby's head, which is my
> guideline for telling moms that they need to give good support to the breast,
> with a bra, hand support and maybe a washcloth roll placed "in the crease"
> under the breast.
>
> Impressions:
>
> 1). Possible ductal thrush, evidenced by the sharp, shooting pains and hx of
> antibiotic
> However, with no other signs in mom or baby, the doc is not likely to give
> her a dose of Diflucan unless I can convince them (any references??)
>
> 2). Baby biting due to forceful MER, but would that cause shooting pains?
>
> 3). Muscle spasms in the ductal system (but then why would warm compresses
> bother this--I would think the response would be elicited more with cold).
>
> We talked about position options as she always holds baby in cradle hold,
> leaning forward (she says that when she leans back, the pain is worse). Also
> breast support options, using her hand under to support breast along with
> nursing bra and the washcloth roll. We talked about watching for s/s further
> indicating thrush and considering asking for the Diflucan 150 mg for one dose
> to see if it helps (my gut feeling is thrush, but will her docs see it this
> way??) We also talked about taking a break if she needed by pumping (rather
> than quitting) and that most pain in bf is temporary.
>
> What am I missing???
>
> Thanks,
>
> Kathy Rubin in NJ
> IBCLC, RN, BC (Maternal/Infant), APN, C (Family Nurse Practitioner)
> PhD student hopng to study lactation issues someday
>
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