I have seen a mom recently with these circumstances:
       Baby was term,2.5 week old,born by C/S for breech(prophylactic =
antibx were used)
       Left breast appeared normal and intact.
       Right side:areola was almost completely pink,unlike light brown =
opposite
                       side. Nipple had an open area about 5x10mm and =
3-4mmdeep
                       No oozing yellow or other discharge except milk =
when mom
                       had a MER.Occasional pinching of nipple and =
slight blanch.
        While babe was feeding,upper lip was entirely pursed under.We =
did the usual to correct this and mom felt better during the feeds.After =
feeds:mom reports deep shooting pains.
         We worked on positioning and the upper lip with dad helping =
"spot"check baby's attachment,some suck training on dad's little finger =
for a minute pre-feeds.
           I informed mom that it could be candida and that if the =
pink(areola on right side was not deep or strikingly pink)remained pink =
or if the sore hadn't become smaller in 5 days to call the OB/PED.
           Follow up call next day:mom reported less to no pinkness and =
feeling a bit better.
           4 days later,no change in nipple" crater "and mom was using a =
lanolin preparation because it"stung" if she let it air dry,exposed to =
air.
           "Please call your OB"I had called peds and that is the way =
they prefer to handle this.Both MD's received written reports and =
recommendation for mom to call them if no improvements in 5 days to  R/O =
bacterial and candidasis.
(THERE has not been any evidence of thrush in baby or on baby)--But nor =
was there any on babe in Riordan/Auerbach's endpages.
             Currently mom is being treated for? I just got back from =
Alabama so I need to call her....
I have a few concerns:Mom has been wearing shells since baby was born...
                                 Will the pores close -could this delay =
healing.
      =20
                                 Should a nipple cream for cracked =
nipples continue to be used if
                                  indeed this is thrush...
I have attended recent conferences on thrush and have heard and read =
K.Hoover's series on candida so the usual info. I am passing along to =
mom even if they might be treating her for mastitis!which is what the =
Peds nurse told me might happen----to which I reviewed the case in =
depth.
BTW:at 3.5 weeks post partum,mom's left nipple/areola is so sore it =
hurts to hold baby even with mom's clothes on.This mom didn't use the =
usual description of "Stinging" until I asked her about the lanolin and =
air drying.No break in skin on left side or redness.
Any comments are welcome.
I will update you in a day or so.I couldn't get to talk to OB as mom was =
waiting for a call back from them while I had phoned the Peds and we had =
other appts Thurs.afternoon,and left for BAMA during the night.
Denise Ferrell,DCF @ iquest.net