There is something going on with the baby that makes him/her unable to 
latch appropriately to one side. When normal things don't work, it is 
time to look at baby's physical anatomy. It sounds like one nipple is 
fine, the other is constantly abraded or damaged. The authors of The 
Breastfeeding Atlas say nipple blebs are caused by damage to the nipple 
while nursing, like a callus that forms over a sore area. The other clue 
is that the nipple comes out looking like a new lipstick. How wide is 
the baby's gape when he/she latches to this side? Do you see a wide U at 
the corner of the mouth or do you see a tight V? The description of the 
nipple shaped like a new lipstick makes me think baby is clamping or 
clenching, or tip sucking on this side. I would strongly suggest to this 
mother that she get the baby to either a SLP or OT or a CST for 
assessment and treatment. See what is going on with the baby's jaw, 
mouth, and palate. I would also try latching the baby on in the exact 
same position as you do for the "good" side so that the neck and jaw are 
in the same position for both breasts to see if baby's neck or facial 
positioning makes a difference. In cradle hold this is done by flipping 
the baby so that the same ear is down for both breasts, but on the "bad" 
side the baby's body goes away from mom's chest, legs past the armpit, 
resting on pillows. Like what we would do for a baby with an ear 
infection, head bruising, or broken clavicle who refuses to nurse on one 
side due to pain. And moms can certainly nurse one sided if they need 
to. The second question is what kind of pump is mom using on this side 
and does she have big enough flanges?

Kathy Eng, BSW, IBCLC
Houston, TX, USA

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