Dear Louanne,

Some comments on your situation:

>Mother gave birth to second child at 38-39 weeks. Had severe pain when
feeding her now 3 year old.  Pumped for awhile but gave up after a few weeks.
 Is having severe nipple pain with now 5 week old.  She tried nursing at the
hospital but the pain was terrible.  The LC followed up and did latch pain
free once or twice but mom has not been able do this. The baby was given
formula because of weight loss but that same night was in the hospital
because he stopped breathing..

KB: He stopped breathing?  What is this about?

>  Mom is now pumping and bottle feeding 24 or
so ounces a day.  She tries latching twice a day and feels he gets some milk
but can't stand the pain.  One LC weighed the baby after an hour of painful
feeding and said he only took 6/10 oz.

KB: I think that it is not advisble to let a mother breastfeed while in pain
for 60 minutes. What is the point of doing so?

 The pediatrician was convinced there
was something wrong with the mother's breast so referred her to a ob/gyn.
Mom was fine.  Ped wants baby on bm only because of the breathing problmens
but will not give insurance referral for baby suck assessment (there is a
local provider that does these).

KB: Well, the mother can pay for help out of pocket. Many times this is what
is needed...and people will *easily*  pay a lot more for dog obedience
classes than they will for professional breastfeeding assistance, at leat in
my area.

>>. He feels that pumping and bottle feeding is
fine.  Mom could pay for assessment herself with no insurance help.  Ped
thinks baby has some sort of reflux. He's not sure. Baby is gaining now,
about 3 lbs. since lowest weight.(baby is now 8 lbs or so).  Baby is using
the avent nipple for new born.  The nipple shield did not work.  Several
nurses and the LC's seem to think it is a suck problem not a mom problem.  No
one has suggested Yeast because pain seems to be only nipple area.  The
baby's suck turns mom's nipple white.  Mother is large breasted but she has
been told her nipples and areola seem normal.

KB: Several things you say here indicate possible problems. First, I see a
situation where there are too many "cooks" in the kitchen.  Lack of
continuity seems to be a real issue for some clients.   Yeast, or fungal
infection, can start on the nipple only. If one reads Kay Hoover's work, or
Lisa Amir, you will see that fungal infections can begin as an itchy
soreness, and can progress, but sometimes it doesn't.  There can be
exquisite pain on an otherwise physically unremarkable nipple.  Can occur on
one side both. So, to rule this out is not correct. I think that in this
case, Dr. Newman's all purpose cream could be suggested to the
physician...as it covers fungus and staph A and the cortisone calms down
inflammation. We have seen it work well in the practice I work in.

>I have not personally seen this woman.  I told her to get a second medical
opion in hopes of getting a suck assessment paid for.

KB: I think that sometimes, if a mother is reluctant to seek further help,
the insurance question ( if there are funds avail.) is a hedge.  People who
really want help get it...and if they don't, then they are working from a
different belief system. Perhaps there is a history of abuse, or of other
psycho-social  issues surrounding breastfeeding.

Also, to get in touch
with the LC that got the baby latched pain free (this LC has a great
reputation but I think the mom has seen so many people and gets told so many
things that she just didn't think of contacting the person again.)

KB:   LIke I said, many mothers would move heaven and earth to see the
person with whom they had the most luck.

The pain she has could also be related to Raynaud's of the nipple...if her
nipple has white/pink or blue/pink/white color changes. Search for Raynaud's
in the archives for  further info, or look in Auerbach and Riordan, or in
Lawrence, or in Jack Newman's sore nipple computer info page.  Does pumping
hurt?  She has had a lot of different things...SNS, nipple shield, and
nothing seems to work, ..is that right? I wonder if continuity in care giver
( ONE person) with daily followup would help her?

ANother question to ask is did she have a predisposition to fungal infection
before birth.? Did she have a recent course of antibiotics or a recent
vaginal infection, or antibiotics during birth for Group B Strep?  Does she
have Raynaud's in her hands? How is her latch?

The basic intervention is to have someone who is very knowledgeable in latch
assess this and make corrections. It is basic, but it is amazing how this
can be overlooked.

Kathleen

Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet, Indep. Consultant
Williston, Vermont
mailto:[log in to unmask]
http://homepages.together.net/~kbruce/kbblact.html
LACTNET Archives http://peach.ease.lsoft.com/archives/lactnet.html

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