I've been out of the country for a week, so this is a delayed response to
Sharon Gollmon's question about a mom tx sore nipples with all manor of
yeast meds with no response and a fussy baby.  Sharon wants to know if the
yeast or yeast meds are making baby pull off after 5 min. crying (acting
"gassy").

 No, this probably  has nothing to do with 'yeast'.  Michael Woolridge's
important article in 1986 Midwifery ("The Aetiology of Sore Nipples") talks
about 2 reasons why nipples become sore:  Incorrect attachment to the
breast, and low milk supply.  In the case of low milk supply or poor ability
to transfer milk, the baby is forced to apply excessive negative pressure to
the nipple trying to get out the milk.  Think about the way you suck extra
hard through a straw trying to access that last swallow of milkshake in the
bottom of a tall glass and you will grasp this idea quickly.  That excessive
application of suction makes the face of the nipple very sore, sometimes
blistered, and usually pink and abraded looking. (Think persistent hickey.)

In the case of Sharon's mom, yeast meds have not improved anything, so
should be discontinued.  Baby doesn't fuss or act 'gassy' when getting a
full feed from a bottle, so this isn't 'gas' at breast but an expression of
hunger and dissatisfaction with flow rate.

What to do?  Try to increase the amount of milk available to the baby.  A
feeding tube device worn at breast might be a way to give the baby more food
and help decrease the excessive use of negative pressure (suction).  Try to
increase effectiveness of milk transfer by improving latch and teaching deep
breast compression during feeds.  Try to improve milk supply by use of
galactagogues, post feed stimulation with a good pump for a few mins, more
rest, better nutrition.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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