Could I ask for help with this situation?   First time mom was delivered of
a baby boy via c-section for pre-eclampsia at 40 weeks gestation.
 Breastfeeding was painless and successful for the first week, then mom
began experiencing nipple tenderness.  At the same time, the baby developed
obvious thrush, and an LC at another hospital recommended Nystatin.  I was
called to see this mom a week later (I am closer than the original LC) as
the nipple pain was not improved, had blossomed into stabbing breast pain,
and mom was almost exclusively pumping and bottle feeding, as it was too
painful to latch.  I looked in the baby's mouth and saw patches of thrush,
but also noticed the baby's tongue was not extending past his lower gums.
No obvious frenum.  Palate seemed unremarkable.  I recommended gentian
violet for perhaps a quicker resolution of the baby's symptoms, and perhaps
Diflucan for the nipple/breast pain.  Pediatrician readily prescribed both.
Gentian violet cleared up the baby, and Mom completed a 21 day course of
diflucan.
Mom also got a referral to see an ENT at a children's hospital 2 hours
away.  He assured her that the baby was in no way tongue tied.
Interestingly, she noted that the baby latched better for a short time
after he was examined by the ENT.
 There was also a little bit of yellowish crusting on one nipple, and I
recommended that it be cultured to see if there was a simultaneous
bacterial infection.  Pediatrician and OB were  unwilling to culture this
 Mom refused to go to the hospital to have an OP visit and be cultured.
 Labs drawn during her 6 week postpartum visit indicated normal white cell
counts, so I'm guessing that there is not a bacterial infection.
At about 4 weeks, pediatrician was concerned about weight gain, and so she
does give about  1 oz of formula after a nursing or bottle feeding pumped
milk
We have been over positioning, latch, all of the basics, and still this mom
has nipple pain that is so bad, she only nurses once a day... pumps and
bottle feeds the rest of the time.  She has breast pain as well which she
describes to me as "stabbing pain in my nipple that radiates through the
breast while nursing." In between feeds, she also has deep breast pain that
"feels like someone is trying to push a marble out of my breast."  This
almost sounded like a MER feeling to me, but it occurs an hour or so after
feeding/pumping.  It is not as bad after a pumping session... much worse
after nursing.  It is painful to her breasts to lay the baby up on her
shoulder or hold him against her chest.
She recently returned to work and is pumping and bottle feeding for most of
the baby's feeds. She uses the pump on its lowest setting, because anything
higher than that is too uncomfortable.  At our most recent conversation
her milk supply has remained stable, supplements unchanged in amounts.
 Her nipples do not seem misshapen when they come out of the baby's mouth.
 there is no obvious compression stripe or cracks or blood.  As an aside,
she is a dark haired, dark eyed person, and the color of her nipples is
much paler that I would expect it to be. I do not know if that is useful or
not, so I include it.  I would appreciate any thoughts.  Please let me know
if more information could be useful.

 Alison Keating RN, BSN, IBCLC

-- 
Alison Keating
3004 2nd Avenue
Altoona, PA 16602
814-946-7061
814-934-0466  cell

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome