> Hello All
> A reintroduction. I have been off Lactnet since July and was mostly a
> lurker even then! I am an RN/IBCLC at a Baby-Friendly Birth Center in
> Eugene, OR where I follow families from prenatal through weaning.
>
> I have received permission from mom to post this case.
>
> Mom delivered 4 mos ago by c/sec for breech (had wanted out of hospital
> delivery, failed version, very disappointed)
>
> Initially had difficulties with latch, largish breasts, flattish nipples.
> Received shield in hospital which she used for about 3 weeks and
> self-weaned. During that time ped tx baby for thrush told mom to use
> nystatin on her nipples as well. Was continuing to have nipple pain after
> nystatin tx. I recommended GV tx.
>
> At 3 mos PP mom calls with extreme nipple pain, BF never totally
> comfortable but now much worse. Babe does continue to have difficulty
> with latch but mom can tell when latch is incorrect and repositions until
> comfortable. Babe is refusing bottles and pacifiers. No nipple damage.
> Hx thrush, pain seems unrelated to latch. Try Gentian Violet treatment
> for mom and babe. She had not previously used the GV as pain had mostly
> resolved.
>
> 5 days later calls with deep pinching pain during and between feeds,
> nipples tender to touch even t-shirt is painful on nipples, did full GV tx
> without results. No nipple damage but slightly red at tips, blanching to
> white after feeds. Excruciating pain. Rec. Ibuprofen for pain and
> inflammation. Consult scheduled.
>
> Ibuprofen has pain under control so that feeding is possible but not
> comfortable. Reviewed comfort measures for Raynaud's from Dr Newman's
> book. Started on Nifedepine 30mg ER qd X 2weeks. Observed feed, babe is
> well latched mid feed but did not observe initial latch. Nipple does
> blanch post feed and get hard, it often takes as much as 30 minutes to
> regain color, does not go through "blue" stage.
>
> 3 weeks later, has finished nifedepine Rx, no lessening of nipple
> blanching during course of rx but past 3 days has not had nipple
> blanching, pain continues but able to feed through continued use of
> ibuprofen. Nipples are now pinkish red, irritated but without skin
> breakdown. Observed feed, babe slurps nipple in like a spaghetti noodle
> causing much pain, once she settles in with a mouthful latch appears
> normal, mom describes as comfortable but only because ibuprofen on board.
> She walk the floor with screaming hungry baby waiting for ibuprofen to
> kick in. Nipple shape post feed is normal. Attempted digital exam, babe
> very playful with finger but no interest in sucking it, does mouth and
> clamp finger. Still will not take bottles or pacifiers. Based on
> observation assisted to start feeds with open mouth to improve comfort of
> initial latch. Based on pink irritated looking nipple and moms complaints
> plan GV tx (which she has on hand) and consider APNO after weekend.
>
> Dad is concerned about over medication (ibuprofen). Mom is being a
> trooper about everything. I am beyond my skills and need some new ideas.
> Help?!
>
>
> Janie Akerlund RN IBCLC
> Nurse-Midwifery Birth Center
> pager #334-1419
>
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