Hello all,
I was hoping someone would confirm my thoughts on a current case I am
working on. I have permission to post.

Mother with first baby. 3wks, girl born vag., epidural, birth went "great".
8lbs,4 oz at birth, 7lbs9 at discharge, 7lbs, 11oz at  two wks. Mother has
always had "sensitive nipples" before pregnancy. She said she gets a tingly,
"foot asleep, now waking up" sensation when she goes from a warm room to
cooler room. Her feet and hands go numb quickly when outside (says she can't
go skiing). She was going to have her thyroid checked before she got
pregnant due to the nipple/feet/hands reaction to cold but got pregnant and
figured it wasn't a problem.

She has had sore nipples from the beginning. She has extreme pain during the
latch, it goes down (from an 8 to a 5) during the feeding and has a
lingering burning pain shortly after the baby stops nursing. I observed a
feeding. Nipple comes out with crease in the center (crease was actually
there even before the feeding) and the crease is white. We worked on latch
and position and the nipple shape was a tad better but not by much.

Soon after feeding, the white goes from just in the center to a white ring
around the tip of the nipple and the bruning starts. It is not an intense
pain but uncomfortable. She usually doesn't notice it because the pain from
latching on the other breast is so severe. Left nipple does the same thing .
She has only noticed the turning white after feedings for about a week .

She also hears clicking sometimes and she resituates the baby and it seems
to stop. I did not hear clicking and I think the baby latched better on the
second side and the nipple did not look as mishapen. She also said it felt a
little better a couple of times. I also observed that her milk comes down
right away, immediate gulping that goes on for a while.

I pulled back breast to try to see lips and tounge and I looked at the
baby's mouth. I am not very well versed in palate or frenulum but suggested
she have both looked at. Baby seemed to have a little bit of a heart shape
to the tounge and the tounge did not seem to have alot of movement. She said
she had never seen the baby's tounge go out over the bottom lip.

This is what we talked about:
1.Continue to work on a deep asymetrical latch and good positioning
2.Get palate and frenulum looked at - could be compounding the issue.
3.Use warm compress or hair dryer on warm after feedings.
4.If that doesn't work, try the treatments suggested by Dr. Newman in his
book which she had. :)
5. She is also trying to pump to see if she can get extra milk to get a
break once in a while. She has been doing one to two supplemental bottles a
day just to get a break because the pain is so bad. She would like to not do
that. She tried a lactina with speed high and suction low and it hurt as
much or more than the baby with 2 oz output after 15 minutes. Should she try
a Symphony?

She has an appointment with the baby's doctor about palate and frenulum. She
has tried to call her doctor about the treatment options (nitroglcerin and
nifipedrine ( I was trying that from memory and I know it is wrong). She is
being very proactive.

What else can she do? Does she need to see a specific specialist? Who does
she speak with regarding reynauds/vasospasm? Do you think that is what it is
 even though the pain after feedings isn't very intense? To me, the #1
problem is latch, #2 is the blanching/vasospasm and #3 could be baby's mouth.

Any thoughts would be appreciated. She is very commited to breastfeeding but
I don't think she can continue through the pain much longer than another
week or two. She needs a light at the end of the tunnel.

thanks,
Micky Jones

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