this is not meant to criticize, because goodness knows I well remember the
terror I felt when I first started helping moms as an LC and was so afraid
I'd miss something.  I share in the spirit of wanting to pass along insights
gained from experience.  That said, I would be very reluctant to attribute
sore nipples on Day 1 (or really even the first week)  to thrush no matter
whether mother had vaginal yeast during pregnancy or  baby had a diaper
rash.  I'd be more likely to suspect that an unrousable baby with a rash was
septic.  Sore nipples on Day 1 are most always, in my experience, the result
of mechanical trauma.  Remember, the nipple is very sensitive.  Think how a
paper cut on a finger tip can hurt all the way up your finger.  This is
because even a relatively innocuous looking fissure on a body part with lots
of nerve endings can be exquisitely painful.  The radiating nerve pain
caused by a cut nipple can "burn" and "stab" and radiate into the breast.
Superficial wounds are also easily contaminated and hospitals are full of
virulent germs.  I've been seeing more and more resistent cases of mastitis
lately, so we want to remember that most of these early cases of breast and
nipple pain that occur in conjunction with cut nipples are much more likely
to result from bacterial rather than fungal infections.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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