A response to Anne's last post about the 'wildly conflicting' advice
she's gotten (sorry, I'm a bit behind in my reading).

We DO routinely suggest the use of an antifungal prophylactically
with severely damaged nipples.  Our deliveries here in Baltimore tend
to be highly interventive (including the frequent use of
antibiotics), and we consider yeast problems to be practically
endemic here.   Combined with the stress of delivery and postpartum
period on the immune system, we find cracked nipples to be great portals of
entry for yeast.  We'll often recommend a Dr. Jack-like "cream for
what ails you" consisting of an antibiotic + antifungal +
hyrdrocortisone that mom can concoct on her own using OTC creams
(with  instructions to drop the hydrocortisone component within
5-7 days).

I like that you didn't necessarily want to rent this mom a pump
immediately.  I, too, prefer to keep the baby at the breast if at all
possible.  I don't think that further damage of the nipples with a
high-quality pump is that much of an issue--it's more that moms get
so caught up in the mechanics of the whole process that they lose
sight of why they originally wanted to breastfeed.  We've had
numerous women start pumping and decide they would just pump and
bottlefeed EBM.  Laudable--but it breaks my heart.  That said, we
must also remember that mom is the owner of those nipples, and knows
what she can cope with.  I've found that many of our moms who
stubbornly demand a pump when they have sore nipples are just as
stubborn about getting that baby back on the breast!

Terry

Terry Dalton Hadley, RNC, IBCLC
Towson, MD