Wise ones: At a consult today, I was helping a mom who is pumping
exclusively (surrogate mom now providing pumped milk) and causing some
nipple trauma.  Mom appears to have thrush, but I'm honestly not sure.   Her
larger/more sore nipple measures 25-26mm and she was using a 24 mm flange.
I suggested moving to a 27/28 mm flange as her standard, and switching out
to a 30mm if nipple swelling appears significant half way through.  Mom and
her partner both noticed significantly enlarged nipples post pumping, which
is why I suggested moving to a 30mm flange during the pumping session.
 
Mom purchased only the 30 mm flange and began using that.  24 hours after
first use (or, about 6 pumping sessions), she experienced wounding on one of
her nipples; some cracking right at the base of the nipple in one her
natural fissures, and cracks that appear like surface 'scratches', one at 1
o'clock and one 5 o'clock.  Not something I have seen before.  Not sure if
it would be the larger flanges, or incorrect pumping position (she noticed
the wounding at the 2am session), or something else.
 
While I was there, her nipples very obviously cycled through typical
Raynaud's symptoms (blanching after stimulation, then purple, then pink and
healthy looking... then... started the cycle again, especially if they were
touched).  Keep in mind that this was without a baby present AND two hours
after the last pumping session.  Only stimuation was my hands and fingers.
We live in a very damp climate and she is 'always' cold.
 
Nipples were so tender that she had to keep everything off them.  She was
loathe to put the pump to them, and I was loathe to allow it!  I suggested
hand expression... she demonstrated her very ineffective technique and then
I demo'd the one that I use (ala Chele Marmet... works very well for me!).
I was on her breast for a total of 5 seconds, with only ONE roll of her
ducts, and NO WHERE near her nipple... my touch was so painful to her, she
began to cry!  This was in response to pain that she was feeling IN her
breasts, not surface pain from nipple wounding.
 
She is going to start gentian violet today, and will see a doc tomorrow for
some APNO and nifedipine.  She does not have a family doc and will need to
go to walk in, so a swab is unlikely.  We are going on best-guess here.
 
I realize this is vague... because... I'm not sure what I am asking for!  I
was stunned by the degree of pain she felt with the hand expression, and I
am honestly not sure what is going on with her nipples, though Raynauds is
very likely, wounds are present, and other things may be at issue.
 
Help?


Karyn-grace Clarke, IBCLC, RLC
Registered Lactation Consultant
HAPPY TRIBE CONSULTING
 <http://www.happytribe.ca/> www.happytribe.ca 
Nanaimo, BC, 250-739-3146

 

 

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