I saw a mother today with so many issues and symptoms I'm having trouble
sorting it all out. I would welcome any input or experiences you have. Sorry
this is so long!
First baby, labored total of 3.5 hours until full dilation at a birth center
with a midwife, determined baby was breech and by policy had to transfer
mother to hospital for c-section. Baby latched shortly after birth and
continued without incidence until mother started experiencing pain on day 3.
Also engorged at same time. Right nipple developed fissure. LC at hospital
and midwives all evaluated latch and felt it looked good, no compression
after. Mother home, pain so bad on right nipple (with fissure) mother rented
Symphony pump and pumped that side while continuing to breastfeed on other.
Fissure healed, returned to breastfeeding on both breasts. Still painful
throughout feeds, started doing more pumping, feeding EBM and some formula.
Pain with breastfeeding is worse some days, better others; when it is worse,
pumping is also painful. Mother limits feeds to a few minutes because she is
too uncomfortable to continue; she also pumps usually just 5-6 minutes
because she says there is no milk flow after that.
Baby is now four weeks old. Mother describes pain with feeding as being
extreme at first latch, then with each suck she feels a stabbing pain. After
feeds she feels a burning pain for several hours, she describes it as
feeling "on fire" and radiating out from the nipple. She reports either
warmth or cool on breasts is comforting. Nipples and breasts are sensitive
to touch. Baby has bilateral dislocated hips and is in a Pavlik harness, so
mother latches baby with baby straddling mom on her lap, sitting up to reach
breast. Mother has to lift breast a little to get it in the right place, but
there doesn't seem to be any other way to position baby due to the harness
which keeps her legs splayed out to the side. Baby opened wide and seemed to
latch well with a wide gape, sucked vigorously for a couple of minutes with
audible swallows and then either went to sleep or fussed and pulled off.
Very slight nipple compression. No current nipple damage.
Digital suck assessment of baby revealed baby keeping her tongue over gums
while sucking, but limited tongue elevation and extension, and some twisting
of tongue with lateralization. Tongue seemed a bit flat and squared at tip.
No visible frenulum and couldn't palpate any tight cord under tongue.
Mother reports having a dairy allergy as a child which she outgrew, but
doesn't consume much dairy now. She says she has always had sensitive
nipples; so much that she always wears a stretchy bra to bed because
clothing moving against the nipple is irritating. She was diagnosed with
fibrocystic breast tissue in her right breast some years ago, can palpate
lumpy areas in outer quadrant (from 9 o'clock to 12 o'clock) and one spot in
inner (at 4 o'clock). Had some pain in breast, took vitamin E supplements
which seemed to help. Pain became much worse about 3-4 months into
pregnancy. Mother is massage therapist and read about lymphatic drainage
massage which she got and seemed to help. She had an ultrasound which didn't
reveal many cysts, just dense breast tissue. In addition to mother's
fibrocystic pain, she reports both breasts in pregnancy were very tender,
any movement was painful.
Mother was also diagnosed with PCOS after long history of irregular menses
and onset of pelvic pain about 10 years ago. She also had regular migraines.
She was on Depo-Provera for 7 years as treatment and symptoms resolved. When
mother wanted to get pregnant, she went off Depo, had acupuncture and took
Chinese herbs for 7 months as preparation. She saw a reproductive
endocrinologist who said tests showed she did not have insulin resistance
(and suggested that there may be two different "diseases", PCOS with and
without insulin resistance). She did one cycle of Clomid and had one
intrauterine insemination and became pregnant. She was on no medications
during her pregnancy, and has never been on Metformin.
Mother reports no history of sexual abuse. She had some vaginal itching at
end of pregnancy but midwife said no yeast and it resolved after birth.
Mother has always had very cold hands and feet but no color changes, and has
not noticed any blanching of nipple. She did have a nipple bleb two weeks
ago that resolved with saline soaks, and a plugged duct last week that
resolved with massage.
As I read through this again I think thrush is at least a likely explanation
. . . vasospasm doesn't seem as likely . . . possible posterior tongue tie .
. . but are the other issues (fibrocystic breasts, hx of breast pain and
nipple sensitivity, PCOS) just zebras, or can they by contributing? I'm not
sure what to have her do first. The only doctor in our area who treats
posterior tongue tie is on vacation for three weeks. Mother will take
herself and baby to chiropractor. I talked about APNO, possibly gentian
violet. I suggested ways to increase her milk production.
Thanks for reading this far, and I look forward to any thoughts you can
share!
Warmly,
Lisa Mandell, MBA, IBCLC
Havertown, PA USA
www.best4both.com
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