Thanks so much to all who contributed suggestions on this rather difficult
case.  To refresh your memories - very normal (can you say that?), natural
birth of twins at 35+6 wks.  From the very first feed mother experienced
excruciating shooting/stabbing pain radiating from her nipple to her
sternum on the right side and from her nipple to her underarm on the left
side.  Her nipples are kind of like extensions of her areola - erectile,
but areola fairly thick/firm and blends up to the nipple.  Pain occurred
ONLY when baby actually suckling ie stopped when baby paused, and also
experienced the same pain while pumping.

When I first saw her I suggested Nurofen (ibuprofen) regularly, warm, dry
packs after feeds, relaxation techniques, distraction techniques, plus I
adjusted her latch to a minor, but helpful, degree.

Well the babies are two weeks old now and she's been at home with them for
over a week.  The pain still occurs just as badly (10/10), but settles to a
5/10 score after about 5 minutes.  The smaller twin (now weighing 5lb) is
doing a little bit of nipple damage - we worked on that; but it is
unrelated to this pain as it happens in both breasts and she has one breast
per baby.  She can't tell by the pain if they're not on properly because
the other pain is so dominant.  She's still taking the Nurofen - twice a
day now.

She feels it has improved because most of the feed the pain is bearable -
unlike initially.  We're hoping that it took 2 weeks to get to this stage,
so another 2 weeks will see it gone - she's taking it one day at a time,
but shows absolutely no wavering of her resolve to have nothing but
breastmilk pass her babies lips.

As to what it is... Carla suggested costochondritis - that's still a
possibility; or a pinched nerve - she doesn't think so and isn't interested
in getting chiropractic care;   Rowena suggested to check palate and
frenulum - both NAD; nipple vasospasm was also suggested - pain isn't
typical and colour changes not seen.  We'd already eliminated thrush.

Jean Cotterman may be closest to the mark I think - distended and therefore
very painful milk sinuses.  Her explanation is a lot more eloquent than
that and very convincing.  I hadn't read her suggestions before I went to
see the mother but will try the reverse pressure technique as suggested and
will let you know if it works.  Jean gives a pretty convincing case that
the sinuses can be quite full from before the first feed (I was dismissing
this as a cause because I didn't think they would be distended until lact
II) Renate also suggested this as a cause.
Certainly the pain decreasing, not straight away, but after several (5 to
10 mins -feeds last about 25 mins) tie in with that.  Also this mother is
strictly clock watching and feeding 4 hourly = uncomfortably full milk
sinuses.  I haven't asked why (she is very religious - I hope she hasn't
seen anything of Ezzo!!) but presumed it was because she wanted her twins
to be in a manageable routine - they don't wake before then, and they are
both gaining weight with good output so I didn't see the need to interfere
with her routine.

Once more - thanks for your assistance and suggestions.

Denise

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Denise Fisher BN, RN, RM, IBCLC
BreastEd Online Lactation Studies
++++++ earn 120 L CERPs +++++++++
mailto:[log in to unmask]
http://www.BreastEd.com.au

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