Dear Lactnetters,
I have a situation that I'm hoping someone has some good ideas for.

8 week old baby, thriving on breastmilk and breastfeeding, however mom's
nipples are still extremely painful and pinched whenever baby comes off the
breast.

They initially started out cracked & bleeding, we worked on the latch &
positioning and breastfeeding seemed to progress and the nipples healed.
However, nipples continue to be pinched after feeding and *very* painful.
They look purple-ish.  They don't really look yeasty; however the OB did
prescribe Diflucan and gave mother a 1 month supply.  Baby shows no yeast
symptoms and was never treated.

Mother has been using a shield off and on on the left side (mostly on)
because of the pain, but for the last 3 days has been using the shield on
both breasts because of the pain.  Her nipples are not pinched with the
shield when he finishes and he transfers milk effectively with or without
the shield.  At this point the shield is mostly for mom's comfort.

Baby's tongue does not cup finger nor extend past gumline on digital suck
assessment, yet baby's tongue is able to elevate and extend well past the
gumline.  Mother uses very good latching and positioning technique and latch
*looks* perfect, yet the nipple is always pinched.  The only position in
which the mother has found no pinching is when she is lying on her left side
and pretty much propped over the baby and offering the right breast.  He got
a *good* mouthful, she says and her nipple wasn't pinched.  The bad part was
that the flow was so great that the baby was choking and it was very
uncomfortable for mom.

We talked about possible Raynauds but neither of us feel that is really the
problem.  We don't believe it is yeast either, but we acknowledge that it
could very well be.  Mom has been taking the Diflucan for 1 week with no
improvement, but again baby hasn't been treated.

Since the nipple is pinched after feedings, that leads me to believe it is
still a nipple trauma issue, but I suppose that yeast could be an underlying
problem which is just exacerbating the situation.  Baby does not appear in
any pain while feeding and again shows no signs of yeast, either oral or
diaper area.

Baby's weight gain is stellar and mom's supply appears neither low nor
excessive.  Baby has an appointment with the ped tomorrow and mom will
discuss with the ped treating the baby for yeast.  I gave mom a copy of Pat
Gima's yeast treatment plan and info from The Breastfeeding Atlas so that
she can decide what else she wants to do regarding possible yeast.

My real question, I guess, is what else can we do about the latch.  She is
using a good asymmetrical latch, I don't know what else to try, except keep
working on it and use the shield when necessary, and try different
positions.  We discussed ways she could make the lying down position
comfortable for her since that one resulted in no pinching.  We also
discussed some other non-traditional positions.  Any ideas?

Thanks in advance.

Cindi Swisher, RN, IBCLC

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