Jessica,
I am wondering if the situation is the same or a different one this time.
Maybe two issues. It is a different time of year, your cooler months in the
Northern Hemisphere. Especially as there is pain at night, I'm thinking of
possible nipple vasospasm, which some women see more of in cooler weather.
As you talked with the mother by telephone, I think it would be good if you
can see her and observe a feed - either that, or ask some additional
questions. Is some of the nipple white when the baby comes off, or shortly
after? Are there other colour changes, i.e. blue and/or red? Does it help
to warm the nipple, e.g. whether with her warm hand or with a warm pack?
If your client's answers suggest it might be vasospasm, wearing an extra
layer over the breast at night may help. For instance, a sleeveless
pullover or a T-shirt. Avoiding caffeine and nicotine are usually advised.
This doesn't explain the pain *during* breastfeeds, though, which is why I
wonder if there are two issues. With nipple pain, often there's more than
one issue. You've mentioned that infant oral anatomy seems fine. However, I
wonder if there is a tight labial frenum, slightly restricting the upper
lip? This may not obvious on an initial exam.
Virginia
In hot, steamy Brisbane.
Jessica wrote: "I have a mom I worked with at 6 days old, she was
complaining of sore breasts when the baby sucked. At that point, latch
looked good, no pinched nipple or anything, oral anatomy was fine, ... It
did get better and totally went away by about 3 weeks. Baby has been
gaining weight beautifully. She just now called me back that her baby is
three months old and the pain started again.
"It is only when the baby sucks, in the breast, not the nipple, no visible
signs of thrush. Pain stops when baby stops eating. Pain is not related to
how full or empty the breast is, but she does say it is worse at night."
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