Met with a woman today who reported having a difficult time breastfeeding her first child. I was seeing her with her 2nd. 

Her first baby gained weight well, but she had nipple pain with every feeding, along with repeated bouts of nipple bleeding, plugged milk ducts and mastitis. She says she worked with a lactation specialist who thought her latch was great, but the pain and other problems continued no matter how good the latch was. She ended up breastfeeding for 5 weeks.

I watched her latch this 2nd baby today.  The baby is 2 days old. Her technique was great - skin-to-skin, baby-led, wide latch, immediate swallowing.

Her nipples were unusual. The face of both nipples was slightly bumpy (similar to most women) but by the time the baby was done with the feeding, it looked like the nipple was covered with blisters. Looking closer, I realized that these were not blisters (no fluid, no blood). This was just her anatomy more swollen.

She said with her last child, these bumps would eventually fall off and leave an open wound that would bleed and cause more pain. She even said she had one of these bumps "rub off" during this pregnancy while she was in the shower.

I recommended APNO and close follow up with an LC.

Any thoughts, ideas of how I could have managed this differently?

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