Claire Payn in New Zealand wrote a long post that I shan't reproduce again here. Suffice it to say, Claire, that you have put a lot of time, effort and care into supporting this mother and her baby, who had a difficult start before the breastfeedng challenges. Some specific issues have been addressed, but the pain continues. It involves breast as well as nipples. There is nothing to indicate latch issues. 

In cases of persistent breast pain, where other issues have been investigated and, if present, addressed, I go looking for "something else". What I'm wondering is - has this mother had a spinal injury in the past? So often when I ask this question there is a history. Remember, the nerves to the breast come off the spine. Any of the larger breastfeeding textbooks will give you an anatomical diagram. (Occasionally, a spinal history that isn't exactly at this level is still found to be relevant.) This mother has had a pregnancy, with an increasingly heavy unborn baby leading to changed posture, including her spine. She has has a diffiucult labour, followed by an emergency C/S. Early feeding positions may have involved leaning forward, e.g. to check latch. (Just a thought: sometimes there may be an old injury, e.g. a sporting one or a fall, that has never been followed up on.)

When I see a mother with overwhelming breast, or breast/nipple pain, and a history of a spinal injury, I send her back to whoever has been treating her back pain. This may be her GP, a physiotherapist, or a pain team. Once addressing this is set in motion, the mother is less consumed by pain and can benefit from specific breastfeeding input or support.  The mother may need to use a feeding position with good back support, perhaps a laid-back one.

Whether this applies to your client, this imformation may be useful for helping other mothers in the future.
Virginia

Virginia thorley, OAM, PhD, IBCLC, FILCA
Brisbane, Qld Australia

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