What kind of pump is she using? You mentioned that she had damage to her nipple when using the nipple shield - i have seen this before when mother has longer than normal nipples  and when the infant nurses the nipple elongates and parts of the tip of the nipple gets pulled out through the holes at the tip of the nipple causing blisters. 

Does she have long nipples or nipples that elongate significantly when pumping? Some pumps are really bad for mother's with longer nipples. The most common one i saw was the tommy tippee - the shape of the pump doesn't allow for extended lengthening of the nipple. Use of a multi-use ("hospital grade") for a couple of weeks may allow time for the nipple to heal. 

The other thing I was thinking was possible "trench foot" although on her nipples not on her feet. If she has had damage to her nipples for an extended amount of time (weeks) and has been attempting to heal the injury at home by keeping it layered with lanolin or some other product it could cause the same injury as "trench foot". The nipple will look raw, red, and very sore. 

Jessica Callahan IBCLC, RN
NC, USA

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