Kathleen,

Here is my armchair analysis, for what it's worth:

If the part about the palate is true, combining that with the baby's "tight"
mouth would indeed account for a lot of the initial pain and damage!  [Had I
seen all of this, I may have taken the baby off the breast in the very
beginning, pumped mom, and done fingerfeeding to train the baby's suck until
the tightness relaxed--- I had a mom I've just finished working with, and her
baby just clamped down very tightly once you got something over the tongue,
which loved to stay up; mouth did relax with alternate feeding, but
unfortunately mom just gave up getting back to breast before seeing me
again-- company interference with appts]   From there, it is no surprise that
thrush was able to set in, and of course after that came the contact
dermatitis problem.  Poor woman!

A tight mouth, too much pressure with compression, whatever you call it,
needs counter pressure to help. Sometimes this can be done against the jaw,
but the last time I saw this done the baby hated it.  Otherwise, baby may
need to be taken off breast  :(  and suck trained with a finger, which can
apply counter pressure during feeding without injury.  Also, damage from this
type of pressure can result in a radiating pain such was described. When you
mix thrush pain and nerve damage, it can be difficult to see what is what at
first! (hindsight is always 20-20, isn't it?)

As for the palate issue, if it stood alone, I would have put mom and baby
into a position that placed baby above the breast rather than allowing the
breast to hang by gravity into baby's mouth. This forces baby to be active in
the nursing process, and baby is "forced" to take more tissue into his mouth
in order to get an adequate hold on the breast!  My favorite position: mother
supine, baby on top in prone position. After L-O, baby can roll slightly to
one side.  Also, finger feeding is good for palate issues because the baby
wants to pop the nipple into the bubble rather than taking it farther back,
and finger feeding "desensitizes" baby to having something farther back in
mouth. The initial problem is that such babies may gag at attempts to put
more tissue further back.....

I'm not as sure about the pumping situation, and am unclear from your post as
to which double pumps she was using.  I have seen that thrush can make
pumping very painful, and sometimes manual expression is the best choice.  At
any rate, had she taken baby off the breast sooner, before extensive damage,
I'll bet a lot of this wouldn't have happened. I don't love to take babies
off the breast, but if we can't get breastfeeding to a reasonable degree of
comfort pretty quickly, I will not allow a mom to get torn up like this;
problems don't get solved this way.

At least now she knows what products to avoid. She might consider doing a
patch test for lotrimon in case she faces yeast with another baby and needs a
treatment.

At this point of weaning, I personally would handle it differently in that I
would not encourage this painful nursing. Rather, I would encourage her to go
back to a pump once she is healed (she's almost there, right? or am I off
track here....). If she was using the Medela double system, take the blue
silicone ring off to decrease the suction pressure if it felt/still feels too
strong.  Then pump and finger or bottle feed baby.  If she had it in her, and
I can understand that she doesn't now, I would just have her pump, slowly
build supply back up, and allow those poor nipples to heal completely. Then,
when baby's mouth has begun to relax, try again to get baby to breast using
"bubble palate" positioning strategy.

Kathleen, this is kind of sketchy and jumps around; it's all I have time for,
but your story hit some points with me. Tell me what you think of my
analysis, and I'm looking forward to reading others. :-)

-Lisa