Hi. This came by way of a colleague of mine. Please send your comments on
this case to the list, and cc: me privately. The LC involved sent it to me,
and would also appreciate any feedback...which I will pass on.
Thanks.Looking forward to comments. Kathleen
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This is an extensive report from a very disappointed mother (with a great
sense of humor) who is striving to make sense of her experience. I will
forward any suggestions, encouragement, explanations to her.
Breastfeeding History of LK
"....in the hopes of gathering information and helping others. M was
born October 23rd, 1995. There were some complications with my placenta, and I
lost maybe 800 cc.s of blood, so I started out the picture fairly anemic.... We
stayed at G Hospital in R-- for 4 days, where I got lots of very good
breastfeeding help from my midwives and the nursing staff. I needed it. I had
cracked and sore nipples on the second day, and it seemed M was taking pieces of
the side of the nipple off. They called her a 'barracuda baby.' ... I heard
the first two weeks could be difficult....six weeks... two months.... a 'number
of months.'
Anyway, we tried pure lanolin to help heal them up, and M started
refusing the breast, so I had to wash it off. We switched to vitamin E. The
nurses all coached me on positions and stuff, and M seemed to have great
technique - getting lots of areola in, always ready to eat, patient with me
adjusting her position - but, boy, was there still plenty of pain.
My husband, B, came with us to visit SJ, IBCLC....somewhere around two
weeks , I guess. She noted M had a high arch in her palate, which may be
impeding the extension of my nipple into the back of her mouth, and leading to
some nipple pain. [Mother's interpretation of "the nipple may slip into the arch
and cause back of baby's tongue to abrade nipple tip, causing pain -- indicating
a need to have her open even wider and be held even closer."SJ] She also noted
that M had a pretty strong suck / bite. I learned the wonders of pillows, and a
technique of holding the jaw down while she nursed to decrease the intensity of
her not-quite 'tonic' bite. [to open M's mouth even wider & silmutaneously
bring her even closer to bring her mouth further onto the areola.] There didn't
seem to be any problems with our technique.
The nursing ...[continued to be] quite painful. There was lots of
kicking, screaming, labor breathing, tears... you get the picture. I diagnosed
myself and her with thrush; it answered a lot of questions. We went on nystatin
- her orally and me topically, four times a day. There was no relief of
symptoms in two, three days, so I went on Diflucan - two pills the first day
and one thereafter for 13 days. The prescription was $90! This was at
Thanksgiving. The nursing was quite painful. I really wanted this to work, and
if there was any hope that it was going to get better, I was able to persevere.
But every feeding was terrible. I was also getting a lot of deep breast pain,
beginning maybe 20 or so minutes after a nursing and lasting pretty much until
the next nursing. The pain was at the nipple and extended, cone-like, down into
the breast tissue. It was also very intense. I was taking a lot of Advil, 3
every 4 hours around the clock - the max my midwife thought was OK. Having
researched this type of pain, I thought it was a yeast infection of the milk
ducts, but when the course of Diflucan was complete and there was no decrease in
pain, I settled on thinking it was just the tender milk ducts refilling. There
was plenty of reason for them to be tender, no doubt.
I also had sore breasts all the time. I had read that is common, and
anyway, the nursing pain was much more severe, so all other problems really took
the back seat. Part-way between Thanksgiving and Christmas the nursing got
better [emphasis mine SJ], which I attributed to the nystatin and diflucan
finally doing the job. The pain at latch-on wasn't as awful, and I wasn't
screaming and kicking each time.
However, it got worse again. I had bumpy and oozing nipples and areolas, and I
thought the thrush had come back, which surprised and depressed me, since
Diflucan is such a powerful antifungal. So I continued with the nystatin
treatments, and searched out any route for help with my problems.
One route I tried was a Naturopath, who, among other things, gave me some
Calendula ointment to apply to the nipples and areolas to help heal them.
At last, M's doctor suggested I see a dermatologist, who I saw December
29th. She took one look at me, and said, "That's not thrush; That's a contact
allergy." I was floored. She started me on hydrocortisone, and I did patch
tests on my arm of the five things I was putting on my breasts, to
see what I had developed allergies to. I got reactions to the nystatin and
calendula ointments. Bad reactions. Needless to say, I was very upset that the
very things I was slathering on myself were the things that were making me so
sick.
The hydrocortisone worked, but the rash kept coming back, again and
again. Each time, we changed the treatment, and after five versions of it, it
finally died. The last version had extended to my stomach and down my arms, and
incredibly itchy. [Could this have been the hormone induced rash preg. & pp
moms sometimes get? SJ] And, of course, the breastfeeding throughout it was
intensely painful. I was very happy when it finally died, and looked forward to
being infection free, so I could, at long last, nurse without pain.
I was rash-free by about January 15. I had some remaining wounds on my
left nipple, but my right nipple was virtually intact. It was wonderful. I
expected to be nursing happily soon. Unfortunately, that didn't happen.
There was some continuing abrasion on the end of the nipples, not much,
which I attributed to her high palate, but the nursing was still very painful.
It hurt where her jaw was, and, afterwards, my nipples felt abused. Needless to
say, I was confused and depressed. We had weaned down to nursing every 5 or so
hours to try to heal me up - M getting formula in between - and if the
nursing didn't happen to get better, I'd be that much closer to weaning her off
totally. The nursing didn't get better.
Some notes: I did try the finger-to-the-jaw trick, and while it was
extremely useful getting me through the worst of the infections, she never did
learn to chill out, and I couldn't see having to do that at every nursing. M
hated it, shaking her head violently. I didn't blame her.
I never had any problems with milk let-down, so that's not the cause of
her strong jawing. I counted sucks a few times ; I would see milk leaking out
her lips after an average of 4 sucks. This pleased me, because I was always
anticipating pain and I'm glad that didn't inhibit her getting the milk. I am
fair of skin. I've heard we are often blessed with tender nipples. I've
experienced no "toughening up" of my tissue. I did try to rotate positions each
time we nursed.
Throughout most of this, I used two versions of breast pumps. During my
bout with thrush, the very strong X double pump gave me the worst wounds I'd
had, worse than M had given me. The integrity of the tissue was just so
compromised. (It may be possible to use this wounding from breast pumps as a
diagnostic tool for thrush in the future.) [As far as I can determine, the
thrush was self-diagnosed and reported as fact to all consultants.] The pumping
was always uncomfortable to some degree, and I hated it. I chose not to keep
pumping and giving her what I pumped.
Where am I now? I have decided to wean. It was a very rough decision.
After everything I'd been through, I thought I'd be able to work it out. We're
down now to nursing every 19 hours or so, and I'm trying to figure out how to
handle the last nursing. My breasts are in much better shape: the water can
hit them in the shower; I can almost lie on my side in bed; and, wonderfully,
I can hold my daughter close to me. Needless to say, I'm rather depressed about
weaning, but I'm absolutely convinced of three things. One, that I was very
courageous and wonderfully determined to give my daughter the best start I
could. Two, that I aggressively pursued any and all leads to improve my
nursing. And three, that weaning is the only reasonable option for me right
now.
I would have abandoned nursing totally by the third day if it were not
for the constant support and encouragement of my husband, who stood by me while
I traveled this difficult path. M was totally breastfed for her first month,
had some formula for her second month and was very slowly weaned during her
third and fourth month.
Always the optimist, I'm still hoping to hear about a magic wand. At
the very least , maybe my experiences can help others. I'm interested to hear
your comments, but please, no flames.
May your milk flow freely and your nipples remain intact.-- L K."
Kathleen B. Bruce, BSN, IBCLC, LLLeader, co-owner Lactnet, LLLOL, Corgi-L
LACTNET WWW site: http://www.mcs.com/~auerbach/lactation.html
Personal WWW page: http://together.net/~kbruce/kbbhome.html
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