Mom of an 8 month old came to see me today.  For the last few months she has
had a painful left nipple.  The baby stopped nursing on the right breast
early on in the lactaton course.  She has been happy to nurse exclusively on
the left side.  This baby has just started on solids but loves to nurse.
This nipple soreness came on suddenly, nipple cracked in the center and ever
since she has experienced burning, itchy, electric shock pain in that
nipple- sometimes excruciatingly so.  The burning will last a while after
nursing and hurts to one degree or another throughout the day.  For the last
few months she has gone to her OB and one midwife for help to no avail.  On
a recent visit to another midwife in the practice who called me, we started
on a yeast infection treatment course.  Diflucan, Nystatin for baby, topical
med for mom too plus cleansing the nipple area with vinegar and water,
boiling toys, pacifier etc.  Baby has used one for quite a while.  Baby at
one point had a yeasty diaper rash which went away- no oral thrush or
gassiness.  Baby does pull on and off during a feeding.  She doesn't eat
dairy products because the baby gets stuffy, crusty eye drainage. She
started this treatment 7 days ago. Last wed. she experienced a mastitis
episode.  Fever, streaking in the upper outer quad of the breast.  Area was
full and firm to touch.  She was prescribed an antibiotic and seen by the
midwife.  Later that day, her breast hurt so badly she went to the ER.  Her
OB referred her to a surgeon who looked at her breast, gave a lot of hmmms
which scared her to death- she thought she had CA or something.  Anyway, his
thought was an abcess and he did incise and drain that area.  Nothing grew
on culture, there was no drain left in place.  There was never any defined
firm lump.  No nursing until office visit he said but after 2 days she
could'nt take it anymore and nursed the baby.  The OB today said the breast
looked fine(incision healed ) but she'd have to stop nursing or she'd wind
up in the same boat again.  She told him forget it and it wasn't that easy
because nursing was important to both of them.  She even noticed a change in
the baby's behavior when she stopped for those two days.  I saw her for the
first time today, the center of her nipple is cracked.  The baby latched and
nursed fine from what I could see except the on-off thing.  Mom had a lot of
burning afterwards- no change in nipple appearance during this or after the
nipple came out of baby's mouth.  I was incensed that this mother has gone
through all of this needlessly-for months!!!!!!!!  Then to have her breast
cut!  Are we on the right track with the yeast idea?  Any other suggestions
would be greatly appreciated.
I told her to watch that area that got red before, to massage and use heat
to help with drainage and position the baby differently to aid with drainage
too.  She doesn't want to stop breastfeeding and after seeing and talking to
her, I want to do all I can to help her out.

Thanks, Laura Walker RNC, IBCLC ([log in to unmask])