Hello, Janet.
       Here are some thoughts about this mother's situation, not necessarily 
in order:
First, even if she can't find a reason/solution to the pain in the left 
breast, she could decide to breastfeed only from the right breast, since that one 
works well and is healthy.  She *doesn't* need to completely wean over this.
       That said, here are some other ideas to explore:
Since this occurs primarily at night feedings, and there is blanching of the 
nipple which might be an indication of clamping, is the baby lying differently 
(slightly different position) when mom nurses on left than when she nurses on 
right side?  Maybe he can't move his jaw as deeply, or doesn't feel as well 
supported so he clamps for support?  Or does she leave the baby on the same 
side of her all night and just "aim" the chosen breast towards the baby?  Some 
mothers don't move baby from one side of mother's body to the other during the 
night, but instead leave baby on one side and kind of lean over more when they 
want to offer the "top" breast.  This might be causing baby to change his 
angle of approach (latch-on) enough to be causing damage to only one breast.  It 
might not be the "top" breast.  If mother is large-breasted and her nipples 
point toward her elbows rather than straight ahead, it could be that the "bottom" 
nipple (as mom and baby lie side-by-side) is aiming into the mattress and 
baby has a hard time keeping it in his mouth correctly.
       I have run into a mother who had thrush in only one breast.  We 
couldn't conquer it until I finally had her into the office and observed a feeding.  
It turns out that baby couldn't turn his head well to one side, so he could 
nurse just fine on one breast, but kept damaging the other one.  His constant 
abrasion of the one nipple broke the intregrity of the skin on only the one 
nipple (intact skin is first-line defense against infections), so she had thrush 
only in one breast.  A couple of visits to the pediatric chiropractor solved 
the baby's neck stiffness, and hence solved mother's thrush (with appropriate 
medication that could finally work since the damage could heal).
       Just a few ideas.
       Dee

Dee Kassing, BS, MLS, IBCLC, RLC 
Collinsville IL, in central USA

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