Hello,
I have a client in Istanbul, Turkey who is complaining of painful breastfeeding at both breasts, left side slightly more pain. I have tried to help her to the best of my abilities, and the pain on her right breast is better, but the left breast is still painful and I am not sure what else to recommend her. I have very limited resources and help in Turkey (although supposed to be a very modern country) and all the other medical professions mom went for help have told her that she should continue breastfeeding even though its painful and that she'll get used to the pain!! So I feel my only resource is to post here for more professional ideas. 
Baby girl born Feb.26 vaginally, but mom was induced (water was broken per mom) at 39 weeks (mom doesn't know the reason) and then baby was delivered with forceps because the doctor thought the right shoulder was stuck and so its slightly damaged. Birth wt: 3.7kg, went down to about 3.1 kg but then back up to 4.08kg and 6 days later (yesterday at MD visit) is 4.2kg so in 6 days she gained some but very little. Stools are about once every 2 days. First 24 hours baby wasn't hungry so no food was given although mom says she had colostrum. In the begining she let baby sleep long hours at night, now feeds every 3 hours for about 20-40min on 1 side, next feed other side. Mom says yesterday at MD visit they checked the right shoulder of the baby and said its healing and don't think its related to BF pain. I'm not so sure, could it be related to more pain at left breast?
Mom has been painfully breastfeeding for 6 weeks and finally called the center I work with because she doesn't think breastfeeding should be this painful although doctors told her the opposite (including a 'lactation consultant' in a private hospital). Mom is emotionally having a very hard time because she so wants to breastfeed but its so painful she cries. 
So me the lactation counselor went to see her on Monday at her house. I started to observe a BF session, but baby was frustrated, very hungry, did latch but mom said its hurting while she was trying the cradle position, so I helped mom move into a lying down on her back position for mom to be more comfortable and baby lead the BF (I supported mom's back and sides with pillows) and she said pain was less in that position. I also noticed baby looks like mushed into the breast, was hard to see her chin and lower lip. So I recommended while baby is coming closer to breast to latch next time, try to pull down chin and lower lip slightly to promote a wide open mouth so lower lip is everted. Baby also occasionally making sounds like she was swallowing air and it seemed to me that its because either latch is not tight enough because of lower lip going inward or baby keeps slipping down the breast. So thats when I put pillows under moms arms to support her and baby a bit. I did see some swallowing but baby stayed sucking on R breast for quite a while and then seemed to stop sucking so I suggested try L breast with same position but there mom said it was painful although slightly less with the supine position and supporting pillows, but I made her stop and go back to R breast because was still painful. Baby fed mostly on R side for at least 30min (I forgot to check time). Then I examined baby's mouth, seemed small, but hard for me tell if unusually small, I asked mom to put her finger in baby's mouth slightly so I can see the response. Baby didn't seem to open mouth too wide and I didn't see the bottom of tongue so not sure if frenulum is a problem. Moms breasts, nipples look normal to me, no redness, no shiny surface that could indicate thrush, but she said she developed an eczema on her L breast, top of areola since BF but dermatolgist says its ok probably was because mom was washing her breasts a lot to keep them clean. I told her she doesn't need to do that and if she wants to put anything on them just to use her own expressed breastmilk. She says she pumps some days because breastfeeding too painful and to store some milk but has only given breastmilk in bottle 1-2 times so far, but today said pump isn't working anylonger so just BF. She was using breast shells inbetween feedings because after feeding nipples hurt. I suggested she air dry her nipples and wear soft relaxed clothing but shells are ok if she's more comfortable with them.
Mom tels me there is pain during BF (slightly towards lower part of nipple) but also another pain inbetween feedings that comes and goes which she desciped as burning, itching, needle like, swelling. This made me think of thrush or a probable start of an infection, and infrequent stools with slow weight gain also concerned me, but since she said the supine position lessened pain while BF I recommended her to BF that way and also lying on the side position for a day, detach if any pain and start latch again maybe slightly pulling chin and lower lip down to promote wider open mouth. Also, I told her about the early hunger signs and to try to feed then, but also not to let more than 3 hours pass inbetween any feeding, for her to express her breastmilk and put on nipple and areola to help healing since its hurting and to spend more time skin-to-skin with baby. 
Then, today about 2 days later we spoke on the phone, she tells me R breast is better but L breast still very painful but she's still trying to feed there too. Still has the other pain inbetween feedings. So, I'm not sure if its because of baby's R shoulder that isn't allowing her to latch well on L side or if its something else or an infection. I don't think its thrush although the pain she descripes suggests that but how can that be only on L breast now? I couldn't observe much of latch on L side because it was so painful for mom. This time I told her to BF on R and next feed try L but if painful to go back to R side and then express milk from L side with warm compresses and massages to keep stimulating milk flow until its healed and ready for a latch again (its not engorged but its painful).
I don't know what else to tell her and I can't refer her to anyone here since I don't know anyone who has more knowledge or experience than me about BF and the pediatrician is saying get used to the pain. If baby doesn't gain adequte wt by next months visit the doctor probably is going to recommend formula which I hope doesn't come to that point. I can go and visit mom again but I'm not sure what else to look for, I'm not so experienced with unusual anotomical mouths or jaws after working in a US WIC clinic, so this may be my first.
Any help, ideas, recommendations is very appreciated. Thank you so much!
Eda

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