Pat, in cases of persistent, intense breast pain (not nipple pain), which is all through the breast, among all the other investigations I'd ask if these is a history of a spinal injury. With different posture in late pregnancy and then a labour, old back problems can be stirred up. Remember, the enervation of the breast comes off the spine. Sometimes, however, there can be referred pain, when the old injury is in a different part of the spine. When I find there is an old spinal injury that seems to be associated with overwhelming breast pain, I send the mother back to whoever was treating her pain prviously - her GP, pain clinic, physiotherapist. Once the underlying injury is addressed, we can work on improving breastfeeding.
I'm not saying this is the case with your client, but asking about soinal history is a useful course, even if only to eliminate it.

Virginia
In Brisbane, Queensland, Australia
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Pat Young wrote:
      One of my fellow APNs is looking for advice.  I will forward answers to her.   
      One of my coworkers is working with a mom who just had her third baby; the two older children are 3years and 11months.  She started breastfeeding with each child but quit after about a month due to persistent breast (not nipple) pain throughout every feeding.  Similar pain is present with this baby.  She describes it a knife-like, sharp pain throughout the breast from the time of latch until the feeding is complete.  She does not have white nipples, flattened nipples, etc. when the baby comes off the breast and no cracks or blisters.  She worked with several different LCs with the first 2 children but never was able to solve the problem and gave up after about a month due to pain.  She would like to breast feed this baby but is already experiencing similar pain (day 4 after birth).  She has normal appearing nipples and fairly large breasts.  We are trying supporting her breasts more during feeding thinking it might be ligament or connective tissue pulling that is triggering pain.  Anyone with any other thoughts or experience with this problem.  It occurs  in both breasts.  If anyone has any thoughts or ideas, please let me know.   Thanks.

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