I learn something new every day!

Yesterday, in our WIC LC office, we saw an experienced mother, one who in
fact has even tandem nursed with older siblings. She brought her five
week old baby in so we could watch him nurse.

Her complaint was terribly tender nipples, especially on one side, with
pain radiating upward in the breast. We saw no obvious skin damage on her
well-everted nipples, but did note that manual extraction was also
somewhat painful for her.

Because of the symptoms, it was tempting to suspect it might be yeast,
but there was nothing suspicious in either the baby's mouth, or on the
mother's nipple.

But her obvious pain, of a nature which she said she had never had with
any of her other nursing experiences, kept us inspired to continue
exploring. Thinking she had grown accustomed to the relaxed nursing
habits of extended nursing with several, we first assumed it was simply a
matter of improving the latch, so we did the usual things with pillows,
cinching his bottom in close, etc.

At first glance, he looked to be well latched, until we tried to inspect
for flanging of the lower lip and cupping of the tongue. We could see
neither, but we could hear swallowing. The nipple did not look damaged or
misshappen when it came out of his mouth, but the mother was obviously
curling her toes much of the time.

We checked his frenulum, and his lower labial frenum, and both appeared
normal. A suck check revealed a bubble palate, (the first I have ever
felt) and a somewhat disorganized suck with the tongue bunching up
halfway through every suck rather than staying extended over the lower
jaw, whose chomping was obvious and strong on the examining finger.

We went on to suggest gentle finger-on-the-lips games, along with using
her mouth to mimic the wide open lips she wanted him to attain, along
with a few suggestions about suck training she might try.

The mother had covered her breast back up while we were explaining what
we were talking about, and suddenly, her attention was distracted by her
nipple beginning to sting, and the pain seeming to "echo" up several of
the ducts.

She again drew the breast out of her bra, and there, textbook perfect,
the surface of her nipple suddenly had an irregular 0.5 x 0.5 cm area of
blanching going on. We all sat and just peered at the nipple, and after
60-90 seconds, it was suddenly pink again and the stinging was gone.

We asked her to leave it in view, and 3 more times within about 5
minutes, the same area again blanched for 60+ seconds, accompanied by
stinging pain in the nipple and "echoing" up several ductal pathways that
she could trace with her finger, which stopped when the blanching
stopped!

She was so relieved to find out that there was something specific we
could point out was going on that she could discuss with her HCP. We
suggested she could use a hot washcloth applied to the nipple whenever it
blanched, as an interim pain relief method.

We provided references on the phenomenon and it's treatment, from both
Lawrence, and R & A, along with a written explanation of what all we had
observed, so she could take it along when she saw her midwife.

It will be interesting to follow up with a phone call and find out what
happened. It is SO INTERESTING to actually observe things I have only
read about up to now! There is always more to learn.

Jean
****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html