Hi, fellow 'netters.

I received a call this afternoon from a former LLL Leader whose 20 yr old
daughter has a 9 week old baby. Apparently birth was okay, but baby sucked lower
lip in during early breastfeedings, resulting in sore nipples that were "laid
open" and raw. They retrained baby to keep the lip out, but one nipple has yet
to heal properly and looks as if the bottom half is gone. (How many of you just
crossed your arms reading that??) "All" the standard nipple healers were used
(lanolin, vitamin E in small amounts, leaving shirt open, etc) to no avail.
Mom was working with hospital LCs, apparently.

Mom had a couple of bouts with vaginal yeast infections during pregnancy so they
suspected a yeast infection. She tried otc creams (Lot-----) and eventually got
nystatin for both mom and baby. (oral for mom, drops for baby)

Meanwhile, at 2 weeks postpartum, mom had first of 4 breast infections on the
side with the worst raw nipple. MD prescribed one round of an antiobiotic (not
sure which one) and since she quickly developed another one, switched her to
augmentum. MD said mom could expect "many" infections because she has thin skin
and is generally pale and so gave her 4 prescriptions of the augmentum to have
on hand. The augmentum seems to do the trick for the breast infections, but the
nipple soreness has increased.

Mom has resorted to using a soft breast shield on the right (most sore) side,
and has been pumping. (She tentatively plans on going to school in 3 weeks.) She
has used formula some, much to dismay of mom and grandma, but felt there was no
other choice. (As I type this I just remembered the warnings not to freeze milk
suspected to be infected with the yeast....) Formula feedings have been by
bottle using the Av--- nipple, and mom uses pacifier to hold baby off. Baby
feeds every 1-2 hours, a longer stretch at night, typically feeds from one
breast per feeding.

"Occasionally" (sometimes once a day, sometimes twice, sometimes not at all)
when baby latches on to the nipple shield, blood gushes and fills the shield.
The blood flow subsides fairly quickly--as if this is draining a pool of blood.

Baby is gaining okay--7 lbs, 5 oz at birth; over 11 lbs at nine weeks. No signs
of thrush in baby, either end.

Mom is cutting back on sugar in diet.

This case raises a number of questions in my mind and I am hoping for some input
from the collective wisdom here on Lactnet.

1. Where do you start when nipples are raw, yeast is likely, and mom is having
continual mastitis?

2. Can something like the difulcan be given at the same time as the augmentum?

I might also add here that mom is large breasted, and grandmom is sure that
positioning is not a problem. (I suggested they check baby for short frenulum.
Baby can at least get tongue to the lower lip, they believe.) I suggested she
try using a sling to support the breast.

She mentioned seeing Dr. Crook on TV the other day talking about his new book so
I gave her his phone number to get input from him.

I did not talk to the mom directly but grandmom was asking her questions I
asked. Grandmom seems very supportive and concerned, and being a retired LLL
Leader knows more than many grandmothers! It has been 10 years since she was
active, though, so some of her information is dated. She recognizes this.

Any ideas? I know yeast has been batted around a lot here before, and I suspect
it will continue to be. Any help will be appreciated! (I have the new LC series
and am in the middle of reading it as well.)

Thanks, and sorry for the length of this post. (At least it isn't crazed
ramblings from my soap box!! :-) )

Melissa Vickers, IBCLC
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