Dear Lactnet subscribers
Permission to post. Please need advice and feedback. Term baby. SVD gas, morphine 30 mins prior to delivery, about 20 min second stage, first baby. SSC after birth. 
History prior to pregnancy touching nipples 'not pleasant' In the cold nipples always became erect when exposed. Mothers mum(maternal grandmother) still has sensitive nipples in the cold when rugged up. No history of cold hands or feet for Mum. History nipple piercing 17 years on Left nipple , stated removed not long after piercing. Tract still patent as milk squirts out tract when expresses. M States nipple sensation same to touch on both nipples. Baby had bottle and dummy in the first week.No history of vaginal thrush or IV AB'S. 
Baby now 4 weeks of age. History of sore nipples for one week when first had contact with M and B last week. Initially was the Right nipple damaged white tip after feeding, got better then went to L nipple.(L nipple had been 'blue' on occasions but no triphasic changes.  A heat pack through M clothes relieved painful nipple.
Baby no signs of thrush on examination. Nipples not red or itchy.Pain burning stinging pain through feed and in between. Occasional shooting pain but not into back. Feels letdown more stinging and intense than was.  Last week I suggested M treat herself and B  for thrush. Made suggestions to improve positioning and attachment skin to skin feeds, baby led attachment,  thought occasional change in colour was due to nipple vasospasm from insufficient breast tissue in baby mouth. Mum wanting to give up breast feeding due to pain of feeding and in between feeds hovers between 5 out 10 to 7 out 10. Baby elevated tongue well,can poke tongue past lips but does not gape widely. No evidence tongue tie.  Mum feels baby does not flange lower lip and baby feels as though at times rolling nipple in mouth. 
Mum used Daktarin gel on nipples  for three days and then ceased had some initial improvement after 24 hours. Didn't treat B as Gp stated no need to and she didn't think B had thrush. Suggested a nipple shield on the sore L nipple.
M then consulted  another Lactation Consultant who suggested using a nipple shield on L nipple and that baby has a labial frenulum continue to work on positioning and attachment. Mum commenced this last night.
Today reviewed baby. Last week baby was 558gms above birth weight. In six days has gained 110gms but at I month age is still 778 gms above birth weight. Vertical crease evident on R nipple after feed today and minimal gape for nipple shield feed on Left. Discussed again re improving attachment M now states pain in both nipples burning stinging through feeds and in between feeds and considering weaning. Describes as burning sensation with sucking. Can't tolerate touching nipples or shower water on nipples. 
I am still inclined to think this is thrush Mum not wanting to treat. Would really appreciate  input/ advice
Many thanks
Kind regards 
Netty

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome