From a recent consultation: mother and father and older brother come to
clinic with new baby.  Mother's only complaint is painful feeds.  Her right
breast is engorged and reddened, with a sore, abraded nipple, but no fever,
and milk flows readily on application of RPS followed by latching baby
asymmetrically, followed again by pumping twice the volume the baby got (he
was test weighed to demonstrate to mother that he was in fact transferring
milk - she had thought he needed supplementation because he has been fussy
after feeds on that breast, but he took an ounce and a half despite not
being really hungry on arrival).
They are from Iraq, but both children were born in Norway.  I asked whether
she had this problem last time - yes, and it never resolved.  They had tried
to get help, but none of the docs or health visitors they saw had any
suggestions for how to make the pain stop, so she just kept on.  I asked to
make sure, did it persist throughout the entire breastfeeding period?  Yes,
the entire TWO YEARS of it!  
I think she appreciated this consultation; actually I think the father
appreciated it nearly as much.  Especially the photos of how to encourage
asymmetric latch, from the UK National Health Service pamphlet, which I can
no longer imagine living without.
Rachel Myr
Kristiansand, Norway

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