Hi All,
I have been working with a mother who has not had a single pain free feeding
at 7 weeks post delivery!  She has given permission for me to post her case
in hopes of getting relief.

Delivery at BFHI Birth Center with CNM, IBCLC.  NSVD, unmedicated, no
complications, baby apgar 8/9  Weight 8# 9oz, nursing well by 30 min,
continued on cue feeds through 12 hour stay.

Follow up has been complicated by having no insurance and living far out of
town with limited transportation.

Home visit at 60 hr baby nursing on cue every 1 1/2-3 hrs 5-25 min, weight 7
# 15oz.  Mom with bilat nipple damage.  Left with peeling scab, Right with
small crack at tip, slightly red.  Started Lanolin, worked to improve latch
and hold.

Phone Follow up 24 hours later (day 4) Milk not in baby has not had BM since
day 2.  Nipples remain painful but maybe healing

Day 5 Weight check, 7 # 9oz, still no stool, cont with sore nipples, damage
appears to be healing, to peds office.  Babe supplemented with 20 mL
formula, home with pump and supplement plan.

Day 6 2am, phone call from mom, milk is in!
Day 6 Home Visit Weight 7# 13.5oz, still no stool.  Cont with sore nipples,
left healed.  Latch appears normal, nipple shape post feed normal, adjusted
position for greater comfort, cont with soothies/lanolin and careful
attention to latch.

Day 7 to peds, still no stool, Ped stimulated for lg yellow stool.

Day 8 Phone follow up, no stools since yesterday at peds office, complaints
of perineal pain with switch from tylenol to ibuprofen.

Day 10, babe "marathon" nursing moms breasts feel bruised, no visible tissue
damage.

Day 11  Weight check 8# 7.6oz, 10 oz gain in 6 days, feeding well, many
stools, voids, milk fully in, discontinue supplement.  Nipples painful,
right with diagonal slice above and outside nipple started 2 days ago, using
soothies will use apno if not healed in 48 hrs.

Day 12 Phone call from mom reporting continued nipple pain, reviewed
alternate positions, latch, plan visit tomorrow.

Day 13 Started APNO

Day 15 Phone assessment.  Continued nipple pain, not during but post feeds
and now bilat.  Not sure if Crack on Right is healing.  Maybe sees white
patches in babes mouth.  Babe otherwise feeding well, gaining appropriately.
Treat mom and babe with Gentian Violet 1% every other day X 3.  Discussed
thrush prevention.  Continue APNO

Day 17 Weight check 9# 2.5oz, excellent gain.  Slight decrease in pain with
GV treatment, will continue.  Once again adjusted position, tends to hold
babe loosely so that she slides off nipple by end of feed.  Digital
assessment shows babe with nice rhythmic suck with borderline tongue
excursion, tongue is visible during feeds, latch looks perfect.

Day 20 Pain had been decreasing but now is increasing again, 2nd GV
treatment started, to continue with APNO. Review thrush handout, prevention
and treatment.  LC GONE TO ILCA!

Day 23  Continued pain, calls with more questions re: yeast and treatment
options.

Day 31  Weight Check 10 # 6.8 oz.  Cont to have pain with feeding mostly
during feeds and after feeds, white tips on nipples after feeds, appears to
be loose waterlogged skin, does not look like Raynaud's at all.  Nipples
appear red, irritated without damage except for a small opening (like a
puncture wound) above right nipple.  Now has shooting pains in breasts
especially after feeds or when chilled.  Once again assessed latch and hold,
baby suck, all appear normal.  Discussed Diflucan, cost is an issue.

Day 32 started Diflucan Treatment 400mg loading dose, 200mg qd x7 days with
2 7 day refills.
Has continued all along with ibuprofen for pain relief.

Day 35  Thought she had some relief after 24 hours of Diflucan but still
just as bad now, wound on Right nipple remains unchanged, started GV tx for
self and baby.

Day 39  Felt a little better yesterday, tried skipping ibuprofen dose, pain
excruciating by bedtime.  Started Dicloxicillin 500mg q 6hr X 10 days.

Day 42 Very slight improvement in pain but so hard to tell at this point.
Will continue ibuprofen and Dicloxicillin through weekend and reevaluate at
6 week check up.

Day 45  TODAY!  Any ideas for this poor mom?  She will be in on Wednesday.

Thanx for your help, sorry this is so long.
Janie Akerlund RN IBCLC
Nurse-Midwifery Birth Center
Eugene, Oregon USA




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

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

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