Molly,
I think the mother has underlying infection all along. Possibly latent from
the last child. I think that perhaps there is latent infection in some
women's breasts and it flares with the next lactation.

All this pain and inflammation and now vasospasm are all related.
Therefore, I would recommend a nipple skin, surrounding areola, and then
clean catch midstream breastmilk cultures. At least the skin and then the
midstream. Her doctor could potentially consult with a doctor who does
breastfeeding medicine. Dr Anne Eglash comes to mind, who is on lactnet,
and has commented on this type of thing before. There are posts in the
archives. I had a client about a year ago who had Rothia? I'm trying to
remember what the bacteria was. She had a terrible time and ended up
partially weaning.
As for her immediate relief, I would recommend about 1-2 days of nipple
rest (express on low or hand express) and bottle feed in a bf-manner. Rest
as much as possible, eat well and hydrate. Pain relief with over the
counter meds (anti-inflammatory like naproxen). I think nipples do better
if out in air and light. Hopefully they will isolate the bacteria and then
the treatment might be several weeks. I do recommend the mother to take a
probiotic for gut health especially whenever she is on antibiotics. I don't
think it is thrush.
Laurie Wheeler RN MN IBCLC
MISSISSIPPI USA

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