Hi - thanks for all the great detail.  

My first thought is to stop the APNO - it doesn't seem to be helping and thus could possibly be hurting.  I have generally follow the rule that it is not a good idea to use APNO beyond two weeks because of the steroid's possible impact on nipple skin.  

If Mom is experiencing vasospasms, rinsing nipples after a feed could make that worse.  Perhaps also discontinue nipple rinsing and instead apply dry heat following all feeds / pumps.  

What sort of pump is Mom using?  Has appropriate pump fit and technique been assessed?  

Ellen

Ellen J. Rubin, MA, IBCLC, LLLL (who will soon be moving to NZ for 7 months!)

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