Sharing with permission:
Primip hired me at 7 months postpartum with the following history
Spontaneous vaginal delivery
Babe to breast within 30 minutes post delivery
Painful feeds from first attempt
Broken down nipples x's one month
Sore nipples x's 8 weeks
Never totally painfree
Thriving large babe with great weight gain since birth
Once teeth erupted, feeds became very painful again and she contracted me.
On my exam I found a big active alert child
During feed babe was extremely active and aggressive
Kicking feet and pushing arms against mothers chest
Poor positioning at breast with babe turning his head to feed, over shooting the nipple and chin on chest
Repositioning and working on getting a wider gape and tipped back head decreased but did not eliminate the discomfort for this mother
Nipples intact, slightly red, Montgomery tubercles enlarged and red. Nipples do not look infected or "thrushy " though I did cover treatment for these possible causes for her pain
Upon exam, babes mouth revealed a lip tie and possible tongue tie. Had trouble flanging upper lip
Dr suspected raynauds syndrome though I saw no evidence of this
My recommendations were:
Work on improving positioning and obtaining deeper latch
Consider CS therapy for mouth ties
Have local dentist proficient in assessing and treating tight mouth frenulums see baby
Limit cool air hitting nipples post feed to discourage vasospasms
Babe was assessed and found to have class 3+4 mouth ties which were revised by laser
Stretching exercises, chiropractic care and CS therapy followed revision on ties
Immediate improvement in latch and comfort during feeds but never became pain free
A few weeks post revision babe became very fussy, eating less solids, fighting the breast during the day and increasing night feeds.
Mother contacted me at 10 months pp c/o babe chewing at her nipples during feeds and very painful feeds once again with babe sliding off breast during feed. This change occurred after babe became ill with a virus. States he is so big and strong she has trouble modifying his positioning and latching at breast. Moms sternum feels bruised from babe hitting her during feed
Mother really wants to breastfeed for at least a year but is very discouraged with her whole painful challenging breastfeeding experience
Summary:
Painful breastfeeding x 10 months
Big thriving healthy babe
Fights at the breast with less than optimal latch
Revised lip and tongue ties with some improvement in latch with frequent regressions
Look of nipples and degree of pain do not match up

Have offered f/u visit but wanted input from this site first

Thank you in advance from any insight you might have


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