I saw a mom/baby couple today at mom's six week postpartum check up. Babe was born 2/23/05 at 36 1/7 weeks. Mom was induced due to severe pre-eclampsia, and baby was born vaginally. Baby was small, 5 lbs 11 oz, but fairly aggressive from birth. However, she tended to fatigue easily with feeds (not surprisingly) and mom initially pumped to maintain supply and fed some expressed milk as supplement. Even with that, baby had an inital large weight loss of about 1 lb, then started to gain. At six weeks she is about a pound over birth weight (6 lbs 12 oz) but really her weight gain has been adequate since she started to gain, averaging just under 1 oz a day. Baby initially also did some feeding at breast with a nipple shield, which did improve her transfer, but she wasn't crazy about it. The problem now is that mom has developed very sore nipples. She had some initial nipple soreness which disappeared at about 1 week of age. Around 3 1/2 weeks she noticed return of soreness. The pain is in both nipples, right more than left, and does not get better throughout a feeding. Pain is a little better with pumping, but mostly mom thinks this is because pumping is faster. She describes a feeling like the skin around the base of the nipple is cracking open with each feed. She has no deep breast pain. On exam, her skin appears undamaged, but her nipples are bright pink, and especially around the base are sore to touch. Her nipples are on the flatter side, but certainly not inverted. Baby has no evidence of thrush, and mom also with no complaint of vaginal yeast symptoms. Mom was treated for a vaginal yeast infection during late pregnancy. Initially, we tried some APNO, and she thought it got a little better, but the last week it has been getting worse again. Mom is getting frustrated and thinking about weaning if the pain doesn't get better soon. I have her trying ibuprofen, continuing the APNO, and started her and the baby on Diflucan today. The baby was sound asleep at today's appt. and would not awaken to latch properly. She did latch briefly, and mom is using football hold with a nice looking assymetric latch. However, since baby would not really suck, I'm not sure she's not slipping down once she starts to feed effectively. Mom has been almost exclusively pumping and feeding pumped milk in the last 3 days. What do you think? Yeast? Something else? What else can I recommend? Jennifer Tieman Family Physician Mom to 4, including my toddler nursling Caroline Rose *********************************************** 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(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html