Guest guest Posted May 4, 2011 Report Share Posted May 4, 2011 Hey wise women, I have a case that is causing me to scratch my head and I wondered if anyone else might have some suggestions. I have a client whose 5w old ds is going to be evaluated for posterior tongue tie next week, but meanwhile mom has switched to exclusive pumping because the pain from baby's excessive pressure and suction is too painful. Now she says that pumping is excruciating as well. This is her fourth baby so it's not the first time she's used a pump or breastfed. She's using a Symphony on the lowest suction settings but still gets irritation on the areola. I fitted her for 21mm flanges but she has since dug out her 30mm flanges because they don't touch her areola (she has a smaller than average areola) and she finds them to be more comfortable. Her nipples turn purple after pumping, understandably, and the only way she gets any amount of milk is if she uses pretty firm breast compression and massage while she pumps, as shown in the Stanford video. She just finished a round of Dicloxacillin a few days ago, which seems to have improved her nipple soreness, but she's still VERY sensitive. She stopped using APNO last week, in case an ingredient in it could be exacerbating symptoms; she didn't see an improvement when she started the cream and has seen no improvement since discontinuing the cream. She's allergic to wool so Lansinoh is out of the question. Right now she isn't using any kind of nipple cream but she's manually expressing milk to massage into her nipples, and is using salt water soaks about four times a day. Today I instructed her on Genna's tongue exercises to encourage baby to use less posterior pressure, but she's scared to offer baby breast until she's completely comfortable and baby has been seen by specialist about his tongue. Am I missing something? Fish oil? Vitamin E? She has burning and pain but no itching; baby shows no signs of thrush. Since reading Hale's info on thrush I don't think that's what we're dealing with, and the APNO should have improved things if it was. I've never met a mom who's so sensitive, and this is something VERY new to her. Any suggestions would be greatly appreciated. Thanks so much! Debbie Gillespie, IBCLC Tempe, AZ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2011 Report Share Posted May 4, 2011 I had one mom who was extraordinarily sensitive, but she’d had the same issue with her first two babies too. we never completely figured it out :/ have you evaluated her for vasospasm, though? I might try the various treatments for that, including, possibly, nifedipine, if she seems to have the history/symptoms. does it hurt during pumping or after? more during nursing or right after? the classic is pain after, but I have had moms for whom it hurt more during as well. tina smillie also has a good handout on nipple pain. I think I uploaded it to this group a few years ago, but can’t look at the moment...if I recall she uses different antibiotics and topicals than what’s typically in the apno and also, it might be worth looking at her nipples and areola under a powerful magnifying glass to see if you can see microfissures, scaly, cracked skin, or anything else notable. lyla Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2011 Report Share Posted May 4, 2011 personally, I hate the symphony for lots of reasons. one reason is that for some women it is quite painful--the suction too strong. you might try another pump. pump in style or hygeia rental pump. just a thought... also, olive oil on the flanges is a great trick that can make less friction for mom. I've had moms who's experienced this, for sure. the first help was to get rid of the symphony! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comBreastfeeding Between the Lines: http://second9months.wordpress.com/Facebook: www.facebook.com/thesecond9months--- Subject: Too sensitive nipples?To: Date: Wednesday, May 4, 2011, 1:05 AM Hey wise women, I have a case that is causing me to scratch my head and I wondered if anyone else might have some suggestions. I have a client whose 5w old ds is going to be evaluated for posterior tongue tie next week, but meanwhile mom has switched to exclusive pumping because the pain from baby's excessive pressure and suction is too painful. Now she says that pumping is excruciating as well. This is her fourth baby so it's not the first time she's used a pump or breastfed. She's using a Symphony on the lowest suction settings but still gets irritation on the areola. I fitted her for 21mm flanges but she has since dug out her 30mm flanges because they don't touch her areola (she has a smaller than average areola) and she finds them to be more comfortable. Her nipples turn purple after pumping, understandably, and the only way she gets any amount of milk is if she uses pretty firm breast compression and massage while she pumps, as shown in the Stanford video. She just finished a round of Dicloxacillin a few days ago, which seems to have improved her nipple soreness, but she's still VERY sensitive. She stopped using APNO last week, in case an ingredient in it could be exacerbating symptoms; she didn't see an improvement when she started the cream and has seen no improvement since discontinuing the cream. She's allergic to wool so Lansinoh is out of the question. Right now she isn't using any kind of nipple cream but she's manually expressing milk to massage into her nipples, and is using salt water soaks about four times a day. Today I instructed her on Genna's tongue exercises to encourage baby to use less posterior pressure, but she's scared to offer baby breast until she's completely comfortable and baby has been seen by specialist about his tongue. Am I missing something? Fish oil? Vitamin E? She has burning and pain but no itching; baby shows no signs of thrush. Since reading Hale's info on thrush I don't think that's what we're dealing with, and the APNO should have improved things if it was. I've never met a mom who's so sensitive, and this is something VERY new to her. Any suggestions would be greatly appreciated. Thanks so much! Debbie Gillespie, IBCLC Tempe, AZ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2011 Report Share Posted May 4, 2011 Debbie,Does this mom have s/s vasospasm? Any other Hx of inflammatory issues (which can exacerbate nerve related pain)? Cole Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2011 Report Share Posted May 5, 2011 Thanks for all the suggestions, ladies. The purple nipples happen only during pumping so I don't know if that would be considered Raynaud's. Her biggest complaint is the pain and irritation on her areola, which wouldn't be Raynaud's-related, would it? Oh, and I suggest olive oil on the flanges to all my clients, but she reported it gave no relief. I'm going to suggest she try the new Platinum. Any more ideas would be welcomed. Thanks in advance! Debbie Gillespie, IBCLC Tempe, AZ > > Hey wise women, > > I have a case that is causing me to scratch my head and I wondered if anyone else might have some suggestions. I have a client whose 5w old ds is going to be evaluated for posterior tongue tie next week, but meanwhile mom has switched to exclusive pumping because the pain from baby's excessive pressure and suction is too painful. Now she says that pumping is excruciating as well. This is her fourth baby so it's not the first time she's used a pump or breastfed. She's using a Symphony on the lowest suction settings but still gets irritation on the areola. I fitted her for 21mm flanges but she has since dug out her 30mm flanges because they don't touch her areola (she has a smaller than average areola) and she finds them to be more comfortable. Her nipples turn purple after pumping, understandably, and the only way she gets any amount of milk is if she uses pretty firm breast compression and massage while she pumps, as shown in the Stanford video. > > She just finished a round of Dicloxacillin a few days ago, which seems to have improved her nipple soreness, but she's still VERY sensitive. She stopped using APNO last week, in case an ingredient in it could be exacerbating symptoms; she didn't see an improvement when she started the cream and has seen no improvement since discontinuing the cream. She's allergic to wool so Lansinoh is out of the question. Right now she isn't using any kind of nipple cream but she's manually expressing milk to massage into her nipples, and is using salt water soaks about four times a day. Today I instructed her on Genna's tongue exercises to encourage baby to use less posterior pressure, but she's scared to offer baby breast until she's completely comfortable and baby has been seen by specialist about his tongue. > > Am I missing something? Fish oil? Vitamin E? She has burning and pain but no itching; baby shows no signs of thrush. Since reading Hale's info on thrush I don't think that's what we're dealing with, and the APNO should have improved things if it was. I've never met a mom who's so sensitive, and this is something VERY new to her. Any suggestions would be greatly appreciated. Thanks so much! > > Debbie Gillespie, IBCLC > Tempe, AZ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2011 Report Share Posted May 5, 2011 I would really consider the mother's nutritional status in this case. I would start with coconut oil on her nipples and in the shields when she pumps, add zinc and vitD as an cute treatment (get her D levels checked), look at removing pro-inflammatory foods from her diet and increasing anti-inflammatory foods. The homeopathic cell salts calc fluor and silica would be probably be extremely helpful. And probiotocs since she used abx, which I doubt she ever needed. Tow, IBCLC, France > > Hey wise women, > > I have a case that is causing me to scratch my head and I wondered if anyone else might have some suggestions. I have a client whose 5w old ds is going to be evaluated for posterior tongue tie next week, but meanwhile mom has switched to exclusive pumping because the pain from baby's excessive pressure and suction is too painful. Now she says that pumping is excruciating as well. This is her fourth baby so it's not the first time she's used a pump or breastfed. She's using a Symphony on the lowest suction settings but still gets irritation on the areola. I fitted her for 21mm flanges but she has since dug out her 30mm flanges because they don't touch her areola (she has a smaller than average areola) and she finds them to be more comfortable. Her nipples turn purple after pumping, understandably, and the only way she gets any amount of milk is if she uses pretty firm breast compression and massage while she pumps, as shown in the Stanford video. > > She just finished a round of Dicloxacillin a few days ago, which seems to have improved her nipple soreness, but she's still VERY sensitive. She stopped using APNO last week, in case an ingredient in it could be exacerbating symptoms; she didn't see an improvement when she started the cream and has seen no improvement since discontinuing the cream. She's allergic to wool so Lansinoh is out of the question. Right now she isn't using any kind of nipple cream but she's manually expressing milk to massage into her nipples, and is using salt water soaks about four times a day. Today I instructed her on Genna's tongue exercises to encourage baby to use less posterior pressure, but she's scared to offer baby breast until she's completely comfortable and baby has been seen by specialist about his tongue. > > Am I missing something? Fish oil? Vitamin E? She has burning and pain but no itching; baby shows no signs of thrush. Since reading Hale's info on thrush I don't think that's what we're dealing with, and the APNO should have improved things if it was. I've never met a mom who's so sensitive, and this is something VERY new to her. Any suggestions would be greatly appreciated. Thanks so much! > > Debbie Gillespie, IBCLC > Tempe, AZ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2011 Report Share Posted May 5, 2011 Second the idea of lubricating the flanges, and trying the larger size. Could the Pumpin' Pals flange shape possibly eliminate that pressure point where the cone angles into the tunnel? I was surprised to hear that you've observed the Symphony as potentially more painful than the other pumps mentioned, My understanding was the the PIS or the Purely Yours reaches the same suction level, but the bigger motor of the rental pump seems to have a smoother suction curve, which I've had many mothers describe as smoother and gentler on their nipples. Nature did not plan ahead for pumps, so it does seem that mothers have these very individual reactions. Women do seem to vary widely on how sensitive their nipples are (since sometimes I'm blanching and wincing over what the baby is doing at the breast, and the mother is just chatting away). But for it to be described as " excruciating " seems like something else is going on. With the nipples turning purple and the description of pain as " burning, " could their be some level of vasospasm? Has she tried warm compression both before and immediately after the pumping sessions to see if keeping the circulation high helps a little. Does she have any history with fibromylalgia? Margaret Wills, IBCLC > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2011 Report Share Posted May 9, 2011 This might apply to the mother Lyla worked with, though probably not to the mother Debbie is working with. I have seen that mothers who have suffered previous sexual abuse often feel severe nipple pain, even when baby is nursing correctly. I think it is a physical reaction to emotional trauma, and wonder if some of the mothers who don't report abuse perhaps have blocked the memory of it, but their body still reacts. Dee Kassing Subject: Re: Too sensitive nipples?To: Date: Wednesday, May 4, 2011, 11:38 AM I had one mom who was extraordinarily sensitive, but she’d had the same issue with her first two babies too. we never completely figured it out :/ have you evaluated her for vasospasm, though? I might try the various treatments for that, including, possibly, nifedipine, if she seems to have the history/symptoms. does it hurt during pumping or after? more during nursing or right after? the classic is pain after, but I have had moms for whom it hurt more during as well. tina smillie also has a good handout on nipple pain. I think I uploaded it to this group a few years ago, but can’t look at the moment...if I recall she uses different antibiotics and topicals than what’s typically in the apno and also, it might be worth looking at her nipples and areola under a powerful magnifying glass to see if you can see microfissures, scaly, cracked skin, or anything else notable. lyla Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2011 Report Share Posted May 9, 2011 yes we explored that, but she denied any such history. hard to know...she pumped for years though – and still experienced pain, if I recall, but not as much. oh also – her nipples were RED, but nothing helped. and the dermatologist didn’t really help either. no diagnosis, if I remember correctly, but it was several years ago, so I may be forgetting some details. From: Dee Kassing Sent: Sunday, May 08, 2011 9:48 PM To: Subject: Re: Too sensitive nipples? Quote Link to comment Share on other sites More sharing options...
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