Expert: Sageda El-Abbasy - 8/25/2008

Question
Hi there - Sorry, but this may be somewhat long! My daughter was born 5
1/2 weeks early (DOB: 7/5/08) and had difficulty starting out nursing
(jaundiced, poor muscle tone) so we were introduced to the nipple shield and
also used a supplementary nursing system (SNS) for the first weeks of her
life. Thus, I was pumping 8-10x/day in addition to putting her to the breast
with the SNS. We were able to wean her off the SNS several weeks ago after
finding with pre-and post-weights that she could get all the milk she needed
straight from my breast, but she continues to have difficulty latching well w/o
the nipple shield. I saw two LC's along the way and was told that my milk
supply was somewhat low (prior to stopping the SNS), so I started on
Fenugreek. My milk supply seemed to then swing in the opposite direction,
and I was engorged much of the time. This also coincided with starting to
wean off pumping as often.

In addition, I developed mastitis at about 25 weeks into my pregnancy. Since
my daughter was born, I've been struggling with recurrent clogged ducts. I
began taking Lecithin a few weeks ago, and that seemed to help some as the
clogged areas no longer felt as firm and painful. However, last week I
developed a fever along with a particularly swollen, red, and tender area on
my left breast and knew that I had developed mastitis again. I'm now on
antibiotics and have seen some improvement (no fever, area no longer red)
but still am sore and swollen in that breast.  The other breast still has some
clogging too. The MD prescribed 7 days of antibiotics and I have put a call in
to see if that prescription should be extended.

All in all, I am trying to figure out how to remedy this situation. I have had to
pay constant attention to my breasts and they have been consistently painful
- frequent hot compresses, cold compresses, massaging, hot showers. Also,
nursing is often uncomfortable as my breasts are sore and sometimes my
nipples too. When I try my baby off the nipple shield, she is willing to latch on
but it seems somewhat shallow - when she comes off, my nipple is creased
and blanched at the end. I also often feel pinching while she sucks, especially
off the nipple shield, but with it as well. I'm not sure if this is related to using
the nipple shield or how to improve her latch - she seems to start off deep
and then pulls off during the feed.

Finally, I am concerned that we may be missing something - is it possible
that there is an underlying thrush condition? My baby does not have white
spots in her mouth but my nipples are very sensitive ('tho not cracked or
damaged). I was on antibiotics during her delivery as they did not know if I
had Streppe due to the early delivery.

Any help would be greatly appreciated! Thank you!!

Answer
First of all I'd like you to check with your GP if you still need to be taking Fenugreek for your milk supply, because this might be messing up the system your breasts should develop for producing just as enough milk as your baby needs.
You also need to regulate feeding times and alternate breasts with every feed in order to make sure that neither of the breasts is left without emptying for a long time.  I've experienced mastitis and I know how painful it can get, but you have to continue to breast feed during the infection and make sure to empty that breast.  A hot water bottle can help soothe the pain in your breast, but keep it away from baby.  Paracetamol can also help you get through the day.
If you suspect that your baby is not latched on correctly the chances are she is not latched on correctly.  The pain and pinching you feels pretty much shows that.  As soon as you feel that baby has pulled off, start over again.  This might be very frustrating at the beginning, but she is going to learn by time.
I don't think that you have any thrush, I believe the pain is due to incorrect latching.  However double check with your GP that your nipples are clear.
I hope I was helpful, and do reply if there's anything unclear.  I wish you the best of luck and I cheer you for trying so hard to continue breast feeding.