Are some problems unresolvable?

Hi all,

Background:
- 12 week old baby
- expressed exclusively for 7 weeks
- have been breastfeeding for last 5 weeks (with a few expressings in there)
- right side generally ok with breastfeeding
- left side varies between very painful and excruciating. Has been this way all along. After a bfeed it aches for a couple of hours (bad enough that it keeps me awake at night)
- had mastitis 1 week ago, but pain is unrelated. Mastitis was actually a welcome break from the feeding pain. Not that the feeding pain went away in this time - was just nice to have a different main problem. If I could choose to have mastitis or the feeding pain I'd go with mastitis hands down. :o

Things it's not: thrush, other infection, cracked or grazed nipples, low supply, overactive letdown, vasospasm (have had this but is not happening at the moment)

Things I've tried: breast shields (very slight reduction in pain, but not enough to consider them effective), different positions (football hold slightly better than others). I have spent HOURS researching and I'm sure the attachment is fine, or as good as is possible (especially given that right side works fine). I have spoken to ABA numerous times, and they have been extremely helpful, but can't think of any more suggestions.

Please don't suggest a LC - too $$ at the moment. I can't go back to the hospital where he was born for help as he is now too old. I can go to baby clinic, which I will do this week. But I've had several experienced bfeeders watch feeds and they can't pick anything wrong with attachment.

The only thing I can think of after all my research is that the problem side's nipple is bigger and flatter than the other (LC in hospital commented that it was quite flat - but I would have thought all the expressing would have drawn it out). Also, dr said that baby's mouth is quite small. It feels to me like he can't get enough of the areola into his mouth, and the nipple is being squashed into his hard palette. When he comes off, there is sometimes a white line through the nipple like it's been pinched. The white line is always from one corner of his mouth to the other. But does a squashed nipple explain the aching afterwards?

Feeds are currently 10 mins either side, and he is getting plenty in that time - good weight gains and sleep patterns.

So my question is whether sometimes there are bfeeding problems that are unresolvable? I'm going to try expressing on the sore side for a few days, but I really want to get back to full bfeeding if at all possible. But I can't keep going with this pain - I've been in pain every day since he was born.

Thanks!

some problems are unresolvable, but it sounds to me like yours may not be one of them. It does sounds like an attachment problem, perhaps as a result of your flat nipple which will make it harder for your bub to latch on properly and drain the breast (hence the mastitis). You have a few options.

You can continue expressing from the painful side, which for some women is a long term option although obviously it is not as easy as feeding straight from the breast.

You could try drawing the nipple out before a feed with ice and see if that helps bub attach. Also try the football hold incase bub doesn't like attaching from the right, some babies have a preferred side to lie on when they feed.

You could feed long term from only the right breast. You will be able to make enough milk from just one breast, although initially would have to work to build up the supply by offering more frequent feeds.

For now I would suggest resting the left side from feeding (but not expressing as it will keep your milk up whilst you make a decision) and give yourself a break from the pain, then speak to your MCHN or go to an ABA meeting where a LC will be able to watch your attachment without you having to pay for a private consultation.

Gee hun, you've had a very bad time :hug:

To answer your question, there are very few problems that can't be resolved with the right information and support. You have done such a great job of getting through the problems so far - 12 weeks of exclusive breastmilk is a fantastic effort. I am sure you will be able to continue hun. With your left side, there are a few things that could be going on. If your nipple is a different shape, it could be that changing your positioning could help. If you are unable to have an LC watch you feed, you could always watch yourself in the mirror. Start by standing topless in front of the mirror and see the difference between the two nipples. You have mentioned size, it could also be that one points in a different direction. This is really common and usually means that the usual position tips don't work so well. One you have checked this out, it might give you a better idea of how you can hold your little on so that he can attach better. Maybe he needs to be turned more so that his top cheek touches your breast? Or maybe a football or vertical hold would work better? Also, have you tried Baby Led Attachment yet? There is some really good info on it here - Australian Breastfeeding Association - Baby-led attachment - and this often helps mums with attachment issues.

ETA just a quick note about the ABA. The ABA has volunteer breastfeeding counsellors. LCs are paid medical professionals. Some ABA counsellors are also LCs, but they keep each role separate. However, it is a great idea to go to a meeting as a breastfeeding counsellor will also be able to watch a feed and help with positioning and attachment, and other ideas.

I am also interested to hear that it is not thrush. Usually pain that stays for some time after a feed is associated with either thrush or infection. If you have already had mastitis then you have probably had antibiotics which would certainly increase the chances of thrush. This can be really hard to diagnose, even swabs don't always come up positive. If there is a chance that this is what is going on, perhaps trying the treatment for yourself and your DS might be an option.

There is always the option also of feeding only from one side. Many mums do this for various reasons - after a mastectomy etc, when feeding twins (in effect!) and also for mums like yourself who have trouble with one side. The only real downside is that you can look lopsided for a while - but you are probably going to notice this more than anyone else!

I really hope you are able to feed without pain soon. I am sure that you will be able to - your determination to get this far is fantastic and I'm sure it will get you through. :hug:

I have vasospasm in primarily the right nipple. It is not *classic* in appearance all of the time but the pain is excruciating and makes feeding a hellish experience. So even though my nipple looks fine, it is the vasospasm / ache in the breast that makes me sit there with a fist in the side of the breast until is ceases (about 20 minutes). When my babies are little I take a combination of nifidepine SR and magnesium as well as the natural treatments of keeping the breast warm (I always wear a breastfeeding top and bra under my top) and heat packs, not getting cold after a shower etc etc.

It settled after 6-8 months of feeding and I was able to cease the nifedipine. I think the increase in mouth size and a decrease in suction intensity helped to ease the symptoms. I am currently 33w and still feeding DD (17 months) and I have noticed the symptoms are returning slightly. I have recommenced on magnesium, wear the multiple layers and will start nifedipine as soon as this baby is born to manage the complications and pain.

I'm sorry to hear you're still in pain Surprised :hug:
I agree it sounds like an attachment issue - the nipple shouldn't get squashed like that. Probably it's something different about that side, as others have suggested.
Early on I had aching, very painful nipples between feeds, which I think was due to damage done by poor attachment. I used nipple shields (didn't help that much with the pain, but just enough to get me through and let my nipples heal) then at 11 weeks DS finally was able to get a good mouthful.
You've done so well to come this far with all your problems :clap:

Thanks ladies for your ideas and kind words - I will try all the suggestions!

What's worrying me a little is that I've only gotten 80 and 50 mL in the last 2 expressings - I used to get 150mL in the same time. I really need to get him back on the breast asap. Will try again with shields the next feed, and maybe try baby-led attachment. Wish me luck!

PS Wasn't the pain supposed to stop with labour?????!

Hi, there,

You have certainly done the hard yards and have done well to work through the issues you face. I agree with the others - there are very few breastfeeding problems that can't be solved with the right help and support. And it sounds to me like you will get over this and go on to breastfeed comfortably and for a long time.
Problems like this are like throwing a 1000 piece jigsaw puzzle onto the floor and trying to put it all together without ever having seen the picture. There is rarely one simple answer - if that was the case you would have had it sorted by now. Part of the puzzle is working out if it is a *mother* problem, a *baby problem* or a bit of both. In my experience, it is more often to do with the baby than the size/shape etc of mother's nipples. Nipples come in all sizes and shapes and babies the world over feed from them.
A word on LCs. Yes I am going to suggest you see one! I can sense you think your problems won't be resolved by an LC and the money spent will be a *waste*. I hear mothers say, frequently, that they can't afford an LC. If the problems get so severe that you have to use formula then that is a significant and ongoing cost to your family - much more than a consult or two with a private LC. It's worth keeing in mind. Breastfeeding is important for both of you, and worth the investment.
Other suggestions given here are good too.

Can I just say I take my hat off to you! To go through so much hard work is real dedication to you. I know people don't hand out medals to mums, but you deserve one. I hope you find some answers :hug:

Where abouts are you - there are a few LCs around who are also GPs, so medicare helps with the cost. The white line and funny shape is not enough nipple in bubs mouth - in my case it was the bottom bit of the nipple (i.e. the bit I couldn't see) that was the problem. Can you get someone to check that too??
Hugs
Kate

No advice from me, everyone else has had great advice to offer, but I had to come in & say well done hun for sticking with it - I know you've had a rough time so far & I think you've done an amazing job sticking with it.
Hang in there & I really hope it gets better for you soon :hug:

Hi ladies,

Thanks so so much for your comments and support. It has really helped get me through the last few days.

Went to my lovely GP this morning and she recommended we go to a day stay facility, where they will be able to look at the whole picture of feeding etc. Will cost as it's a private one, but I think you're right Barb. My baby has dairy and soy allergy so we are looking at very specialised formula if we have to go down that path and really hoping to avoid it.

Thanks again everyone :)

Hi lovely ladies,

Just thought I'd give you an update after my visit to the day stay place (which I somewhat dramatically arrived at with a raging case of mastitis - my second in 2 weeks!!)....

The problem... (drumroll please)... is Raynaud's! The only problem with this being the problem is that there isn't a great deal you can do about it! But keeping really warm, drinking hot drinks and taking calcium/magnesium tablets seems to be helping.

It's such a relief to actually know what's wrong, and to know the attachment is perfect and that we're doing everything right.

Thanks again for all your encouragement!

(Michelle... looks as though we are 'bosom buddies'! hahaha

So glad you have a resolution, I never even thought of Raynauds (I have it in my fingers and toes, must be excruciating in your nipples). I had my last 2 babies in Scotland in the winter and to keep warm I kept a flask of camomile tea by their cot so I could have a warm drink during night feeds. It might help you to do the same, not to mention it helps you get back to sleep quickly.

There is something you can do about it!!!!!! And yes we are "bosom buddies" ;) Get yourself prescribed nifedipine in the slow release formulation. It only needs to be for a short while but if the non pharmacological treatments aren't making a major improvement there are other options for you to make this all sooooooo much better. Check out the two journal articles I have attached for evidence to support and something to take to your GP. Good luck!!

Raynaud's Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding -- Anderson et al. 113 (4): e360 -- Pediatrics
Vasospasm of the nipple–a manifestation of Raynaud's phenomenon: case reports -- Lawlor-Smith and Lawlor-Smith 314 (7081): 644 -- BMJ

Hi Surprised,

I'm another vasospasm bosom buddy!

I just wanted to throw another suggestion in there - I'm taking a bresfeeding multivitamin plus fish oil and evening primrose oil, which, when used alongside some of the other suggestions you've been given (warmth etc) helps to keep it under control day to day. I do have the odd flair up, but generally this works for me.

I might go and buy myself some magnesium now though to add to the mic - thanks for that one Michelle!

Hope you get the pain under control soon!

Hi girls,

Thanks for your replies. I am finding the magnesium and calcium work really well. Still not pain-free, but vastly better than it was. Might try some fish oil/EPO too. At the moment I have thrush so it's hard to tell what pain is from what problem, but you do actually get to know the different pain sensations LOL! Michelle - the nifedipene is a nice thought in the back of my head if nothing else fully works.

Surprised, I have heard that thrush is sometimes the cause of vasospasm, so once the thrush is cleared the pain might ease, or even stop - fingers crossed!! How are you treating the thrush? It is important to treat your baby's mouth too.