Need latch help for sore/bleeding nipples

[@llli*darius]

Hi - I'm nursing my 2-week-old and both nipples are very red/sore with cracks, one side has a bleeding crack. MD diagnosed yeast (both baby and I are being treated) and, after seeing a spot of pus on the bleeding crack, mastitis (I'm being treated). I have very large floppy breasts (L cup) with flat/inverted nipples. I'm using a "modified sandwich" squash to get as much aerola into his mouth as possible, and use my thumb to guide the breast into his mouth (then remove it quickly) since there's not enough nipple for him to "catch". The problem is that he's still sucking out a "high side" on both nipples - when I take it out of his mouth, the nipple is misshapen with a higher top side and white ridge that goes away after a minute. I can't find a way to get more of the bottom of the nipple into his mouth.

I met with a lactation consultant, who suggested a couple minor adjustments to the latch but otherwise said it was OK. baby is gaining weight well and nurses for 20-40 minutes at a session, but there is a lot of pain whenever he eats (and for a couple hrs afterwards, which I'm told is from the yeast and should resolve... but hasn't)

Any suggestions for a better latch, or ways to get more of the bottom side of the nipple into his mouth? Or, any suggestions for healing the nipples? i'm currently coating them with bactoban/hydrocortisone/lotrimen at the advise of the lac. cons. after each feed.

Thanks-

[@llli*lu.smom]

I am so sorry to hear about your pain. I had sore nipples at the beginning too and it was terrible. Once you finish your meds you should try putting some BM on your nipples and letting them air dry. Do you have access to any LLL meetings? You should try going if you can to get some advice on how to get a better latch. That is the key. My breasts were average (don't know if it will work for you) and I would squeeze my entire nipple/areola to give it a flat shape when my LO was latching.

I really hope that it gets better. Sore nipples are the worst. Keep going though, you are doing the best thing for your baby

L

[@llli*mtmama]

I had a bad crack in the top of each nipple after the first day. He was just not getting it all the way in, I think I have large nipples
I made sure to correct the latch but it was still painful because the cuts were sensitive. I ended up lathering the area with lansinoh cream as often as I could.

I kept it in the pocket of my bathrobe and it stayed warm, made it easy to put on. I even kept it under my pillow at night to stay warm. Within a few days they healed a little and the pain went away.

Hope that helps!

[@llli*bxlgirl]

Part of the problem is having flat nipples, which LO will eventually reshape. I had those too, and it's *not* easy.

I wasn't aware that pus in the nipple was a mastitis symptom, but glad you're being followed closely

Some latching problems are just due to LO's mouth being small--it's a mechanical problem. LO will get bigger and grow into a better latch. Ouch, the truth hurts, doesn't it? It took 6 weeks for my pain to appreciably reduce, and then around 8 wks I realized it didn't hurt anymore. YMMV--I also have Reynaud's phenomenon which caused vasospasms and was bfing in the dead of winter, which exacerbated the situation. However, I am so very very glad that I stuck with it, minute by minute sometimes. It's far easier to bf than use artificial milk, and the best way to stop a toddler tantrum in its tracks. I'm so happy we perservered because bfing for me has been my #1 mothering tool and with a toddler, plus pg, I need all of them that I can get!

[@llli*kaitlyns.mom]

Once you finish your meds you should try putting some BM on your nipples and letting them air dry.

While normally this is a great idea I wouldn't do it unless you are positive you are yeast-free. It can make the thrush problem difficult to resolve as thrush thrives in sugary environments (which your milk provides).

Part of the problem is having flat nipples, which LO will eventually reshape. I had those too, and it's *not* easy.

I wasn't aware that pus in the nipple was a mastitis symptom, but glad you're being followed closely

Some latching problems are just due to LO's mouth being small--it's a mechanical problem. LO will get bigger and grow into a better latch. Ouch, the truth hurts, doesn't it? It took 6 weeks for my pain to appreciably reduce, and then around 8 wks I realized it didn't hurt anymore. YMMV--I also have Reynaud's phenomenon which caused vasospasms and was bfing in the dead of winter, which exacerbated the situation. However, I am so very very glad that I stuck with it, minute by minute sometimes. It's far easier to bf than use artificial milk, and the best way to stop a toddler tantrum in its tracks. I'm so happy we perservered because bfing for me has been my #1 mothering tool and with a toddler, plus pg, I need all of them that I can get!

I agree with all of this! I had bleeding/cracks with both LOs, and to be honest what worked the best was time. I did take Motrin for a few weeks to get me through the worst of it. It's wise to use the mixture your LC has suggested because it's very similar to All Purpose Nipple Ointment and is a good replacement if you can't get a prescription for APNO. I also had infected cracks and ended up with mastitis - watch yourself carefully! If you start getting a high fever call your doctor ASAP. If you are already on antibiotics because they suspect thrush you might want to add in a probiotic to your diet.

Have you tried breast shells to protect your nipples from your clothing? They helped me a ton. If you suspect thrush don't use those soothies pads.

The pain while eating could be just from the cracks. When he is done nursing do your nipples change color at all? That would be a sign of vasospasm which I have, as well as the previous poster who mentioned it above. That can cause symptoms similar to thrush including a burning pain between feedings. Vasospasms can also be caused by nipple trauma.

I also had flat nipples and both times my LOs pulled them out to a shape more conducive to breastfeeding. The first six weeks were hard both times, but now I am at three months with DS and it's honestly a piece of cake. We are here for you!

[@llli*darius]

Thanks for the replies. I do recall from my daughter that it took about 2 months before bf'ing wasn't acutely painful.

- I've put ink dots on the areola outside baby's mouth while he's eating to see what's getting in there, and he is getting the entire nipple + 1/4"+ of the areola on either side. no more will fit into a mouth that size. but the nipple is fully in there.

- Any idea what causes the deep pain that comes and goes for a couple hours _after_ feeding, and how to fix this? I've been on the diflucan, vinegar rinses, etc for almost a week and that pain is not really improving. Ibuprofen lessens that pain somewhat but does not make it go away (and of course doesn't help once the ibuprofen wears off)

Thanks much-

[@llli*darius]

>> The pain while eating could be just from the cracks. When he is done nursing do your nipples change color at all? That would be a sign of vasospasm which I have, as well as the previous poster who mentioned it above. That can cause symptoms similar to thrush including a burning pain between feedings. Vasospasms can also be caused by nipple trauma.

Can you tell me more about this (what to look for and, in particular, how do you treat it??)

Thanks much-

[@llli*kaitlyns.mom]

Can you tell me more about this (what to look for and, in particular, how do you treat it??)

Thanks much-

This is a good link, as well as this one. In my case, shortly after nursing my nipple turns white, then eventually pink again. In a chilly room or after taking a shower it will also do this. While changing colors there is a burning or throbbing pain. It has gotten significantly better - they still change colors but the pain is more or less gone, or at least not noticeable. The links I included give some treatment options. The best way to know if this is happening is to quickly look at your nipples when you notice the pain after nursing. If they look like a normal color, probably not vasospasms. If they are white or are changing colors, it could be vasospasms. Honestly, heat or dressing warmly didn't work for me. Motrin did, until things improved.

[@llli*darius]

I think it's not that.. the nipples are pretty bright red and stay that way, except for the blisters (which turn white when wet).

I'm at a loss on the deep-pain-after-eating.. after nearly a week on diflucan i'd expect this to have waned if it were due to yeast. is it possible that it's just an extension of the sore nipples, which i hope resolves in time? i'm starting fish oil supplements supposedly can reduce inflammation, along with a probiotic.

here's a more complete description of the pain:
1. Occurs mainly in the left breast, milder on the right
2. It occurs within 5-10 minutes after feeding on that side, and lasts for a couple of hours
3. It usually occurs on the right side of the left breast, nipple all the way up, tho i can feel it in my armpit as well and sometimes radiates around. Normally, it's all up the right side of the breast
4. The pain comes in waves, like contractions. Ex: pain will come, hit a peak, fade.. stays away for 5 minutes.. another peak, fade... etc. the cycle will repeat for a couple hrs.
5. I feel it in any position but it is much worse/stronger while lying down
6. motrin helps somewhat but it can give me rebound headaches so i dont like taking it.



Thanks-

[@llli*lizziesmom]

The pain between feeds could be pain from the breasts refilling.

about using breast shells. They are the only thing that helped my nipples start on the path to healing. (Though, at 7 months, they are still misshapen and seem to have permanent scars. Yeah, it was a rough road.) Be careful, especially if you have a generous supply, that you don't use them longer than you need to. They can encourage leaking and over-production of milk, which may just be another headache to deal with.

To help your LO to get more of the "lower" nipple into your mouth, make sure LO is approaching the breast from below. It should almost be like he is reaching up for the nipple. There should be plenty of space between his chin and chest.

The problems you are going through sound very similar to my experience. Please keep stopping back here for support. I know I would not have been able to keep going through the intense pain if it weren't for the wonderful mamas here to help.