Re: Still having latch problems at 4 weeks!
Welcome to the forum and congratulations on the new baby, and on making it to 4 weeks of nursing despite some significant hurdles!
The first thing I want to assure you is that yes, it does get better!!! Your baby is still so very young- even younger than her chronological age, because she was born a bit early. Tiny babies have tiny mouths, and they are weak and uncoordinated. This makes them difficult to nurse even at the best of times. Imagine trying to hold onto a water balloon bigger than your own head using just your lips and tongue, while simultaneously being too weak and uncoordinated to move your head where you need it to be- oh, and you never did it before, either! That's what nursing is like for a newborn. But the awesome thing about babies is that they and their mouths grow, and they get stronger and more able. As that happens most latch problems go away. (I speak from experience- I had terrible cracks for the first 4.5 months of my first baby's life, which is way longer than average. I reconciled myself to dealing with the pain until I could wean her to solids, but then all of a sudden the cracks healed and we went on to enjoy another 3 years of nursing!)
It sounds like you are definitely still experiencing latch problems, since nursing is still so painful. When baby unlatches, what shape are your nipples- more symmetrical, like pencil erasers, or more asymmetric/ridged/wedged/shaped like new lipsticks? Lipstick nipples would indicate a problem related to a shallow latch. If that's what you're seeing, I would encourage you to go back to the LC and inquire about something called the sandwich technique, which is good for cramming maximum breast into a tiny mouth. I would also experiment with different positions- a lot of moms have good luck with the reclined, down-under (a.k.a. football hold) and side-lying positions. You never know what position will enable baby to gain a better latch.
Large-breasted moms often have to hold the breast throughout the feeding. Otherwise it drags down on the baby's tiny mouth, causing her to slip up and lose her latch. If your hand is getting tired out, the side-lying position can help, since the bed will support both baby and breast. You can also prop your breast up into a better position using a rolled-up washcloth.
Blebs are a lot more common when a latch problem is in the mix. They often result not from improper drainage to the breast, but rather from abrasion/compression of the nipple. The bleb is basically a little callous that is forming in response to injury, and is sealing off one of the ducts. Varying your nursing position may help, since the baby's mouth will fall in different orientations and no one bit of nipple will be bearing the brunt of the baby's latch issue. If you get another bleb, I personally feel that the best person to take care of it is you- just sterilize a needle and pick at it until you can get milk out of that duct. You're better equipped than any other person on earth, including the midwife, to know when you have gone too far, because you're the only person with nerve endings at both ends of the needle.
Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
Coolest thing my little girl sang recently: "I love dat one-two pupples!"