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Thread: FTM needing help with painful ulceration

  1. #1

    Question FTM needing help with painful ulceration

    Hi there! New to the forums here and new to mommy-hood.

    So I have fought really hard to EBF my 2 week old son (born 12/14). I had an emergent c-section due to baby being in distress while laboring. (He was also overdue by a week) I did have a large amount of IV fluids during labor when he started to get in trouble, and birth weight was 7lbs 2.8 oz. He had a 12.6% weight loss over our three day hospitalization and was down to 6lb 5oz prior to leaving hospital (They almost made us stay an extra day because of this!). However, he never had any jaundice. I met with the IBCLC at the hospital twice, and have been using a medela symphony breast pump. We supplemented at the hospital after every feeding with formula and as my milk came in, began supplementing with expressed breast milk. His weight was back on track at 12 day pediatrician weight check- 6 lb 15 oz and averaging approximately 1 oz wt gain per day. Did I mention I've also had a breast reduction ten years prior to pregnancy?!? Lol...

    That all being said, after fighting so hard to get to breast feed LO, I find myself struggling to keep going because I have a HORRIBLY painful ulceration at the base of my nipple. The cracking I experienced initially was resolved pretty quickly with lanolin. However, this ulceration is so excruciating every time he latches and for the initial part of the feeding. I have tried airing it out, lanolin, moisture, dryness... I am a nurse and am very familiar with thrush/yeast infections-- this is not thrush at this point, and it does not appear to be infected. It does occasionally bleed very small amounts (Only noticed because of white nursing pads). Would nipple shields help? Should I go back to the LC to work with nipple shields? Pump for a few feedings instead? I have also tried switching up latches to try and change where the pressure is being placed on my nipple but continue to have tears brought to my eyes with pain every time he latches to that left side.

    DS always seems to be satisfied with feedings afterwards. Another thing I've noticed is I have to wake him up for every three hour feedings. I do allow him to sleep for one five hour stretch per day. How long should I continue to wake him up for feedings? When can I just trust him to tell me when he needs to be fed and not be worried I'm starving him? So many new things to learn when you earn the title of "mommy!"

  2. #2
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    Default Re: FTM needing help with painful ulceration

    I think when you have a breast injury that is not healing it is important to go see an IBCLC to work on latch. Nipple shield MIGHT help, although that is not really what they are for (they are for helping a baby latch who cannot) or it might be helpful to pump for a while on that side to help it heal. But I have no idea if that would be needed or not. An IBCLC should be able to help you get baby latched in a way you are no longer getting injured, and once that happens, it can heal.

    You might want to consider washing that nipple with soap and water and/or putting a topical antibiotic on it. (or have soem all purpose nipple ointment made up for you.) Open wounds like this may lead to infection (mastitis) and while you can live through that and keep nursing, of course it is best avoided. Also may lead to more rapid healing. See links below for more.

    As far as waking baby, as long as baby is gaining very well, nursing a minimum of 10 times a 24 hour day, and you are not getting engorged or uncomfortable full between nursing sessions, it is not NEEDED to wake baby (or encourage baby to nurse in sleep). But more frequent nursing certainly is not going to hurt, and in fact, because it is easier for baby to latch on a softer breast, more frequent nursing can even help wiht latch pain. BTW, at around 2-3 weeks babies typically 'wake up' and start asking to nurse more often-sometimes way more often- anyway.

    .Nipple hygiene http://www.cwgenna.com/nhygiene.html

    APNO http://www.breastfeedinginc.ca/conte...ename=doc-APNO
    Last edited by @llli*lllmeg; December 30th, 2013 at 09:14 PM. Reason: added links

  3. #3
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    Default Re: FTM needing help with painful ulceration

    Oh I missed about the pumping. Are you still pumping and supplementing? how does pumping feel? Pumps can cause and exacerbate injury too, so you need to be careful about how high a setting you pump at and taht teh flanges fit you correctly. Also some think that supplementing may lead to/exacerbate a poor latch.

  4. #4

    Default Re: FTM needing help with painful ulceration

    Thanks for the advice... I guess I just needed that confirmation to call the IBCLC. And didn't even think of mastitis as a possible complication from the open area. I think I always just associated that with engorgement/fast weaning issues. The pump and flanges were the same ones I used in the hospital which were set up by the LC as well. And we aren't doing the supplementing with every feed at this time, since he was gaining weight appropriately with breast milk exclusively.

  5. #5
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    Default Re: FTM needing help with painful ulceration

    Can you describe the location and appearance of that ulceration a bit more? Is it really at the base of the nipple, where the nipple meets the areola, or is it more towards the crest of the nipple? Is it a wound that gapes larger after nursing, or is it more of a slit-like crack or series of cracks?
    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!"

  6. #6

    Default Re: FTM needing help with painful ulceration

    It's at the base of the nipple where it meets the areola. It is irregular and gaping, especially if I bend the nipple or after nursing. The other key was the fact that it BURNED horribly when LO would latch initially. Plus, DS has been more gassy and fussy, and turned up with a diaper rash this morning as well. Wound up going to see the IBCLC today... and glad I did. She does feel it's the beginning of thrush. And here I thought I'd know a yeast infection when I saw one! Goes to show the value of professionals. Putting lotrimin on it until pharmacy in the area that mixes APNO is open. We are keeping gentian violet as our "ace in the hole" if ointment doesn't work. Pumping single sided for now and putting baby to breast that is not as painful. Going to call pediatrician tomorrow to see if LO needs treatment as well.

    Oh, and thanks for the links! Good information.
    Last edited by @llli*lelea3; January 1st, 2014 at 05:28 PM.

  7. #7
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    Default Re: FTM needing help with painful ulceration

    If this is thrush, your baby should definitely be treated as well, even if he is asymptomatic.
    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!"

  8. #8

    Default Re: FTM needing help with painful ulceration

    Pediatrician agreed and we have started oral and topical bottom nystatin.

  9. #9
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    Default Re: FTM needing help with painful ulceration

    Glad to hear the pediatrician knew the right course of action! Let us know how it goes, mama.
    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!"

  10. #10

    Default Re: FTM needing help with painful ulceration

    So things seemed to be getting better, less sore with nursing, less swelling near areola, LO's diaper rash cleared up... I have continued using the Newman's nipple ointment and nystatin topical and oral for baby boy. I continue to boil for 20 mins everyday everything that touches his mouth or my breasts, including pump parts.The soreness seems to be coming back again, to the point I am using ibuprofen for pain, and the open area just looks like it's not healing. How long should I expect until this starts to heal? Do I need to consider further treatment? Definitely getting a bit frustrated. At least DS seems to be getting much better- less gassy, no more diaper rash and mouth no longer has the mother of pearl appearance.

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