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Thread: Cracked Nipple, Plugged Duct(s?), and Latch Issues, Oh My!

  1. #1
    Join Date
    Oct 2007
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    188

    Default Cracked Nipple, Plugged Duct(s?), and Latch Issues, Oh My!

    I am on my fourth child (12 days old) and have come up against a problem that I just don't know how to deal with.

    My left breast developed a crack just 2 days postpartum. I have been treating that with lanolin almost religiously, and it does seem to help a lot. I actually thought I had it almost healed, but my newborn has decided that she doesn't want to latch properly right off the bat, and will almost "chew" on my nipple, potentially spit it out, then root some more. If I can get up the courage to re-latch her on my left side, usually she latches a bit better, and then as she nurses, her latch gets better. All of this probably contributed to the plugged duct. Which of course means I should be latching her on as often as possible on that side, but I just can't bring myself to do it as often as I should because of the pain of the crack.

    I sit there holding her in front of the breast, trying to coax her into opening her mouth wide, and then when she does, trying to psych myself into trying to stick my nipple in her mouth before she closes back up, which takes far more tries than she has patience for. Of course this process is very frustrating for both of us. And then, when she latches, it is excruciating, and I sit there gritting my teeth trying not to cry out or clench my hands, trying to wait for when my nipple goes numb to most of the pain and hoping she can drain enough of the breast to relieve the plug to avoid mastitis.

    Thing is, I can't really find the 'plug' to massage out myself, but half my breast is red and tender, and I have a low fever, so I can only imagine that is what it is. One weird thing that happens is my areola gets puffed up, almost like there is milk pooling underneath them that doesn't get sucked out. But that is the only real physically tangible thing I can feel a difference in.

    I just tried doing a football hold to try and see if a different angle would help, and it was a disaster. Not only did she "chew" and spit out the first time, she only nursed half heartedly for 5 minutes before doing it again, and then promptly screamed. I switched to my right side, where she latched mostly well, nursed and then went to sleep. Now I am sitting here crying at the thought that I will have to try and latch her on my left side when she wakes up, because I *really* don't want to.

    Right now I am waiting for properly sized pump flanges to come in the mail so I can pump, but until that happens, I am on my own. I suppose my huge nipples combined with her newborn mouth don't help the latching issues. I just want to be able to latch her on without fear of how painful it will be.

  2. #2
    Join Date
    May 2006
    Posts
    21,262

    Default Re: Cracked Nipple, Plugged Duct(s?), and Latch Issues, Oh M

    Ouch, I am so sorry about the crack! Been there, done that, and I know just how painful it is and how you really have to psych yourself up to attempt a latch on a badly cracked nipple. It's like voluntarily sticking your finger in an electrical socket over...and over...and over...again.

    So at this point, I think you should go and see your doctor or midwife and get a prescription for antibiotics. The plug, redness, pain, and fever all suggest that you have mastitis, which is more common when there is a crack in the nipple, providing a convenient pathway for bacteria to get into the breast.

    Meanwhile, nurse on that side as much as possible, hand express, use cool compresses to treat the pain, and go braless for a while. If your baby is doing a poor job of emptying that breast, it would be great if you could find some way to get the milk out. Hand expression, pumping, nursing an older child or even your partner... Some moms with soft, flexible breasts and long necks can even self-nurse- believe it or not, that's how I once beat a case of mastitis.

    I would also want to treat that nipple crack with something other than lanolin. My LC recommended a combination of 1% hydrocortisone cream and Bacitracin antibiotic ointment. The hydrocortisone fights inflammation and pain, the Bacitracin is for infection. Use a pea-sized amount, mixed and applied using a clean fingertip.

    Another thing that can help with the latch-on fear is to hydrate the crack before nursing. Scabs tear open more painfully when dry and hard. So get a shot glass and fill it with warm water. immerse the nipple in the glass and bring it up to the skin so that it forms a seal, and then hold it there for 39-60 seconds. A soaked washcloth can also work.
    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!"

  3. #3
    Join Date
    Oct 2007
    Posts
    188

    Default Re: Cracked Nipple, Plugged Duct(s?), and Latch Issues, Oh M

    Thanks for the response. That analogy is very accurate. I told my husband that it is actually worse than birth, because it is self inflicted, and I can stop it anytime...but I shouldn't, and I have to do it repeatedly, encourage her to keep going and don't yell or cry out no matter what.

    I do have an appointment tomorrow with my doctor, and I will see what he says, but I am not very optimistic, as I am in South Korea, and not very many women nurse. It is actually pretty much a given that you won't. Also, I am not sure I have crossed over to mastitis just yet...The symptoms listed on Kellymom match pretty well for the plugged duct. My fever is only 99.2, and all the other symptoms can go either way. Also...not feeling flu-like yet. Still, better safe than sorry.

    I am trying to nurse more, but I think she is starting to associate that side with anxiety, because she cries more readily when I lay her that way. I think I did actually find the plug earlier, though. I got the idea that a shower wasn't doing it, so I ran a hot bath, and then expressed underwater. After a lot of work, I could finally identify three of the main ducts that I know are there working, and the "balloons" under my areola started to empty. Still have some work to do, but I am optimistic. If I can get just half of what is supposed to come out flowing, maybe she will stay interested long enough to start helping out. And I might try that self nursing thing...

    Is the hydrocortizone/bacitracin safe for baby, or would I need to wash it off before nursing? That would be wonderful to try and dull the pain a bit. I don't have a scab anymore, the lanolin keeps it moist enough that the scab I had came off somewhat easily, and so long as I keep applying it, it doesn't come back, but it is super sore. Huge nipples + tiny mouth = pain for mom, and the healing nipple and bad latch make it worse.

  4. #4
    Join Date
    Jun 2009
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    5,749

    Default Re: Cracked Nipple, Plugged Duct(s?), and Latch Issues, Oh M

    Wow. Looked it up and do not see a single IBCLC is South Korea on www.ilca.org
    Lots in Japan though
    Some IBCLCs work with moms via Skype but I have no idea how to find one.
    This is the facebook for Seoul LLL : https://www.facebook.com/LLLSeoul?fref=ts
    Catherine Watson Jenna suggests once or twice a day soap and water washing when nipple injured. See: http://cwgenna.com/nhygiene.html

    Getting the latch more comfortable should help. Here are several ideas in one article: http://feedthebabyllc.com/latch-and-positioning/

  5. #5
    Join Date
    Jun 2009
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    5,749

    Default Re: Cracked Nipple, Plugged Duct(s?), and Latch Issues, Oh M

    Is the hydrocortizone/bacitracin safe for baby, or would I need to wash it off before nursing?
    no need to wash it off. You only need put a scant layer on, and after each nursing session.

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