Dear Kathleen- on nipple damage healing and pumping

We receive hundreds of emails and messages daily from Leakies looking for help and information in their breastfeeding journey.  As so many seek support from us, we are so honored to have the support of Kathleen Huggins, IBCLC and author of The Nursing Mothers’ Companion.  Kathleen is jumping on board with The Leaky Boob to have a regular article answering Leaky questions every month.  The questions will be selected from the huge pool we get in every day to try and help cover the wide range of topics about which Leakies are asking.  These questions are from real moms and represent hundreds of requests for more information in the past few weeks.  Please understand that this is simply the professional opinion of one International Board Certified Lactation Consultant in an informal setting and is not intended to replace the care of a health care provider.  Kathleen is offering support and information, not diagnosing or prescribing treatment.  For your health and safety, please seek the care of a qualified physician and/or IBCLC.  Kathleen does have limited availability for phone or online consultations, see her website for more information.

Dear Kathleen,

My nipples are a wreck following a shallow latch and then thrush with my 8 week old.  After working with an IBCLC that helped fix my daughter’s latch and take care of the thrush, things are improving.  However, my nipples are still cracked and bleeding and I think they just need a break to heal.  The IBCLC I work with suggested I just pump for a little bit until I’m healed and I’m ok with that.  I feel like I’m a bit lacking in the pumping department though and only got 4 ounces the first time I tried with a hospital grade double electric pump and my daughter downed that pretty quickly.  How often should I be pumping to keep up my supply?  How long should I expect healing to take?  How do I pick a bottle that won’t encourage my daughter to prefer the bottle over me?

Thank you so much for your help!

Sore Nipples 

 

Hello Sore Nipples!  I am so sorry to hear that you are still struggling at this point in time! Sounds like you have been through a rough go.  Yes, you and your L.C. are on the right track.  A break from any more trauma is certainly in order.  I am happy to hear that you have a clinical grade pump.  I do hope you have the right size flanges for more comfortable pumpings and for removing the most amount of milk possible.  If your nipples are swelling very much in the tunnel, I would suggest getting the next size flange for more comfortable and effective pumping. Another product, “Pumping Pals”, slipped into any flange, makes pumping even more comfortable and for some moms even more efficient.  You might want to visit their website to see what I mean.  The company is very helpful in getting you the right size flanges to use in your kit and they are fairly inexpensive. With that being said, still many pumps still leave quite a bit of milk on the breast.  For that reason, I suggest “Hands-on Pumping”, that is using your hands to help remove the most milk possible at each pumping.  Please watch Dr. Jane Morton on Stanford University’s website on breastfeeding issue and see her mini-lecture and video of hands-on pumping.

I would like to talk to you more about the condition of your nipples.  If your nipples are still cracked, I would like you to consider treating them with an oral antibiotic.  Mothers with injured nipples longer than 5 days are at a much greater risk of developing mastitis; 75% of moms with open nipples go on the develop a breast infection because of the bacteria in the open areas.  And this seems much more common during the cold weather months.  There was a great study done by two Canadian physicians some time ago that showed the consequences of wounded nipples that were untreated leading to mastitis.  Also, nipples are more difficult to heal when they are infected with bacteria.  For both of those reasons, I suggest speaking with your midwife or doctor about getting treatment for at least 10-14 days.  I don’t think most doctors are aware of this connection, but with your nipples being in this shape so late in the game, I am convinced they are colonized with bacteria.  Yes, I am sure that this makes you worry about yeast, but yeast is much easier to treat than a case of mastitis, which can also lessen your overall milk production.

Mastitis risk with damaged nipples

I do think that getting 4 ounces is about what a baby at this age requires at each feeding.  You will want to aim for about 8 pumpings each 24 hours.  If you are not getting at least 3-4 ounces when you pump, you may want to also consider using some herbs.  You can use fenugreek capsules that are available at most any health food store, 3 caps three times a day. This is probably different that the dose given on the bottle.  I actually find that mothers do quite well using Mother Love’s More Milk Plus, a combination of milk stimulating herbs.  You can visit their website and see if there is a local distributor or order them on-line directly from Mother Love. Nursing teas are a very weak form of any herb, so I don’t recommend them as the primary way to stimulate higher milk production.

Babies typically down a bottle in no time flat and may still act hungry!  This can lead parents to believe that the baby may need more milk.  Four ounces with a slow flow nipple, might help some but keep in mind that many nipples that are labeled as slow flow, really aren’t!  Hopefully, the baby takes 5-10 minutes to drink 4 ounces of milk. There is an old saying, “It takes 20 minutes for the brain to know when the stomach is full!”  So true!  If you are very worried that the baby will come to fall in love with the bottle flow, you might reconsider and have one nursing every 24 hours, but I leave that to your discretion. I think for most babies, if there is a healthy supply of milk, they should return to the breast without too much of a problem.

I wish you every success and very soon!  You are quite a determined mom!

Best wishes,

Kathleen

Kathleen-HigginsKathleen Huggins RN IBCLC, has a Master’s Degree in Perinatal Nursing from U.C. San  Francisco, founded the Breastfeeding Warmline, opened one of the first breastfeeding clinics in  the United States, and has been helping breastfeeding mothers professionally for 33 years.  Kathleen  authored The Nursing Mother’s Companion in 1986 followed by The Nursing Mother’s Guide to Weaning.  Kathleen has also co-authored Nursing Mother, Working Mother with Gale Pryor, Twenty Five Things Every Breastfeeding Mother Should Know and The Nursing Mothers’ Breastfeeding Diary with best-friend, Jan Ellen Brown.  The Nursing Mothers’ Companion has also been translated into Spanish.  Mother of two now grown children, Kathleen retired from hospital work in 2004 and after beating breast cancer opened and currently runs Simply MaMa, her own maternity and breastfeeding boutique.  She continues to support breastfeeding mothers through her store’s “breastaurant,” online at The Leaky Boob, and in private consultations.  
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Do we have thrush?

by Tanya Lieberman, IBCLC, sponsored by Motherlove Herbal Company.

Having thrush is be painful and frustrating.  And trying to figure out if you have thrush can be confusing.  Here’s our guide* to aid in determining whether you and your baby have thrush. 

Please note that we are not discussing treatment options in this post. For information on treatment please see Dr. Jack Newman’s Candida Protocol.

 

What is thrush?

Candida albicans is a fungus lives in our bodies.  Some conditions such as antibiotic use and illness can cause it to grow out of balance, and this overgrowth can cause painful infections, generally in moist areas such as the mouth, nipple area, vagina, and diaper area.

 

How is thrush diagnosed?

Diagnosing thrush is difficult, because skin tests are considered unreliable, and the results aren’t available for several days – a lifetime when you have pain!  Most doctors diagnose thrush based on symptoms and not diagnostic tests.  So you may hear that thrush is diagnosed through treatment – if it responds, it must have been thrush!

 

What makes me more likely to have thrush?

You and your baby may be at higher risk for thrush if you or your baby have recently used antibiotics (often used for a cesarean birth), have been ill, or perhaps have been in a very warm and moist environment.  Thrush takes time to develop, and may not be obvious until a few weeks after this trigger, so pain in the first week or so after your baby is born is unlikely to be thrush, and is much more likely to be caused by a shallow latch or one of the other causes mentioned below.

 

What symptoms are strongly associated with thrush?

Mother symptoms:

One study of mothers between 2 and 9 weeks postpartum found that mothers who have two or more of the following five symptoms are likely to have thrush.  Having three or more makes it even more likely.

  • shiny or flaky skin of the nipple/areola
  • burning pain on the nipple/areola
  • sore (but not burning) nipples
  • stabbing pain in the breast
  • nonstabbing pain in the breast

 

And a mother is highly likely to have thrush if those symptoms include:

  • shiny skin of the nipple/areola with stabbing pain, or
  • flaky skin of the nipple/areola in combination with breast pain

 

The study also found that mothers were likely to have symptoms on both breasts, though sometimes not right away.

 

Baby symptoms include:

  • White patches on the baby’s cheeks, gums, palate, tonsils, and/or tongue.  If you try to wipe off these patches they will appear “stuck” there, and may bleed.
  • A yeast diaper rash, which may be red or red with raised dots

 

Can you have yeast inside your breasts? 

Shooting and/or burning pain deep inside the breast is sometimes diagnosed as intraductal thrush – thrush in or around the milk ducts inside the breast.  This diagnosis is controversial, as recent research has found that mothers with suspected yeast infections may actually have bacterial infections or Raynaud’s vasospasm, and that yeast hasn’t been cultured in the milk of mothers with suspected interductal thrush.

 

If it isn’t thrush, what could it be?

Other causes of pain which may make you suspect thrush:

  • Shallow latch
  • Raynaud’s Phenomenon
  • Bacterial infection
  • Mastitis
  • Skin problems such as eczema, psoriasis, dermatitis

 

My baby’s tongue is white.  Does that mean he has thrush?

Babies’ tongues normally have a white coating.  This in itself is not an indication of thrush.  If your baby has white patches on the inside of his cheeks or gums (if you try to wipe them off they may look red or bleed), this is an indication of thrush.

 

My doctor said that my baby doesn’t have white patches in her mouth, so we couldn’t have thrush.  Is that right?

Some babies who have thrush do not have white patches in their mouths.  Some may have a yeast diaper rash and no symptoms in their mouths.

 

I was treated with Nystatin and it didn’t work.  Does that mean I don’t have thrush? 

Nystatin is ineffective at treating thrush in an estimated 68% of cases.  So if the symptoms didn’t go away using it, you may still have thrush.  Consult this guide to thrush treatment for other treatment options.  See this study for more information on the use of Nystatin in treating thrush.

 

My doctor said that since I have symptoms but my baby doesn’t, she doesn’t need to be treated.  Is that right?

If thrush has been diagnosed in either of you, you both should be treated to prevent recurrence.

 

I keep getting thrush over and over.  Could it be something else?

If you have repeated cases of thrush, or if treatment doesn’t resolve your symptoms, you may want to explore whether your symptoms are caused by some other problem instead or, or in addition to, thrush.

 

I think I have thrush.  What should I do now?

Contact your health care provider and explain your symptoms. You may also wish to consult this guide to thrush treatment.

 

*This information is provided for educational purposes only, and should not be construed as medical advice.  For care suited to your own situation, please consult your health care provider.

 

References: 

 

Mohrbacher, Nancy.  Breastfeeding Answers Made Simple: A Guide for Helping Mothers.  (Amarillo: Hale Publishing, 2010), pp. 652-53

 

Jimi Francis-Morrill, M. Jane Heinig, Demosthenes Pappagianis and Kathryn G. Dewey.  “Diagnostic Value of Signs and Symptoms of Mammary Candidosis among Lactating Women,” J Hum Lact August 2004 vol. 20 no. 3 288-295

 Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms  in hospital and pediatric settings.  She writes and produces podcasts for several  breastfeeding websites, including  Motherwear,  Motherlove Herbal Company, and  the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-  speaking moms.  Prior to becoming a lactation consultant she was senior  education policy staff to the California legislature and Governor, and served as a  UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.
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