#1 Reason moms stop breast feeding is: Sore Nipples
What is normal?
It is not uncommon to have sore nipples the first few days of breast feeding. The tenderness may be worse when the baby first latches on but should NOT last throughout the entire feeding. This soreness is also likely to be worst between 3 and 5 days after the baby’s birth, but should not last past the first week. Nipple sensitivity is increased during pregnancy and peaks on approximately the 4th post partum day. Normal sensitivity can be distinguished from the pain due to nipple trauma by its time and course. Normal sensitivity typically subsides approximately 30 seconds to one minute after suckling begins. Pain due to trauma persists at the same or increasing levels throughout the nursing session. In general, normal sensitivity completely resolves within approximately 7 days of delivery. Severe pain or pain that extends beyond the 1st postpartum week is more likely due to tissue damage, yeast colonization or a combination of both.
What is NOT normal?
Tenderness lasting throughout the entire feeding.
Soreness past the 1st week
Skin breakdown: like cracks, blisters, bruises, or bleeding on the nipple or areola.
Severe redness, rash, itching or sharp needle like pain during feeding. These could indicate a yeast overgrowth.
#1 Cause of nipple soreness is: INCORRECT LATCH
Ways to identify incorrect latch-
clicking sounds that corresponds to breaking suction
tongue not visible below the nipple when the lower lip is pulled down
creased nipple following nursing
only the erect part of the nipple noted to be in the baby’s mouth
(the milk sinuses are in the areola and to move milk effectively the baby needs to compress these sinuses. Therefore, babies need to have as much of the areola in their mouth as possible)
Identify ankyloglossia in the baby (this is also known as tongue-tie)
If this is identified it can make a correct latch difficult
Ways to help correct a poor latch
Seek out a lactation consultation
Ways to prevent sore nipples:
Identify cause of sore nipples and correct
Things that can cause a delay in the milk coming in can cause a lengthened period of sore nipples.
Induction of labor/pitocin
excessive intravenous fluid in labor
delayed first feeding
sick infant that is unable to nurse
lack of nipple stimulation
First feeding within 1 hour of birth
Correct the latch
Unmedicated baby (help mom be prepared for labor and avoid the epidural in labor) Medicated babies often have an uncoordinated suck and therefore decreases nipple stimulation and will have a increasingly difficult time latching correctly. Both the inability of the baby to coordinate his suck and the mom’s lack of nipple stimulation can affect this breast feeding dyad’s success.
Help heal sore nipples
#1 Identify cause of sore nipples and correct while treating this mom!!
CORRECT THE LATCH
CONSULTATION WITH A LACTATION CONSULTANT
Give lots of TLC and support to these moms through this difficult time
The first treatment to do after #1-
**Hand express colostrum or milk and rub over nipples and then let them air dry
Rubrics from Synthesis:
*These could be any symptom that the mom may be feeling including how the baby is reacting to the situation. Some rubrics that I could think of were:
-Chest, pain, stitching, mammae (with a lot of sub rubrics) pg 1211 Synthesis
-Chest, pain, sore, mammae pg 1206 Synthesis
-Chest, pain, sore, nipples pg 1206 Synthesis
-Chest, pain, mammae pg 1189 Synthesis
-Chest, pain, nipples pg 1189 Synthesis
-Chest, inflammation, mammae pg 1176 Synthesis
-Chest, inflammation, mammae, nipples pg 1176 Synthesis
-Chest, cracks of nipples pg 1166 Synthesis
-Chest, discoloration, mammae, redness, streaks pg 1167 Synthesis
-Chest, discoloration, mammae, nipples pg 1167 Synthesis
-Fever, heat in general pg 1661 Synthesis
(and any rubrics related to the fever i.e., when is it worse and when is it better)
-Any mental rubrics that would apply to this mom would be important
-Chest, abscess, mammae pg 1159 Synthesis (abscess is different than mastitis)
-Chest, abscess, nipples pg 1159 Synthesis
Rubrics from Mac Repertory:
Chest; NIPPLES; Sore, smarting pain (6)
Chest; NIPPLES; Sensitive (7)
Chest; NIPPLES; Scabs on (1)
Chest; NIPPLES; Painful (3)
Chest; NIPPLES; Pain, simple (7)
Chest; NIPPLES; Itching (11)
Chest; NIPPLES; Inflamed (10)
Chest; NIPPLES; Fissures (8)
Chest; NIPPLES; Excoriated (17)
- Castor Equi
- Lac Caninum
I would do a lactation evaluation with this patient as well as a homeopathic evaluation. I would want her description of when it started, description of her pain, what makes her symptoms better or worse, any treatments she has tried and with what success, an evaluation of her latch, evaluation of the baby and whether he is thriving or if he is ill, the baby’s response to the breasts, is he nursing well on both sides or refusing, does the baby have thrush, or is he tongue-tied?
The answer to these questions would determine where I might go with my questioning. I might stop to do some teaching about Lansinoh if she had been using that and give her an alternative, since often people slather it on and then the baby can’t latch properly adding to nursing problems especially latch.
Sticking with the homeopathic evaluation, I would want her description of symptoms from the mentals to the NWS, and any detailed description of her pain or sensations……All this would be after her lactation consultation.
-cracked ulcerated nipples, deep painful cracks
-sore nipples excessively tender
-swelling of mammae
-violent itching in breasts
-great sensitivity in the nipple area even when they’re lightly touched or when they come in contact with clothing.
-mind – unusual laughter about things not funny
-mastitis pain is throbbing; redness, streaks radiating from nipple
-breasts feel heavy; are hard, red, and hot
-very red inflamed
-<3pm-11pm, after midnight, <lying down
-mammae hard and very sensitive
-breast hard painful and of purple hue
-mammary abscess-breast lumpy, stone hard, tender in spots
-when child nurses, pain goes from nipple all over body
-cracks and small ulcers about nipples
-aching, soreness, restlessness
-bloody, watery discharge from breasts
-generally <cold and cold damp
-aggravation at night
-mammae lax and shrunken, HARD, painful to touch
-stitches in nipples and breast
-wants to press breast hard with hand
-breasts enlarge and become painful before and during menses
-itching of breast
-aggravation from suppression of sexual desires
-mentally closed, flat or hard people, mental dullness or confusion
-breast pain due to any type of motion including deep breathing
-better lying on painful side (decreases movement)
-pain sharp and stitching
-breast hot painful and stony hard
-abscess of mammae
-hard, hot, painful breast, better from heat
-sharp stitching or splinter like pains in the breast
-patients emit a sour smelling discharge from the breast
-extremely sensitive to cold air or cold applications
-irritable and angry outbursts, critical, impatient, hurried
-chilly and aggravated by cold, intolerant of drafts