DD 5 weeks and I've had pain and misery with BF from day 1 - please help

[chocciechip]

DD and I both have thrush and the GPs didn't treat this properly a few weeks back, so a lot of my pain (I hope) is down to that. I'm now on a massive fluconazole dosage, and DD and I both using Nystatin stuff. That's been for a week now, and my nipples are still a weird pink colour, with very dark edges (what is that???) and very sore, even between feeds. I think there is minor improvement but don;t know how they can ever heal when I need to either feed or pump......?

DD was also snipped for a minor tongue tie (which I don't think really affected latch).

We've been to see lactation experts twice, and taught the biological nurturing positions. It helps on the right breast (I can actually feel the 'brrr brrr brr' of milk as she sucks). Left breast still could make me scream when she latches on and really hurts all the way through, right breast feels bruised throughout. Nipples ache and itch between feeds constantly. I struggle to not cry during feeds.

I have been determined to keep going with BF but am at my wits end. Have been expressing (initally with an Avent pump but this weekend spent an ill-afforded £100 on a Medela swing in desperation) in an effort to give my nipples a chance to heal. Pumping hurts as well but I am now pumping more than bf'ing. I think my supply is dropping. DD drains 120ml at a feed and this is the maximum I seem able to express in one sitting. Just expressed again and got 100ml so don't know what I am going to do at her next feed.

Added pain too in that I have large cysts in both breasts which makes 'massaging' them to extract last drops of milk agony. I am seeing a surgeon on Weds in the hope of these being drained and hoping this will take some of the pain away.

She is gaining weight, but I think only at the 'just acceptable' level. She sometimes is very unsettled after feeds which makes me think she might need more than the 120ml I can manage, and wish I could give her enough that she leaves some behind and I KNOW she is OK.

I have given her formula and will do so if I need to but I think it affects her tummy: she went for 6 days without pooing recently after a spate of formula top ups. And she was miserable for all of those days. I am not anti-formula, but not sure her tummy knows what to do when one moment its BF and the other is formula. Wondering if exclusive formula might not be easier for her, but that would break my heart. Not the choice I want to make for her for various reasons.

What the hell else can I do? Really need to get on top of the pain, and find a way to increase supply. At the moment I feel chained to pumping and feeding and cleaning equipment all day long - I am self-employed and contracts are slipping - and I am in total despair now. It's even worse on the days DD won't settle - impossible to hold her and pump at the same time!

Can anyone offer any ideas on what I can do to give us a chance to get through this.

[fewcloudy]

"I have given her formula and will do so if I need to" You need to.

I think you should take a step back from this and think what you might have suggested to anyone in your situation. From the outside looking in, all that you have described makes it all sound like hell, and it shouldn't be.

Why would it break your heart to stop BF? To the extent that you would let your own health and even baby's health suffer?

"Just acceptable" weight level is not enough, and your baby's well being is a higher priority than your own feelings IMO.

You are already in contact with people more knowledgeable than I re. BF so I have nothing to add there but please consider things from all angles. You want to do the best of course, but losing work/money and your own health (physical and psychological) have to be considered too.

Good luck.

[organiccarrotcake]

fewcloudy I'm sorry, but you are not in a position to say whether or not the OP should be giving formula (no one can from a forum), and to suggest that she may be affecting her baby's health without proper information is at best unhelpful, and at worst unkind.

"Just acceptable" weight gain IS acceptable. The clue is in the word "acceptable".

chocciechip, you have been through an awful time and clearly things are still not right. I would firstly suggest that you take a read through this leaflet:

www.breastfeedingnetwork.org.uk/pdfs/BfN_Thrush_leaflet_Feb_2009.pdf

I would consider changing from Nystatin to Daktarin. Nystatin isn't as effective a topical treatment as Daktarin and it sounds like you need something that's going to get your nipples treated asap.

Do you know what else to do to treat thrush? It's a bugger to get rid of but it WILL go. But it lurks on your clothes, towels etc so you need to be really careful about hygiene. Some ideas:

• Change your bra daily, wash at at least 60 degrees and iron the inside of them to kill lurking spores
  
• Change your bathing/showering towel after each use (or dry your breasts with a facecloth and boil wash that to minimise washing)
  
• Boil wash breastpads, or use disposable ones
  
• Try to go top-naked as much as possible to keep yourself aired and dry. I know.. :)
  

The cysts make things sound so much worse. Hopefully they will be dealt with soon - make it clear to the surgeon that is absolutely urgent. I would suggest not doing breast compressions at all - little point in putting yourself through that.

You can take paracetamol and ibuprofen for the pain.

If formula is upsetting her tummy, going onto formula full time won't make this better.

Is there anything there which sounds like it's new?

[organiccarrotcake]

On another note, if the thrush is causing the nipple pain then they will start to heal very quickly on the Fluconazole/Daktarin combo. If not then you might want to check that the TT hasn't grown back and also get another bit of help about the positioning. If your nipples are damaged I would do this anyway. Thrush can create the kind of pain you're describing but it's more associated with soreness, itching, and the deep breast pain rather than skin breakdown.

I also forgot to mention that grapefruit seed extract can be taken to support the Fluconazole, and you can put a few drops of the stuff into the rinse cycle of your washing machine to help to get rid of it in your clothes, too.

www.highernature.co.uk/Products/Citricidal

Some people recommend putting a solution of it on your nipples but in my experience it's very drying. It can be very effective for that, but just be aware it could make things worse.

I also wanted to say that people go through what you're going through and come out the other side, exclusively breastfeeding. It takes the commitment you've clearly got, and the support of people who know what they're doing IRL. Do talk to the lactation consultants again, or your local LLL leader or NCT counsellor if you have one. They will be there for you as long as you want them to be. As will we, here.

[Mamakath]

This sounds horrendous, and you've done so well continuing to BF for this long. I was in a similar situation - had to pretty much exclusively pump for about 3 weeks early on, to give my shredded nipples time to heal. What I found helped on a practical level was:

(a) going easier on the cleaning/sterilising regime. A BF counsellor reminded me that breastmilk stays fresh for 6 hours at room temp; so you only need to clean and sterilise your pump every 6 hours, not after every pumping. You can keep the pump in a ziplock bag in the fridge to stop bacteria getting to it. This spared me a lot of faffing about in between feeds.

(b) having my mum come to stay for a couple of weeks to help out. This meant that there was someone to look after DS while I expressed - as you say, you can't express with your hands full!! Is there anyone who could lend you a hand at the moment?

It did get better for us and we gradually moved back to BFing directly. If you do want to keep going my advice would be to just take it one feed at a time and see what happens. Keep getting expert advice - sounds like you could do with some reassurance particularly about supply (100 mls at one session sounds like plenty to me but of course it depends how many times a day you're expressing, and on your baby's appetite etc...). On the other hand if you do want to move to FF you have absolutely nothing to feel guilty about, and you've already given your baby a brilliant start.

[organiccarrotcake]

Sorry for the multiple posts.

I just want to clarify on the formula - what I said about formula and her tummy does not (and should bot be taken as) me suggesting that you don't give her formula. If she needs it for the time being, that's what she needs while you get through this. However, focusing on BFing and expressing as much as possible, as much as you can manage really, to keep your supply up, is important.

[organiccarrotcake]

Some very good points from mamakath and she's right, 100mls is an excellent amount.

[chocciechip]

Thank you organiccarrotcake and Mamakath. I'm glad I logged back in after seeing fewcloudy's message.

Fewcloudy, whether you meant to or not, you made me cry with the inference I'd put my personal feelings above my DD's health. If you only knew what we've gone through the past 5 weeks.

DH is badly asthmatic - has it under control but knows what its like to be a child with asthma. And his niece suffers from eczema; we can both remember her screaming while her parents bathed her in lotions and wrapped her arm and legs in bandages EVERY night. She's now 18 and still battling with it.

I want to avoid both of these for my DD and the genetic propensity worries me. From what I have been told, BF'ding gives her the best starting chance of avoiding this. I am not anti formula, but if I switched and she developed a lifelong need to control asthema, I'd never know if I could have made things different. At least this way - as nightmarish as it is for me - I know I've tried my best.

organiccarrotcake is right: when I said 'just acceptable' I meant that within the NHS guidelines of acceptable weight gain, DD is at the lower end - which does hurt me - but the lactation expert described her as 'thriving' and the health visitor said she was absolutely fine and I had nothing to worry about. I came on here because I want both for her - improved weight gain, better feeding, and maintain the 'natural antibiotics' that BF'ding will give her.

organiccarrotcake and Mamakath, thanks for the tips, especially wrt changing bras and towels etc. I had no idea. Will stop using my washable pads and switch to disposables. Have been sleeping topless will carry that through to some day sitting in front of the TV as well.

We have both tried Daktarin but found it less effective for DD's mouth than the Nystatin - apparently it depends on the type of fungus for the thrush.... also, I was told to apply the gel (not told anything about the cream!!) and it dried out my nipples even more. There has been improvement in DD's mouth so have been told to stick with Nystatin for another week. If no further improvement we'll switch again (but this time get the cream for me).

Will def buy grapefruit seed extract and try that too. Thanks for the tip.

Mamakath one feed at a time is literally where we are. I've hit feeds twice now where I felt they were totally the last, but managed to do another and another. It feels like an endurance race, but really hoping we'll come through. It feels like its been forever. I expressed again 2 hours after and got another 40mls (only - worried) to build up her feed so will stagger along like that as well, but will top up with formula if there's just nothing there to give her.

Can I ask about pumping: Medela suggest a funnel size that's just the size of your nipple so the pump takes in little or none of your aureola, but the lactation expert said they use larger sizes in NHS hospitals so tend to go the opposite direction allowing the pump to suck in more of the aureola. Which do you think creates less trauma to nipples and less a feeling of bruising around the aureola? I know I can buy parts from expressyourselfmums.co.uk and think I need to up or downscale one size depending on which would be least painful.

Thanks again.

[organiccarrotcake]

WRT pumps, if you can afford to buy several different ones it's worth trying a few, but in my experience the soft shell ones (Ardo do them, not sure about other makes) are much better than the hard plastic ones (the soft shells line the hard plastic).

I've never heard of Nystatin working better for some varieties of thrush but AFAIK there's only one type... candida, the same as that which causes vaginal thrush... but I could easily be wrong. Nystatin has quite a lot of sugar in which tends to help the fungus grow! Also, as it's a liquid drop it doesn't stay in the mouth as long as Daktarin gel. But some doctors are worried about giving Daktarin to little bubs as it's only licensed for 4 months+ because if parents put in too much it could choke a baby, being a gel. So, of course, the answer is to use a small smear and just put a smear on the top left of the mouth, another on the top right, and so on. There's no way it can cause choking if it's just a small amount!

That said, that's just what I know about these treatments and your GP may know something I don't, so if Nystatin is working for you then you do right to stick with it.

GEL is for oral and CREAM is for your nipples :) I see you've figured that :)

Can you talk me through the weight gain? You feel it's just acceptable, but the HV says she's fine, and the LC says she's thriving. Do you feel they're wrong? Is she tracking her centiles? Is she on the lower end of the centiles but tracking them?

I'm SO with you on the asthma/eczema thing. DS1 has bad eczema and it made me utterly determined to EBF DS2, despite a multitude of problems not unlike yours. We're BFing at nearly 16 months, and planning to term BF :) I remember when DS2 was about 6 or 8 weeks, sobbing to my husband that I really do now understand why people just can't do this (DS1 was easy to BF but I introduced some formula at about 4 months and he has CMP intolerance which triggers the eczema :( ). My NCT BFing counsellor was one of many people who just kept telling me that it WOULD be ok if I kept going and that it WAS something that I could resolve. And we did :)

So I have some understanding of where you're coming from, I think, and whatever happens you'll have 100% support from me, and the others here :)

[organiccarrotcake]

Crikey, multi posting here, sorry.

Another thing that may be helpful is probiotics (acidophillus). Try Holland and Barrett. Keep in the fridge once opened. You can open the capsules and smear a bit of the granules in your DD's mouth, too.

And more info:

www.kellymom.com/bf/concerns/thrush/thrush-resources.html

Note that Gentian Violet is no longer available in the UK (it's listed on this Kellymom site which is a US site). Best to just focus on the other treatments.

[KlickKlackknobsac]

Another comment
I mixed fed my fb from 6 weeks- a bit upset tummy but soon got used- and I went on to BF for 9 months- when your flow has regulated it should not affect anything.
Do not worry about mixed feeding- I figured as long as they get breast milk, then other stuff isn't a problem- it doesn't remove the goodness from breastmilk.
You have multiple problems but stick with it.
Good luck

[organiccarrotcake]

Not wanting to upset anyone but just as a point of fact, some formula does detract from the breastmilk. It removes the protective lining on the gut that protects the baby's body from pathogens and allergens being able to pass into the body (which is why FF babies are more prone to gastroenteritis - it's not just about clean water). It is estimated that it takes around 2 weeks from the last FF to repair the lining.

However, ANY breastmilk will still have a HUGE beneficial effect. If formula is necessary, it's more of a risk to not give it than to give it, so this isn't a consideration. If formula is genuinely a choice, this is a factor to consider.

Once EBF is back in place, any effects from the formula are quickly negated and while mix feeding is in place the BM will be protecting the baby with its antibodies, as well as providing the optimal mix of nutrients and the unique developmental components that it contains.