nipple shape after feeding

[nearlyreadytopop]

I posted here a number of weeks ago asking about nipple pain. A bit of background info. DS is now 17 weeks and ebf. After a number of weeks of pain I managed to get a perscrition for Dr Jack Newmans All purpose nipple ointment. I have used it for three weeks and have noticed some improvement but the nipple still stings and looks 'wrong' after feeding. I have had DS checked by a lactation consultant, two GP's, a paediatrician, a bf specialist HV and a number of midwives at the breastfeeding support group we go to. All have said his tongue looks normal and the latch and position look good.
I also have had a fast let down and oversupply, to overcome this I use one side per feed and either feed lying down or in BN position (unless I am out and about and its cradle hold).

To get to the point
One side is painfree. If I take DS off when he is actively feeding the nipple is elongated and cylindrical. The other side hurts and when I take him off this side my poor wee nipple is bright red, short, the end is wedge shaped and the whole nipple is like a flattened circle.
Why is this? Can babies suck differently depending on what side they are lying on? Or is it more to do with the general morphology of that nipple?

Again sorry for the ramble and if you have got this far

I have no idea why, interesting though...
try putting him under your arm to feed him that side, so that he is turning his head the same way as when he feeds the other side, and see if that makes any difference.

A lot of babies do have one side that they favour, as Waily suggest perhaps trying a different position so that he is facing the same way as he would the pain free breast.

You already know that there is something going on with the painful breast. The nipple shape on the "good" breast sounds great but an odd shaped nipple on the painful one is not right.

Unfortunately these things are pretty impossible to diagnose online. I'm sorry that you have not been able to find an answer although it sounds like you have lots of great places to go to for support!

Oversupply and fast letdown can be really tough although should improve with age as he becomes bigger and more able to deal with the milk flow. I would suggest trying different positions on the painful side, for example you could lay down to feed as though you were going to feed on the good side but lean over slightly to feed off the painful one, and see if you can find one that works. If you do find something then give your nipple time to recover, if the position you find is not practical for when you are out then just feed on the good breast when out and save the other for home. You may find that doing that for a while and giving your nipple the chance to recover and your ds the time to get used to feeding off that side properly will mean that after a while you will be able to feed in cradle or however you like on either side.

Incidently you say you are feeding one side per feed to help your oversupply. You may want to look up "block feeding" if you are still struggling with that In block feeding you do several feeds in a row on one side. The idea being that the other side gets pretty full in the meantime and sends the message to your body to reduce milk supply. You need to take care though, allowing yourself to get too engorged could lead to blocked ducts.

waily, thank you, I will give it a go next feed.
Indith, I think my supply has settled down a lot. Im not soaking through breast pads as quickly and DS no longer comes off and on when let down happens. I will def try the change of position at the next feed and let you know.
I was also wondering if it would work (in terms of milk supply) to pump and feed from the sore side and continue to feed from the breast when its the 'good' sides turn?

Tongue ties can be missed. Who has checked it so far?

Bertie, thats what I was worried about so I have been asking anyone that might have an idea! So far its been the lactation consultant, two GP's, a paediatrician, a bf specialist HV and a number of midwives at the breastfeeding support group we go to.

I should add that DS is doing very well. He had a week in SCBU at the beginning (I expressed) and he lost a little weight but since day 14 he has been tracking the 91st centile on his growth chart. This makes me all the more determined to keep it going.

A friend has suggested that as he had a forceps delivery a cranial osteopath might help. I have never heard of this before so am about to start on a web search.

It is really fustrating isn't it! My DS makes my nipples 'lipstick shaped' and the tips go white where he nips with gums (is 6 weeks) I have been to a number of people who all say latch is fine and I know he feeds well but he does this in all positions and is to quick for me to break the latch before he does it, he then feeds normally again. I have got nipple pads that go in the fridge and using these helps me recover between feeding but cluster feeding can make me cry so am expressing and using bottle o have a break sometimes. Will be interested if any one else has a solution.

Candr, something isn't right with the latch or possibly tounge tie or other slightly abnormal mouth shap. Who has seen your latch? You need to see trained BF counciler or the infant feeding specialist from your hospital. It really shouldn't hurt like this.

nearlyreadytopop - was the lactation consultant you've seen trained in tounge tie devision? as I belive they are the experst and they can be missed espicialy if postiera. Although you'd expect to be having the same propblem on both sides. I don't know if something like a high arched pallet mite cause this sort of problem if you have two different shaped nipples. Has anyone check him for this?

That's great that your ds is doing so well nearlyready.

Expressing can provide you with temporary relief and if it is really far too painful to feed then anything that keeps you going can only be a good thing. However, expressing is not as efficient as a baby at getting the milk out so doing it long term and too often is not going to do your supply much good. Also, babies find bottles easier than the breast, you don't want them to get too used to it! Candr if you are expressing a fair amount then have you looked at cup feeding the milk rather than bottle feeding it? Since your baby is only 6 weeks old I would be a little concerned about how well he is established at the breast. It oculd be that while a bottle is giving you a break it is not helping you to solve your problem.

A lipstick shaped nipple means there is a problem with the latch. I know it is frustrating having people telling you everything is fine but if your nipple is mishapen after a feed and you are in pain then it isn't fine. Do both of you demand that your babies are checked for tongue tie by someone who knows what they are looking for, not just your GP. Other than that it is a question of positioning which can't really be done over the internet.

Anybody looking at ds1 would have said that he was NOT tongue tied.

But he is.

They would have needed to put fingers in his mouth and either lifted his tongue to see, or felt the two little strings that attach to his gums.

All the stuff you read about not being able to stick out the tongue, heart shaped etc etc seems to relate to the end which joins to the tongue. But the lingual frenulum has TWO ends and the positioning of the end on the floor of the mouth is equally important!!

You need to find somebody who is an expert.

I dont have a lactation consultant near me who is trained in tt. I have been in touch with a LC who has given me the name of a Doctor (200 miles away) who will do tt division privately. There is a three week waiting list and I need a referral from a GP or LC. As my GP doesnt believe in TT I have just ordered an online consult with Milk Matters.
Fingers crossed.
Thanks everyone for the advice, I will let you know how it goes.

I was going to link you to the milk matters website, but I see you've found it already!

Where are you based? (you don't have to answer if you don't want to!)

There is a pic on my profile of under ds1's tongue. It's not the best pic ever, but you can sort of see the problem with it. I have no idea what it looked like when he was a baby, because I knew nothing about tongue tie and it didn't even occur to me to look. DS1 is suffering terrible gastric trouble and I am quite convinced that it is because he can't chew and swallow properly because the movement of his tongue is restricted. It is important that if your ds is tongue tied that you get it dealt with sooner rather than later.

Good luck!

Depending on where you a biased there is also a lady who although baised in London will travel to do TT divisions. In fact she travel's all over the UK but I guess you'd like to know if it is TT first. Her name's Ann dobson, I've met her recently she's very passonate about this topic.

Sorry, have been offline this afternoon. I am in Northern Ireland. According to Gp they only consider tt division if infant can't feed, which seems pretty rubbish to me.