Estimated reading time: 5 minutes
Angela Howard, North Bucks, UK
Photo: Casey Geller
By the time you are breastfeeding your third baby, everyone thinks you are an expert. It isn’t always that straightforward …
After a few initial problems in the early weeks, everything was fine. When my baby was four months old, I started to get a pain in my breast after feeding him. To start with, it wasn’t too bad but gradually became worse. My friend who is a La Leche League Leader thought it might be thrush. I didn’t realize you could get thrush in your nipple or breast.
Thrush can be very difficult to get rid of once you have it. It’s a fungal infection caused by an overgrowth of a yeast-like organism called Candida albicans that is naturally present in your body in balance with other organisms. It doesn’t usually cause a problem unless something happens that allows it to multiply excessively (illness or antibiotic use, for example) causing infection with possible symptoms of pain, itching, and irritation. The fungus thrives in moist, dark environments, such as on the nipples, in the vagina, in the mouth, and in the baby’s diaper area.
I went to see my doctor, who told me he thought it was a positioning problem, common at the start of breastfeeding. When I went back to see him a second time after no improvement, he gave me an antifungal cream to put on my nipples, which didn’t help. By now the pain was agonizing, lasting for up to four or five hours after breastfeeding. At its worst it was like the pain of labor, I couldn’t even talk while I was experiencing it. It felt as though someone were stabbing me in the breast with a knife.
My doctor spent the next few months giving me different creams, painkillers, antibiotics and yet more creams. Nothing worked. I shared LLL literature with him. La Leche League Leader Amanda did all she could to try to help me. Eventually I went to see a doctor who had breastfed her own children and she prescribed me a course of fluconazole (Diflucan) an oral antifungal. This is usually offered only when there is a definite diagnosis of thrush and topical treatments have been ineffective. Although it is licensed to be given to babies in neonatal units, fluconazole is not licensed in the UK for use by breastfeeding mothers of babies under six months. It is only available at the discretion of the doctor. I had two courses of the medication—often if you have persistent thrush one course won’t be enough. It helped. The pain wasn’t as bad, but it was still there.
I went back to my own doctor again. He told me he wasn’t prepared to prescribe me fluconazole and admitted he didn’t really know how to treat me. He was still convinced it wasn’t thrush. My only consistent symptom was pain. I decided to see a lactation consultant out of desperation. By this time the pain was much worse and I was on the verge of giving up. It was affecting my older children, I found it very hard to make their breakfast and get them ready for school, while being in pain after feeding my baby. It had been almost seven months since the thrush started.
The lactation consultant said she thought it was thrush too. (Researchers have conflicting views on the diagnosis and treatment of thrush. It has been suggested that thrush cannot spread in milk ducts. However, some practitioners believe thrush may enter milk ducts by tracking back from skin at the nipple, causing stabbing pains in the front of the breast.) My doctor eventually prescribed me a course of fluconazole and, finally, this third course did the trick.
I can’t describe what a depressingly difficult thing it was to breastfeed through day after day of pain. The older my baby got the more “why don’t you stop if it hurts?” comments I got. I can remember taking my older children to a party, feeding my baby, then going to sit in the car in the cold in order to hide the fact I was in pain. I stuck with it because it’s really important to me that my son gets the best nutrition, and that’s breast milk. I’m really glad that I did persevere.
I’ve shared my story because thrush in breastfeeding mothers is not something that all doctors are familiar with. Getting the right treatment can be difficult. It felt as though the medical profession was only concerned about the benefits of breastfeeding during the first few weeks. I was determined to breastfeed. This was my third baby, so I had experience to draw on. I can only imagine how much more difficult it would have been as a first time mother.
With appropriate treatment, breastfeeding mothers and their babies may overcome thrush and continue breastfeeding. Because thrush spreads easily a fourfold approach to treatment may be necessary that deals with good hygiene, diet, dietary supplements and medication.
If thrush is diagnosed, to prevent recurrence, both mother and baby are treated at the same time, even if one of them has no visible symptoms.
I would like to thank LLL Leader Amanda for all her help and support. I wouldn’t still be breastfeeding now at 13 months if it hadn’t been for her help.
A mother may experience any of the following symptoms if she has thrush:
- burning nipple pain
- Itching nipple
- painful breasts without tender spots or sore lumps
- ﬂaking and or shiny skin on the nipple or areola
- stabbing pain in the breasts behind the areola
Itching of the nipples or burning pain are probably the most common symptoms. Your nipples and areola may also look pale. Pain persists throughout feeds as well as between them and generally occurs in both breasts even if it starts in one. Breast pain alone is less likely to indicate a thrush infection. Alongside mother’s symptoms, her baby might have white patches in his mouth, be uncomfortable while breastfeeding, or have nappy rash.
Thrush is more likely if mother or baby has been treated with antibiotics or corticosteroids, if other family members have thrush, or mother takes the contraceptive pill. Thrush is also associated with previous nipple damage that has been healing. In the early weeks, the use of bottles increases the risk.
It’s important to eliminate other possibilities before assuming you are suffering from thrush. During the first week or so of breastfeeding, nipple pain is much more likely to be caused by trauma from a poor latch. Check and adjust your baby’s breastfeeding position and the way he latches on to your breast, particularly if breastfeeding has always been painful or your nipples are ﬂattened or wedge-shaped after breastfeeding. An LLL Leader can help you with positioning. Visit your health care professional to seek a diagnosis because there are other conditions that can present similar symptoms. With all cases of nipple pain seek help from both your LLL Leader and health care professional to determine the cause.