My Breastfeeding Experience - Ductal Thrush

If you've read my previous breastfeeding experience posts you could be forgiven for thinking that breastfeeding as a whole has been the worst thing I've ever done. Hands down, it's been the most draining, tiring, commitment and determination requiring, and at times, painful, thing I've done but I promise it's not as bad as these posts perhaps make out.
I will write a positive breastfeeding post soon, I promise.

These days, breastfeeding for me is just a normal part of my day. A massive part, because it takes up hours and hours of my awake time. I've managed to get Quinn in to a routine of feeding about every two hours - but please bear in mind that she very very rarely sleeps in between those feeds so it feels constant to be honest. However I don't really think about it that much, it's just feeding the baby after all.
However - Quinn's latch is still shocking. A baby should open it's mouth super wide as it approaches the breast, and get a big mouth full of soft boob tissue in the mouth, basically - baby's lips and Mum's nipple should never meet. Someone tell this to Quinn. This is, in part, the legacy left behind by her tongue-tie, but she also has an upper lip tie, which means her top lip is connected to her top gum by a flap of skin that descends to where, eventually, her teeth will be, so she can't curl her lip up. There's not a lot you can do for a lip tie (they're only surgically altered in quite extreme cases) but it does effect her latch somewhat.
Good news is - breastfeeding, on a typical day, is no longer the eye watering, painful experience that it was. Bad news - the latch issues mean that I'm more prone to blocked milk ducts and mastitis, and pretty much have to accept this as my fate if I want to continue feeding. I've tried everything to correct Quinn's latch but she genuinely can't feed comfortably in any other way so I've had to just let her get on with it.
I'm so used to this now that on days when I notice a lump forming under my skin I immediately get a hot compress on it, massage (from the lump towards my nipple in long, firm strokes) and feed like crazy on that side to shift the blockage. This usually works a treat and I avoid infection setting in and mastitis developing.
But there is something worse than mastitis. So, so much worse. Boob thrush. The top reasons that people stop breastfeeding are as follows:
  1. perception that baby is unsatisfied/supply issues
  2. cracked nipples/painful latch
  3. post natal depression and/or anxiety
  4. pain from thrush
  5. Mum's return to work
  6. baby has colic/reflux symptoms eased by a bottle
Blocked ducts and mastitis don't feature (horrific as they are) - but thrush is the No. 4 reason that people quit breastfeeding. The pain is like nothing else.
I asked some other breastfeeding Mum's to describe the pain of having a thrush infection in your nipple. Results below:
"like someone piercing, and re piercing, your nipple constantly with a shard of broken glass"
"like someone pushing a hot needle in to your boob through your nipple"
"like a gerbil is eating your boobs"
"like running your nipple across a cheese grater all day"
"like dying, probably."
So yeah, seems like I'm not alone in finding the whole thing overly horrific. The pain of thrush is a very sharp, ouchy, needle-like pain, but at the same time, persistent. It doesn't really go away but is worse during, and especially immediately after, feeding. The pain of blocked ducts and mastitis is more like a hot bruise so they're pretty easy to tell apart once you've experienced both.
Some of the symptoms to look out for if you think you might have thrush:
  • baby may have white lumpy or furry looking residue on tongue. Sometimes this can be milk - so check their tongue before, not after, a feed.
  • Pain as described above
  • Nipples looking particularly red, sore and shiny
  • Damage to the nipple - yeast infections find it easier to "get in" if your nipples are already cracked and sore - however - using nipple shields can make things worse unless you're absolutely militant about boiling the hell out of them after every use.
Because yeast infections pass from one person to another so easily, if you're suffering from thrush in your breasts then baby will need to be treated for oral thrush too.
Suffering from thrush does not mean that you're dirty, or even doing anything wrong. Almost all breastfeeding Mums will experience a bout of thrush at some point on their breastfeeding journey because the yeast thrives in warm, moist, sugary environments - your baby's mouth being absolutely ideal. Short of not feeding your baby, it's very difficult to stop them from developing oral thrush, and it then becomes almost inevitable that it'll spread to your nipple with regular feeding.
The normal treatment for oral and nipple thrush is a clotrimazole cream for Mum, which is applied to the nipple and surrounding areola after feeds, and a treatment for baby too. Initially Quinn was prescribed Nystatin which is an oral suspension (like Calpol) but I found this made no difference what so ever - and most Mum's I've spoken to had little or no success in treating their baby's oral thrush with Nystatin. A prescription for Daktarin gel seems more popular - which is what I've used to treat Quinn successfully. It's an orange flavoured gel which you rub on to their tongue, gums and roof of mouth with a clean finger. Daktarin gel can only be given to babies under 4 months with a prescription from the doctor - but after that, can be bought over the counter.
Sometimes, the thrush doesn't go away. And here's my experience of ductal thrush. If the yeast infection continues to spread in to the breast tissue it may eventually reach the milk ducts and set up home there. This is where the pain gets to pillow-biting levels. Yesterday I actually screamed when Quinn latched on - and I never felt pain like that even when my nipples were bleeding and red raw in the early breastfeeding days. This is grim.
Symptoms are still as above, but the pain is a lot more intense - like someone holding a red hot poker to your nipple, and the application of a cream won't touch it.
I've since been to the doctor and been prescribed a 14 day course of Fluconazole tablets which on Day 7 as I write this, still aren't making that much of a difference. Ductal thrush is extremely persistent and hard to shift, and thus is responsible for the end of many a breastfeeding journey.
If you're suffering from thrush, as well as sticking to your prescribed medications, there are others things to remember in order to get rid of the infection.
  • Boil all bottle teats, pacifiers/dummies, teethers, nipple shields and anything that baby puts in their mouth - where older babies are concerned this is pretty much everything. Your normal steriliser isn't enough and items need to be in boiling water for 10 minutes to kill of the thrush apparently.
  • Replace all bottle teats, dummies, teethers etc. weekly. This gets expensive. 
  • Change breast pads after every feed and either hot wash your reusables or use disposable liners until the infection is clear. I initially used my reusables but I wouldn't usually change them after every feed and it's hard to keep on top of, washing wise, so I'm just using disposable breast pads for the time being.
  • Wash all fabrics that come into contact with the nipple daily on a hot wash - bras, towels, clothes etc.
It is perfectly safe to breastfeed with thrush. If you feed less regularly as a result of the horrific pain (as I made the mistake of doing) you then put yourself at risk of blocked ducts and mastitis and believe me when I say, from experience, you don't want both at the same time - so feeding through it does kind of become your only option. However, if you express breast milk whilst you have thrush you need to feed it to baby straight away - as giving milk that was expressed whilst thrush was present, after the infection has cleared up, could reintroduce it (and freezing doesn't kill the thrush)
See a breastfeeding counsellor or lactation consultant if breastfeeding is painful or uncomfortable (access these via your SureStart Children's Centre or ask your health visitor for contact details). If you suspect that you're suffering from thrush see a pharmacist. If baby is under four months, or you'd rather get treatment on prescription, see your GP.

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