When it looks like thrush but is not thrush

I think I googled every article about thrush when I was struggling to breastfeed May in those early weeks. I had no idea that it existed, what the symptoms were and how to treat it. It looked like a pretty classic case, I had a burning sensation that began towards the end of a feed rather than pain at the beginning. The burning continued after the feed. The sensation of clothes or towels against the skin was deeply uncomfortable. My skin was red and raw. I had a crack on my left side. When it first started it was more on the side of being uncomfortable, that's the best way I can describe it. Being new to breastfeeding I didn't even know that how I felt was not normal. My midwife and I spoke about it and we decided to try Daktarin cream after each feed to see if that would clear it. Sugar and anything with yeast (such as bread) was also eliminated from my diet in an effort to combat it too. It appeared to be cut and dry, a yeast infection.

Four days passed with little improvement. I began to imagine that perhaps things were getting better only to find as the day wore on and the nights approached I was in increasing pain. By the middle of the following week the pain had now spread as a deep tissue pain in the breast. To describe that pain is very difficult, it is not like anything I have ever experienced. It was like a stabbing sensation and felt like it needed counter pressure when it would come on which was straight after a feed and last on and off for at least an hour. With May feeding every two hours it was a constant cycle of feeding, applying cream, pain and my tears. A week following the onset of symptoms I went to my family doctor to receive a prescription for fluconazole, an oral medication to combat thrush. I have a lot of faith in my family doctor, but when it came to breastfeeding I think the knowledge was limited. May came with me to this visit which involved quite some logistics to time feeds and get her out of the house at less than 3 weeks old. An examination of her milky tongue caused some concern and so the decision was made to also treat her with miconazole gel after each daytime feed. Though she had no other symptoms and was not having any other significant issues. A single large dose of flucanazole was prescribed for me alongside continuation of the cream.

May was such a tiny baby at that time. Therefore it was vital that the gel given to her was applied in very small parts so she would not choke on it. This meant rubbing small amounts onto her gums and tongue. Adding this routine to our feeds involved time and frustration for both her and me. Days passed and instead of seeing improvement in my pain it worsened. A return visit to the doctor was in order to receive a course of treatment of the fluconazole. May was once again bundled up and off we went to the practice. I was given a course of 10 days of drugs.

When three weeks of symptoms and pain had gone by I was starting to feel desperate. My feeding relationship with May was nothing like I had expected. With each feed that passed I would dread the next one. I would just begin to feel the pain subside when I would hear her looking for me and my heart would fill with dread. Those special bonding moments over a feed were nowhere to be found and I started to seriously doubt my energy to continue breastfeeding her. I found the nights particularly difficult when I could not fall back asleep following a feed because of the pain I was in. However, nursing May was something that I felt could improve if we could just find the solution to my pain and the support from my mid-wife was invaluable. She reassured me that we would find the answer and that things would get better. Whilst I felt like I was failing as a mother, my mid-wife told me I was brave and strong. With no improvements following almost three weeks of treatment it was time to consider that my classic case of thrush was not actually thrush. If it had not been for my mid-wife I would have never got to the bottom of my problems with feeding May and may have given up breastfeeding. Another trip to my family doctor resulted in an opinion from his female colleague that I was overproducing and needed to pump following a feed and to discontinue all medication. There were strong indications this was certainly not my problem. It was time to see a specialist.

It was the specialist that confirmed my mid-wife's suspicions that I was suffering from a bacterial infection rather than a yeast infection. May was examined and it was suspected that she never suffered from an infection at all. There was a huge sigh of relief that I could discontinue the oral treatment of May which had been taking place after each feed for almost two weeks at that point. A combination cortisone and anti-bacterial cream was prescribed for me. I should have felt on cloud nine, but to be honest that was the fourth doctor visit I had that week and at that point I just felt that it was another opinion on what was causing my problems without me knowing that this would be the solution that would work.

The cream was only to be used for five days following each feed and slowly but surely things started to improve. The raw redness began to heal, the deep pain was starting to subside. The light at the end of the tunnel began to shine. Those three weeks of constant pain, which became so unbearable, were probably some of the worst weeks of my life. After a pain-medication free birth I thought I was prepared for anything, but I can now safely say that childbirth is not the worst physical pain I have experienced. Emotionally it was also difficult. I still struggle with the thoughts that I let May down by being reluctant to nurse her, especially when she was looking to comfort nurse. She was such a tiny baby and needed me. I remember the positives though, that we stuck together through our difficult nursing relationship and that now, three months in, we are bonding more than ever before as she smiles up at me from a feed. I am so grateful to my mid-wife for the support she gave me to believe that it would get better and that we would find the solution. A cut and dried case of a yeast infection was not so clear after all and I have learnt that many things can easily disguise themselves as being thrush.

Back to the beginning

When May was born we did skin to skin for around 2 hours before the midwife came back to measure and weigh her and put her in some clothes. It was late in the evening when we were then transferred down to our room. They wheeled the bed down the hallways and I held May in my arms and felt like I was floating on air.  

The following day the nurses helped me to latch the baby for feeds some of the time, but it was brisk and as soon as it was done they left the room. I asked for some additional support, how was supposed to know if she was drinking or not? Whilst some nurses were somewhat helpful, I was also told that I 'would feel the difference', which didn't mean much to this new mum. No one sat through a feed with me which I found a bit disheartening. The hospital also very much pushed the advice that I had to feed May for at least 15 minutes on each side for it to count as a feed. I found this quite difficult and spent a lot of time anxiously watching the clock. Those first few days I think I spent more time watching the clock during feeds than my new baby.

I had no idea that I would be able to judge some aspects of the latch by looking at my nipples after a feed. I knew that it was not supposed to hurt to feed, but I was in pain at the beginning of each feed and my left side in particular was cracked and sore. I asked the nurses about it as I was concerned but was told this was normal. May's second night in hospital she spent the whole night awake and wanting to nurse. I was exhausted, but stuck with it. I had no idea that the lipstick shape and the compression ridges on my nipples were signs of a bad latch, combined with pretty much constant feeding at night meant that by the time I checked out of hospital I was in quite a bit of pain during feeds.

When I came home I was so glad to have a visit from the midwife who had run the prenatal class myself and my husband had attended. We put the 'must breastfeed for 15 minutes each side' advice aside and focused on feeding May on demand for as long as she wanted it. I have a very strong let down and she was an efficient feeder. I don't think we have reached 15 minutes each side since we left the hospital. It was an unrealistic goal for us. I instantly felt more relaxed feeding May and was able to give her the attention that had previously been reserved for the clock. I also learnt the importance of nipple shape and got much more hope when they looked more like erasers at the end of a feed rather than lipsticks!

Whilst that should have been the beginning of a good nursing relationship, it was not to be. We were home probably less than a week when I felt what I thought was a 'tingling' sensation. Also, when May latched on the left I felt she was sucking with her upper gum which was very uncomfortable. I mentioned these to the midwife and she told me tingling was normal but any kind of burning sensation was not. Later that morning, after I fed May I realised that really it really was a burning sensation. I took a shower and afterwards did not want the towel against my skin it was so uncomfortable. A phone call to the midwife was in order and she suspected thrush.

Thrush? You can get thrush on your breasts? Who knew? It was Thursday and she recommended I try a cream after each feed. Off to the pharmacy we went and that started the first round of creams/gels. By Monday there was no improvement and by now things had progressed to a stabbing pain in the tissue which was lasting an hour between feeds, which were only 2 hours apart. It was exhausting and the worst pain I had ever experienced. My labour was 16 hours with no pain medication and it was a breeze in comparison to this. Combined with post-natal emotions it led to a lot of tears from me and I dreaded every moment May would wake up to feed. Those idyllic scenes you have in your head of nursing your baby in your rocking chair seemed like a lie. I felt like I was failing her.

By Wednesday the following week it was time to see a doctor. In my opinion family doctors are not really in the best position for these cases, they seemed quite unsure what to make of the situation. I was prescribed a once-off oral dose of medication and given an oral gel for May in case she had thrush too. So I added a regime of cream on me after each feed and having to rub what seemed like a huge quantity (when your baby is only 3 weeks old) of oral gel into May's gums and tongue. This went on for another 5 days which felt like a lifetime as I was both in chronic pain and sleep deprived. No improvement and if anything my pain got worse. Back to doctor we went. I was given a course of medication this time and was optimistic that this would clear it up. Of course I was wrong.

Measuring out the oral gel for May

More time passed and by this point three weeks had gone by of feeding, pain, medication, more pain, tears, and start again. My mid-wife found my case to be highly unusual. I had a constant phone line open with her as we talked almost every day. She recommended seeing a specialist. The only other similar case the mid-wife had come across before had turned out to be a bacterial infection (not thrush) and therefore she recommended I switch creams from anti-yeast to anti-bacterial. I had advice from a lactation consultant to get a combination cream for me that would be both anti-bacterial and fight the thrush. I saw my family doctor again who consulted a colleague whose recommendation was that I had an oversupply issue and to quit all medication and to pump after feeding.

Luckily I got an appointment with a specialist and we packed May into the car and drove as fast as we could to see if we could get some straight answers. This was to be our fourth doctors visit in a week.

At the consultation the specialist diagnosed me with multiple problems. There was never any yeast infection as far as she was concerned and it was time to quit the gels and creams. That was a small victory in itself as the regime, especially for May, had become exhausting. The specialist figured that the cracked skin had led to a bacterial infection and that an anti-bacterial cream in combination with cortisone to heal the irritation would help with the biggest issue (and deep tissue pain). That was not the whole story though. Our latch was not at all where it needed to be, May had a shallow latch, was clamping (which is why I felt like she was sucking with her gums) and was breaking the suction regularly. You could hear the clicking noise every time she broke the suction during a feed. In her diagnosis the specialist advised me to work on our latch or else the irritation would likely continue and lead to reoccurring problems. Whilst it was not as simple as fixing the latch as I had a bacterial infection, if I wanted to avoid further issues it was something we were going to need to work on. At this point May was more than 5 weeks old and we had yet to experience a pain free nursing relationship. This was to be the beginning of working towards that goal.