Yeast.

Nipple yeast. Candida Albicans. Candidiasis. Thrush.

Often misdiagnosed, often the source of much excessive and unnecessary new mother obsession and angst.

So, let’s start with the fact that yeast is a normal flora. It is a fungus (hence the mushroom above) that lives all over your body in varying concentrations. We are never actually “yeast-free,” nor should we attempt to be. This is an important fact for you to remember.

My mother warned me as a child to never sit in a wet bathing suit or I may get “crotch rot.”  A pretty graphic description for a vaginal yeast infection, but you better believe I always got out of my suit in a timely fashion. Since yeast loves dark, warm, wet places, vaginas, mouths, and rectums are common sites for it to overgrow.  Remember, it always lives in low levels in these places, but yeast is an opportunistic bug. Given the edge—a wet bathing suit, the disruption of pH from sex—yeast overgrows and oversteps its bounds. The result is a burning, raw, sometimes itchy sensation.

We pretty much only hear about yeast overgrowing on nipples during breastfeeding. It is rare to get a yeast infection on your nipples at any other time. Not only are lactating nipples a warm, moist, and dark place, but they also often have varying degrees of breakdown in the tissue. That, coupled with an already low immunity from lack of sleep, leaves the perfect opening for yeast to overgrow.

There is a lot about yeast out there on the interwebs. I am going to give you my run down on yeast: how to figure out if you have it and how to get rid of it (i.e., knock it back to normal levels).

  1. Yeast pain is usually new onset pain, not pain that has existed all along.
  2. Yeast will creep up on you slowly. If you are paying attention, you may be able to knock it back with some natural remedies. If you aren’t paying attention and it knocks you back, get drugs.
  3. When you are a breastfeeding mother who is directly latching her baby onto the breast with or without a nipple shield any number of times a day, symptoms will almost always show up in both nipples. Bilateral symptoms is a hallmark of yeast as the yeast is traveling from the baby’s mouth to one nipple to the other nipple and back again.
  4. You can re-infect yourself and your baby with milk you pumped while you had yeast. It is fine to use this milk while you are being treated for yeast, but don’t feed it to your baby once treatment is over.
  5. You must, must, must treat both mother and baby in order to properly get rid of yeast, even when baby doesn’t show signs of oral thrush.
  6. It is a really good idea to treat for seven days past cessation of symptoms. If you don’t, yeast overgrowth will often return.
  7. The internet will send you down a dangerous rabbit hole that will convince you that every surface in your house is crawling with yeast. It will have you bleaching and vinegar washing and boiling everything it sight! Don’t go down that rabbit hole. Just take the right meds so you can feel better.
  8. Yeast is very often misdiagnosed when the true culprit is vasospasm. Treatment for yeast almost always makes vasospasms worse. So, if you are being treated for yeast and symptoms get worse, not better, you were probably misdiagnosed with yeast when you really had vasospasms.

Here is how I figure out what’s up with a mom’s nipples. I ask a series of seemingly repetitive but important questions about what she is feeling:

  1. Is this is new pain, or have you had pain all along? If you have had pain all along, is the pain suddenly now different or worse?

It is really rare to have nipple yeast straight out of delivery, even if mom got antibiotics during labor. So, if you have had pain since delivery, it is most likely a latch issue that is causing subsequent nipple trauma. The nipple trauma left you susceptible to an overgrowth of yeast, which may have taken that nipple pain to a whole new level of intensity.

Alternatively, a pretty clear case of yeast is when pain comes out of nowhere after a period of mom being pain free. New onset of pain after a period of being pain-free is rarely the latch and is often yeast.

  1. How do your nipples feel?

I care much more about what mom is feeling that what I am seeing. I find that inspection of nipples is often arbitrary. I can look at nipples that seem hot pink and mom says they feel fine, or I can think that nipples look fine and she can say they feel like someone is sticking them with hot pokers.

  1. How would you describe the pain?

I spend a lot of time talking in great detail with mothers about their nipple pain.

This is what yeast sounds like:

“Both nipples burn before, during, and after breastfeeding. When the baby is nursing on one breast, the other nipple burns. The burning sensation starts in my nipples and radiates up into my breasts. I don’t like it when anything touches my nipples, like a towel after the shower, because it feels very raw. It feels good to have my nipples open to air.”

  1. Pumping usually doesn’t feel better to yeasty nipples.

If you are having pain from latching the baby, it often feels better to pump since the pump provides an even suction. But yeast is just as angry being pumped as it is being nursed. So, I am suspicious of yeast for a woman who says pumping doesn’t give her any relief.

Once I am pretty sure it is yeast, I treat. Now, I know there are a ton of all natural remedies, vinegar washes, laundry washing regimens, dietary changes, gentian violet, grapefruit seed extract, etc, etc. I find these strategies to be only worth considering for repetitive, difficult-to-treat yeast that is unresponsive to medication alone. The vast majority of nipple yeast doesn’t require the stress and workload that accompanies the aforementioned maddening yeast eradication protocols.

Let me remind all of you out there who want to write nasty comments on this blog about how I am a drug pusher—this is Balanced Breastfeeding. I do not feel that some of the regimens pushed upon new mothers are balanced. They are crazy making. And I happen to know what yeast can look and feel like when it gets out of control (i.e. are treated with vinegar instead of Diflucan). It is much harder to treat and takes much longer to get rid of.

If you would prefer to start with a more natural remedy, go for it! Give it about five days. If symptoms improve, great! Keep it up! If they get worse, you may need to consider taking medication.

We treat mom and baby simultaneously until seven days past cessation of symptoms.

This may take three days or 30 days depending on how long the yeast has been festering.

We treat seven days past being symptom-free because yeast loves to die down and hide so you will let your guard down and stop treating only to have it flare up again. When you think yeast is gone, keep treating for seven more days to really get rid of it.

If after three to five days of treatment, symptoms have gotten significantly worse, it is wise to consider stopping treatment and taking a fresh look at the possibility that this is vasospasm, not yeast. If symptoms feel about the same or a little better, press on with the treatment. It can take weeks to fight yeast back to reasonable levels that don’t cause pain.

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