As a peer breastfeeding counselor with Nursing Mothers Counsel here in the Bay Area (we also have a Santa Cruz chapter), I agree with much of the advice you've gotten so far.
I do have a few suggestions to help:
- Air drying could be exacerbating the problem, as wet wound healing has been shown to improve the skin's elasticity (which is important for a nursing mom!) and lessen the risk of scarring. I know scarring isn't something you're probably concerned about with nipples, but think about how a cut feels when you let it air dry vs keeping it covered with a band-aid. When you let something air dry, it tends to become tight with decreased elasticity, and when you think about this happening with nipples, I just cringe thinking about the pain that could be felt while the nipples go from dry & tight to good & wet.
- I 2nd the tongue-tie possibility. My 1st was tongue-tied, but we didn't know until he was 2 wks old. Long story short: ENT told us @3wks no he's not, LC diagnosed him with Type 3 Posterior Tongue tie @4mo, got his tongue clipped @4mo = IMMEDIATE difference. However, I've heard from other moms of tongue-tie babies that they didn't notice a difference at all, so I'm thinking it has a lot to do with the TYPE of tongue-tie or extent of the tie itself. Worth getting it checked out, though!
- No one has suggested Reynaud's Phenomenon. I had this with both my kids, and it was EXCRUCIATING! It's a vasospasm of the nipple, even though it's most often found in the extremities. Blanching of the nipple after a feed, stinging pain when nipples are erect, painful sensation when brushed with clothing (ie: nursing bra, shirt)... these are just 3 symptoms. You can find out more by googling it, but what worked for me was 4 days of 250mg of B12, then a maintenance dose of 25mg per day. I did this 25mg maintenance dose until about 8mo, then did a trial run without it and ended up being fine. I wish I would've known about this with my 1st because it was unbearable at times!
- At Day 8, you should not still be experiencing engorgement. Ways to alleviate this are: feed baby often (10-12 times per 24 hours), pump just to relieve pressure and soften nipple enough for baby to get a good, deep latch, cold cabbage leaves or ice packs (unless you feel you have Reynaud's!!!), ibuprofen/tylenol for the pain/ache. If baby is already feeding 10-12 times per 24 hours (which is VERY typical of a wk old baby!), then I would NOT pump in between feedings unless it's just to relieve the pressure. This could lead to what another suggested about overproduction.
- My last suggestion is something we just learned about 2 weeks ago and is a fairly new thing that LC's are trying now with babies who won't latch or don't feed well in the traditional breastfeeding position of laying down on his side. It's call Laid Back Breastfeeding, and it's just what it sounds like. Mom lays back at approximately a 64 degree angle, and baby lays on her tummy. Gravity ensures that baby gets as deep a latch as possible, and it's actually a lot more comfortable for mom because you can lay your head back on some pillows and rest instead of leaning over baby and giving yourself a crick in the neck.
I can email articles to you about any of these suggestions if you'd like. Just send me a private email at ____@____.com (I can't attach anything on Mamasource). You can also check out NMC's website at http://www.nursingmothers.org for more helpful info as well as a schedule of our free breastfeeding classes on the Peninsula (for you or any pregnant mommas you may know!). Good luck, and happy nursing :)