I say to a pregnant women who asks, exactly the same sort of thing I say 
to anyone who asks about anything: there is a huge spectrum of 
experiences, and no one knows where you will lie on the spectrum, until 
it's happened to you.

I then lay out the spectrum: on one end, an emergency c-section where 
the mother is knocked out, and wakes up several hours after her baby has 
been born and baby may have already been supplemented with formula - on 
the other end, a mother who labours with no medication and delivers in 
her own time and has an active suckling baby before the cord is cut.  
Both can happen, who knows which one it will be?

On the establishing breastfeeding, it's the same thing: active suckling 
baby, little more than 'stretch' discomfort for a few days, no pain, 
excellent relationship from the outset versus disorganised and sleepy 
baby, or motor issues, bad advice, extreme pain and mangled hamburger 
nipples.

Then it's a dicussion of odds, and likely hood.  My pitch is that the 
vast majoirty of births are very good, and the vast majoirty of mothers 
have some pain but no significant problems on first breastfeeding.  
However, the vast majority of breastfeding support at birth is crap, and 
they need to be well armed with info and have made contact prior to 
birth with someone who can come out and help if It Goes Wrong.  I 
encourage all pregnant mothers to visit with a La Leche League group 
prior to birth, to sound out the mothers' local experience of that 
maternity hospital/services, and so they have a face to a name if they 
need to phone.  I also say that regardless of how bad a 'bad' scenario 
gets, breastfeeding can be established with support.  So if any mother 
does wake up several hours later, their second thought isn't "Oh my god, 
breastfeeding has failed"

I also tell them that agony isn't normal, and whilst some discomfort can 
be normal at first, if the pain is bad enough to need to do anything 
about - Then There Is A Problem, and that needs fixed asap.  I do spend 
time discussing that the fiddly business of latching baby on and off 
etc, is as much about mother's fine motor skills as anything else, and 
is a skill that will be learned, not something that is automatic, nor 
'maternal' - just juggling!  Pain isn't the only issue that makes 
mothers feel they are failing, as I can testify: sometimes just getting 
the baby and the nipple in the same post code can be challenging! ;-)

I then always give them baby led latching resources, so they can see 
what the baby is capable off, and suggest they prepare for the first 
latching, by preparing for their baby to do the work, whilst they 
concentrate on keeping outside intervention down to a minimum. 

The message I give on pain is expect some, rejoice if there is none, and 
if it's a lot - COMPLAIN, for that is a sign they have not been 
supported enough.  And if anyone poo-poos their pain, COMPLAIN and PHONE 
FOR HELP.  One of my personal friends, who had agonising pain at latch 
for six weeks (until, I presume, the motor issue righted itself through 
the right muscles doing the right thing enough times) was actually told 
by her midwife to bite down on a stick, to get her over the 'hump' - 
which is actually what she did.  She said it stopped her from screaming 
out loud....few mothers will get through that.

The pain issue is, to me, a reflection of lack of knowledge, training 
and support.  So many 'counsellors' are trained in basic techniques - 
and if baby is showing a good asymetric latch from the outside, they are 
totally floored on what to suggest next if the mother is then in pain.  
So I tell mothers upfront that pain issues are about poor support and 
knowledge in their supporters: I fix them on how they will deal with 
that if it occurs, not on how to cope with agony should it happen.

So, to sum up, my approach to all things is: prepare for the worst, hope 
for the best, in between will usually happen.  In terms of 
breastfeeding, that is to alert mothers that some pain/discomfort is to 
be expected, but they may have none whatsoever and won't that be 
wonderful - and if they do experience real pain that means something has 
to be done; there is a problem and they and their baby deserve help.  
Mother Nature did not design the system to include pain - pain is a sign 
something isn't working.  On this, I'm going to add in some stuff that 
Diane Weisssinger said at a talk last week - about you need to have pain 
to know there is a problem, for if you don't know there is a problem, 
you may not know your baby is struggling to get enough milk.  The pain 
is a protective mecanism on behalf of the baby - the signal you need to 
Do Something About It and find a better/more effective feeding 
position.  And if others refuse to pay attention to your baby's pain 
signal, KICK ASS on behalf of your baby.

I find the biggest thing that makes a difference on this, is when I say 
it can hurt for a couple of weeks whilst it all gets settled out.  But 
that in context of giving birth, and having that relationship, it's not 
much of a pain to bear.  I genuinely felt quite fond of my little 
'stretch' pain for the first couple of weeks - for I knew he'd latched 
on properly when I felt it.  Just saying it _can_ hurt appears to 
validate their fears.  And when you hear women talk about how much it 
did hurt, and how no one listened to them, I usually want to throw 
something through a wall...

Morgan Gallagher

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