>> At the extreme end of the
scale is the new mother who appears to experience severe pain in the total
absence of any physical cause and I have to conclude that the cause must be
emotional.  I have worked with three women in recent months who draw back
and cry out in apparent agony and terror just before or just as the baby's
mouth brushes the nipple - the baby is not yet latched (and has never
latched before, so there is no question of trauma) and the latest one
(yesterday, still fresh in my mind!) reacted this way to a breast pump.

I've referred before on Lactnet to Roger Short's elegant little study
showing a huge increase in nipple and breast sensitivity even to light
touch in the last weeks of pregnancy and the dramatic increase in the first
days postpartum. I've seen women exactly as described above and they are
simply the far end of this spectrum: even silk against their skin can be
exquisitely sore. This is real, this is organic, this is not psychogenic.
It is treated with TLC, knowledge that the effect plateaus around 3-4 days
postpartum and slowly starts to decline; with pain relief as needed,a nd
any comfort measures that work. I call it initial hypersenstivity.
Reassurance sorts this, especially if the mother thinks of it as positive
proof of her body's tremendous capacity to respond to the lightest touch of
her suckling baby, and knows that it is time-linited.

Then of course there's dermatitis due to a myriad things from
jogging/exercise to stubble, shampoos and sanitised nursing bras (no need
for major redness or any significant signs) and thrush (often invisible)
and hairline fissures (invisible but excruciating, and can develop in
pregnancy) and so on. All of these can be very sore and look quite
unremarkable.

Please don't read too much psychology into anything when we know so little
of the range of normal responses. Even if true, psychological diagnoses are
frequently depressing, damaging to morale, confidence, and the rest. I
avoid them like the plague without clear diagnostic signs, taking it for
granted that a mother with very sore nipples has good reason to feel sad,
upset, depressed, apprehensive, anxious, sleep-deprived, and the rest. In
my view, the mother who has very sore nipples and is not some or all of
those things is psychotic or on medication! When you've lived with nipple
pain for three months you know what I mean here! I loved Ann Oakley's
comment that post-natally depressed women are neither bad nor mad, but sad:
and for many the circumstances of their lives are such that they would have
to be psychotic not to be sad; sadness and depression are the appropriate
human response to their lives. Which raises doubts about the wisdom of
using medication to suppress appropriate human distress rather than
providing supports to fix the problems that make women sad...And I make the
point to medical students that if the only male organ of equivalent
sensitivity to the female nipple were to experience severe pain during
normal physiological functioning, men might get post-coitally depressed and
even think twice before going on with the job...

As for sexual molestation: not the most common cause in my view, and not to
be assumed as common. There are usually other clues besides the physical
too, if a good history has been done.

A small plea: here on Lactnet could we restrict the word nipple to the
human things on chests, and use the word teat for the artificial things
that some people see as a perfectly adequate substitute? Language matters:
by calling teats nipples we are humanising them and the process. They are
not nipples; it is an insult to nipples to call them that; and given that
the fluid that most frequently flows through them is basically bovine, teat
is the better term to use. If Americans find teat offensive they need to
invent another word; but the very fact that it is offensive if used for
bottle ends, but OK if used for udder things, is symptomatic of the
problem. At the very least it should be artificial nipples versus nipples..


Maureen Minchin IBCLC