Valerie, you wrote:
< I think we do not know enough about the
causes of sore nipples.>
I couldn't agree with you more. And I am convinced that a very
significant part of early (2-3 weeks) latch pain in not necessarily even
coming from the nipple button itself, or its skin, whether appearing
damaged or not, but from compression of the newly expanding walls of
overfull milk reservoirs, especially those deep inside under the nipple.
I am not suggesting that discussion of a pain scale would be helpful in
EVERY situation, by any means.
<I am disturbed by suggestions that an outsider(the LC) can determine the
amount of pain a mother is experiencing. >
A pain scale is not rated by the "outsider". It is rated by the mother,
herself, in order to give her a larger vocabulary, a conversational tool,
to EXPLAIN more clearly some facet of her discomfort to the HCP so that
they can arrive at a "meeting of minds".
If correctly used, as pain control literature for many other health
conditions uses it, it is not a <negation of a person's
experience of pain>, but validation that I am trying to get some clearer
idea of how much SHE feels it is bothering her, in order to determine the
probable cause and the best thing to do about it.
Hopefully, that would be just the beginning of the conversation, which as
Carol stated so aptly, some HCP's never continue. I think this is often
because they don't have the insight and the conversational tools to
investigate further.
< I think it would be far more informative to ask, whem the pain occurrs,
how long it lasts, and what has the mother been doing about it.>
Yes! Yes! A very important part of an assessment, and one that doesn't
often get done. Too often, a knee jerk conclusion is made on the basis of
a stat interpretation of that one word "sore" without adequate questions
or observation.
< Watching a mother breastfeeding, looking at the nipples will give you
a good indication of the problem. I can tell rather quickly by watching a
mother breastfeed that she is suffering--she flinches, her body stiffens,
her toes curl over, her hands are white-knuckled or she absolutely
refuses to breastfeed.>
You have very sensitively described some very important points. Body
language is very revealing. Women are frequently unaware of their
reactions as a "language" that a knowledgeable HCP can pick up on.
Often, by drawing attention to it, I can explain to the mom that her
"clenching" etc. shows me how very uncomfortable she must be, strongly
validating her perception and helping her to understand that no way am I
<trying to dismiss her pain by rating it>
But much of what I do is postpartum telephone counseling, where I have
only the mom's word to go on. Also, I have found that the more sleep a
mom has lost, the less supportive her family is, and the more discouraged
she is by every other aspect of her postpartum experience, the more it
seems that ANY degree of nipple pain will get her attention.
This often leads toward discontinuation of breastfeeding as at least ONE
thing she can subtract from her stress load. All the more so if
discomfort was never mentioned prenatally.
I believe there are situations in which the mother can move ahead more
confidently if, for instance she rated her pain as a 7 at the latch, and
then 60+ seconds later can realize that the pain has in fact decreased to
a 3. And then, two minutes later, can honestly say "Wow! It doesn't hurt
at all now!" It is a good way to help both the mom and me to compare
whether an intervention is in fact succeeding in lowering her pain.
<I think prenatally we must be honest with mothers about sore nipples.
That means that we must tell women that like labor there is a whole
range of experiences. Women are very much aware of the horror stories
about sore nipples. If they get sore nipples, they need to be aware of
the ways to correct the problem and ways to cope with the pain. >
My initial point exactly. Though she may have heard "horror stories"
elsewhere, I don't think they are helpful as part of prenatal
instruction. I deliberately try to exclude the word "sore" when I teach,
because I have observed repeatedly that it clouds communication,
suggesting different pictures in different people's minds. I think it is
important to clarify in the beginning of the discussion that there is a
difference between "tenderness" and "damage".
Then, explaining the existence of a pain scale as a way for mom to report
tenderness is a non-threatening way to be honest. Mentioning the distinct
possibility of a 1 or 2 or 3 for any woman, temporarily, till she and the
baby "get it together" can be followed with Susan's very clear admonition
< I tell them a two is OK...maybe a three is OK.....call me when it gets
above
four or when there is obvious nipple damage.>
Perhaps I chose some pretty strong phraseology when I picked up this
thread. My still-vivid personal memories from nearly half a century ago
still motivate me to take careful evaluation and appropriate management
of nipple pain as very serious matters, and to help others do likewise.
I meant to suggest that the use of a pain scale is a valuable tool for
helping the HCP understand the mother's subjective experience more
clearly in order to work toward an objective interpretation of the cause,
and thereby, choose an effective intervention.
Jean
----------------------------------------
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
___________________________________________________________________
Get the Internet just the way you want it.
Free software, free e-mail, and free Internet access for a month!
Try Juno Web: http://dl.www.juno.com/dynoget/tagj.
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
