I, too, have gone from expecting to have to "toughen" nipples, to believing
any pain at all is a bad sign and am swinging a little back to accepting
that some initial discomfort may be normal for some moms.



First, everyone's perception of what constitutes "pain" is different.  We
see this in childbirth where contractions are seen as everything from a 12
on a scale of 1-10 to being seen as simply strong contractions without any
real pain.  Sometimes, those first few sucks can feel quite strong (I
remember thinking the baby was going to turn my breast inside out my first
time!).  Even when breast play has been part of one's sexual activity, a
baby at a lactating breast is still a brand new sensation which some may
experience as simply, "Wow, that's different!" while others may experience
it as uncomfortable.



Second is the question one very supportive doc raised.  Does the fact that
most women today do not expose their nipples to the elements mean that they
are more sensitive when used to feed a baby?  I'm not sure that is a factor,
but it is worth considering.



This is why assessing a feeding has to consist of more than "Does it hurt?".
Moms who believe it is supposed to hurt (or who experienced pain with a
previous nursing baby) may say it's "OK" when they really need to make some
adjustments in the attachment.  On the other hand, a mom who has been told
that any discomfort means there is a problem may interpret normal, new,
strong sensations as pain and worry that nursing won't work for her.  I
usually start with an open ended, "How is it feeling?".  Then, based on her
response, I may explore further.  If she indicates there is some discomfort
I will ask about baby's jaw movements and the shape of the nipple after
feeding.  Does it feel like a pinch or bite?  Is it more of a strong
"tugging" sensation?  Does it last throughout the feeding or just the first
couple sucks?  Does it diminish, stay the same or increase during the
feeding?  If everything except some initial discomfort appears to be
"normal" I will ask her to contact the LC if it gets any worse, there is any
change in nipple shape after feeding, or does not improve in a day or so.



I think the reason moms liked tea bags and maybe the reason some like the
gels now is the soothing effect even if there is no measurable change in the
appearance of the nipples.  As long as she isn't led to believe that
whatever she is putting on her nipples is a cure-all for soreness, latch is
observed and adjusted if appropriate and the substance doesn't do any harm,
if it feels good, why not go ahead and use it?



Winnie


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