Since the mother uses the pain scale to rate her own pain, I agree with Jean
Cotterman that a rating scale becomes an effective and respectful
acknowledgment to the woman that she is being listened to.  Sharron Humenick
describes the use of a rating scale to give mothers a vocabulary to describe
engorgement.  She and Pamela Hill did their own research and cited other
research to validate that mother's self-assessment is an accurate way to
measure discomfort.  In their own work, Humenick and Hill asked mothers to
describe on a scale of 1-6 what their engorgement was like.  Level 1="soft,
no breast changes" and level 6 = "very hard, very painful".  Because
Humenick and Hill's research documented more breastfeeding problems when
women reported no engorgement AND when they reported severe engorgement, I
always perk up my attention a little when my history taking reveals
engorgement at either end of that spectrum.  It is also a useful phone
triage technique.  The two impt. articles on engorgement that inform this
post appear in JHL 1994 10(2).

Visual evaluation and other types of history taking generally give us the
reasons for the pain (which can be as varied as pain elsewhere in the body)
but the self-rating gives the mother a chance to report how she perceives
the pain, and how distressing it is to her. Given each individual's unique
circumstances, each will respond somewhat differently to pain.  The LC's
response to the mother's response to pain is one of those areas where
hopefully some counseling skills will prove useful.  There are times when
all I need to say is:  "This feels scary and is so new you don't know
whether to be appropriately worried.  Your situation is uncomfortable but
does not appear dangerous, and will prob. resolve with a few changes in
technique, etc."  This gives rookie moms a perspective.  Other times, I say:
"You are absolutely right.  This is not normal and clearly is painful.
Let's get you some medical help and find other ways to improve your
experience."

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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