This thread has been very interesting - I think it's probably true that
*some* of us in the West are not very stoical about pain and expect nothing
to hurt, ever, but I am sure a lot of us have seen mothers struggle on with
nipples that are clearly agonising (cracked, chewed, bleeding) and they
don't necessarily have a high pain threshold either.

I had the most *excruciating* sore nipples with my first baby, which I hid
from health care staff for a whole week, as I was terrified they would
'order' me to use formula  - well, I was a lot younger than I am now : )
With my third the pain was  bad but there was no cracking. The midwive made
me so cross - she looked at them, and said 'well, they're not cracked -
just a bit pink' as if she was implying I was making the whole pain thing
up!  And I have lost count of the number of mothers wo call, say they have
great pain, and that the HP has said it's not positioning because the latch
is okay - and yet when changes *are* made the pain lessens and disappears.

I think there probably is evidence that a lot of us have nipples than
experience tenderness, even pain, as a response to 'getting used to' bf.
As well as making sure the positioning and attachment is good from day 1, I
suggest to mothers they see if the pain gets better as the days go by - the
pain on day 4 should be less than on day 3, for example. If the pain is not
lessening, then this is a warning sign.

I too - like Jeanette P - have worked with mothers whose pain has been
ignored/dismissed for weeks.  They may be mothers with an excellent initial
milk supply, so the baby has thrived without having to learn about good
positioning. Teaching the babies a different way to feed is very, very
difficult, and it needs a lot of patience from the mother.  But the usual
things help - lots of skin to skin, practice when the baby is *not* crying
for a feed and just nice and relaxed and alert, taking the baby off if he
hasn't got it right and trying again. In my experience, the soreness rarely
goes away instantly (though sometimes it does), but it does start to
improve very quickly.

Heather Welford Neil
NCT bfc Newcastle upon Tyne

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