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Subject:
From:
"Catherine Watson Genna, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 10 Mar 2003 19:07:32 -0500
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I don't think that nipple pain is normal, period.  It is common, but
that's mostly because of the way birth and breastfeeding are handled in
our society.  And sometimes it's about the infant oral anatomy too (or a
mismatch between baby and mom).

Studies have shown that babies never seperated from mom after a totally
unmedicated birth crawl up to the breast and latch and SUCK CORRECTLY.
Babies taken away do not all get to the breast, babies medicated do not
all get to the breast, and these babies are more likely not to latch and
or suck correctly when put to breast.  Add to that the fact that many
Western mothers have never seen a baby breastfed when they give birth,
and you have a setup for difficulties.

Yes, time is almost always helpful with minor breastfeeding problems.
But the main difficulty with just applying the "tincture of time" to
every situation is that bf problems are most "fixable" if caught early.
  Some babies and mothers are vulnerable to low milk supply and the
whole cascade of difficulties that causes if the latch is not perfect.
Some babies don't have the resources to continue to struggle, and become
increasingly lethargic; making their feeding less and less efficient,
and that both puts the baby in danger, and kills the mother's milk
supply at the most vulnerable 1st 2 weeks, when prolactin receptors are
proliferating.  Since we don't know which babies are going to wind up
with hypernatremic dehydration at 7 days of age, we should intervene
when babies are not feeding well at the outset.  Simple interventions at
first (skin to skin and helping with latch for newborns; spoon feeding a
little hand expressed colostrum to wake a sleepy 2 day old;
fingerfeeding pumped milk for the 3-4 day old who can't latch on due to
abnormal tongue movements.

I am both a LLLL and an IBCLC.  LLLL's see a wide variety of moms, most
of whom have relatively minor issues.  Breastfeeding is robust, and
needs to be, or else how would the human race have survived so long!
But babies used to die all the time.  Our current technology saves
babies that would once have died.  These babies often have feeding
difficulties.  LC's see these babies who once would not have made it.  I
have personally seen kids with genetic syndromes, cleft palates, heart
defects, airway malformations, gi malformations, premies, and tons of
severe tongue ties.  If these little angels were left to fend on their
own, they would not have made it.

I am strongly in favor of helping moms breastfeed comfortably and
effectively from the beginning.  The amount of intervention that most
lactation consultants use is not excessive when you think of the
multiple difficulties that most of the dyads we see have.  Breastfeeding
is the normal mode of feeding for human babies.  IF the baby cannot
breastfeed, there is something wrong.  Minor sore nipples are a "getting
started" difficulty that many inexperienced moms and babies have.  The
IDEA that soreness is normal is what gets too many moms into trouble,
ignoring a dysfunctional suck or anatomical problem until the milk
supply and the baby are both in trouble.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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