Susan, you wrote:
< Many women don't know what to expect and when things don't
go well and comfortably, they are often at a loss. I have spoken with
mothers
3-4 weeks into bf who have very sore, cracked, etc. nipples, fussy baby,
poor
latch, etc etc. and they have just been toughing it out.>
Alas, I also find this to be the truth too often. Moms don't always hear
or remember what is said in classes - at least, they don't always imagine
in their mind what the instructor had in hers when discussing pain and
latch and positioning, etc.
That is why I am convinced that the mother's own breast is a superb
teaching tool. In addition to sight and hearing, it engages one more
sense, her sense of touch. (Which is, of course, the sense with which any
pain will be experienced.) It gives a chance to teach her to digitally
extract just one drop of colostrum - that alone provides first time
nursing moms with tremendous insight and a valuable self-help tool.
If privacy is available, as in an exam room during a 3rd trimester
prenatal appointment, or even in the postpartum room, if she chooses an
assessment, it even helps to have her breastfeeding support person
present if so desired. (This is not always the same as the labor support
person. Their hormones are not recycling, etc., and they may be able to
remember some points more clearly, in order to reinforce instructions.
The mom will be a captive audience to their day-and-night presence, and
outmoded ideas need to be replaced as far as possible.)
<If only someone had noticed their flat or inverted nipples, or lack of
breast change during pregnancy, or even enlightened them about postioning
and the course of normal, healthy bf... The dream of the future would be
for
prenatal caregivers to assess their clients, and require bf education. It
has
been my experience that women who educate themselves ahead of birth,
particularly by associating with other successful nursing moms, do
better,
and know to seek advice when things are not going well. >
A few numerical terms have made for more objectivity about adequacy of
newborn intake: 12 or more feedings in 24 hours, 6+ soppy wet diapers and
3-4+ stools by day 4, etc. But objectivity in regard to breast discomfort
is indeed difficult.
The LC community is way behind some other fields in routinely teaching
moms to use a comparative scale of 0-10 to describe their pain
perceptions. That, in itself would be a great improvement.
Perhaps we might better explain it by saying that discomfort, IF IT
OCCURS, should never be more than a 1 or 2 at the most, and then, not for
more than a few days. There should be no visible damage of the nipple
skin, ever.
With these guidelines, she might seek help more readily, and sooner if
told that anything beyond this needs more expert assessment. Seems more
like "truth in advertising" not to gloss completely over the subject of
discomfort.
So many nipples, so little time . . . .
Jean
- -- - - - - - - - - - - - -
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio
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