MHS:   Source date is:     03-May-95 18:15:00 -0300 EDT

Hi.  I'm Judy Canahuati and I am new to the net. By way of introduction, may
I say that I am the mother of two grown bf children and have been involved
in bf since 1973, first as LLL leader and then as IBCLC.  However, my focus
has been on program, rather than clinical management.  Currently, I work at
Wellstart International's Expanded Promotion of Breastfeeding Program in
Washington, DC.  Although Wellstart works in the US and internationally, EPB
works mainly in the developing world, assisting countries with setting up
national programs.

The discussion about breastpain and my visits to a new mother who has sore
nipples prompts me to ask a question that has bothered me for quite some
time and for which I have never found a satisfactory response. I am visiting
a first time mother who continues to have abrasions on the nipples at the
end of the first week.  There were some positioning difficulties that seem
to have been corrected, but the situation has not resolved itself.  What
struck me when I first saw the baby was that she seemed to have a pronounced
arch in her palate.  One of the most difficult cases that I ever handled was
with another mother who had a baby that had a pronounced arch.  In that
particular case, the woman's sister-in-law with a four-month old baby had
been wetnursing her nephew because the mother's nipples were so painful and
SHE said that her nipples burned after the baby nursed for a while.  Another
woman, who had nursed five children and had very long, tough nipples said
that she had no pain when she tried wetnursing the baby.

In these two cases and one I had many years ago when I was first starting to
work, it seemed as if a primipara mother might not have nipples that really
had stretched out enough to get way into the mouth and get beyond the arch.
In the case of the woman who had the sister-in-law wetnursing, it seemed as
if she had a bubble at the top of the palate or that there could have been a
cleft but there wasn't.  Have you come across such situations?  I seem to
sense some reference to this in some of the literature, but I can't seem to
find a satisfactory strategy for resolving this.  Is this a real anatomical
variation in your experience?  Can it lead to prolonged sore nipples?  How
should I handle it?

Thank you for your input.
Ordinary corrections of positioning and having the baby open the mouth wide
doesn't seem to do it, or does it.