Jean, In my Master's thesis at Case Western I looked at 16 variables that were stated in the literature to be associated with sore nipples. Among those 16 were "lovemaking ", conditioning from clothing(not wearing a bra), and mother's stated sensitivity of her skin. These were not found to be associated with nipple soreness. This study was repeated by a graduate student several years later with similar results. It would be interesting to look at these 3 variables again either separately or together.
The other variables I researched were: conditioning from previous breastfeeding, type of nipple, maternal medications in labor, maternal age, maternal desire to breastfeed, social support, engorgement, duration of feeding, frequency of feeding, infant sucking, attachment, weight of infant, and supplemental feedings. Only engorgement was positively associated with nipple soreness.
L'Esperance, C 1980. Birth and the Family Journal, 7(1):21-26.
The discussion of sore nipples is very interesting. I have been looking for answers for the last 20 years. Research has provided us with some information: limiting time and frequency don't prevent soreness; we don't have a way to prevent sore nipples; some soreness is common; positioning may be a factor, but we only have clinical data, not research data;; surgical research tells us that moist wounds heal faster than dry; many chronic sore nipples are infected with bacteria or candida.
I agree that providing the best anticipatory guidance to women about what early nursing is like is helpful, but we should not state that nipples will be sore...period. I have seen too many women 3+ weeks in agony because they thought this was normal. I like having the Mom rate her pain because it gives the mother and the HCP/LC some way to assess when a mom needs intervention/referral and it is useful in evaluating effectiveness of interventions.
Nipple pain is a major situation for many women in their early nursing at the very least it makes early nursing miserable and at the worst it causes a woman to stop nursing. We need more research! Imagine a man having pain you know where and being asked to rub it vigorously for 20-40 minutes 8-10 times a day!
Regarding other cultures, it would be an interesting study. Do they have sore nipples and just "gut it out" because they have no other choice. If they do not, why not?
Thanks you all for all the great discussion.
Carol L'Esperance, RN, MSN, IBCLC
Albuquerque, New Mexico
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