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Subject:
From:
Sharon Mattes <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 18 Dec 2001 14:56:50 -0600
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Regarding Heather W. Neil's post about "normal":

"Sore nipples are the most common single reason for seeking help, and
these are positional sore nipples....and the worst of it is, that
most (yes, most) women have been told by their professional advisers
that soreness is 'normal' - because of course they see so much of it.
Yes, even cracks and bleeding are 'normal'.

We are also very tired of hearing mothers say 'the (whatever health
professional) has seen me feed and says my positioning is fine, so it
can't be that....' Yet when we see what's happening, or even hear a
description of it, we are often able to suggest ways the mother can
feed without pain.

Here, positional sore nipples are far commoner than thrush (though
they may co-exist); thrush is becoming 'fashionable' as a diagnosis,
though.

A few weeks ago, a mother with a (then) 6 day old was diagnosed with
thrush and given meds....but the cause of her soreness was a very
pronounced tongue tie that  was interfering with the baby being
comfortably positioned."

I cannot agree with Heather more....here in the Dallas / Fort Worth Metropolitan area I can say that nipple soreness is the single most common reason for mothers seeking help. Frequently the problem is positional in nature.  Though we have greatly increased the number of hospital-based LC's and they offer assistance immediately after birth, many mothers do not really notice positional difficulties until they are home and soreness is complicated by engorgement.  (Which is also more "common" than it should be)  

Another factor which sends mom seeking help is the weight loss in the newborn noted at the 2 week Pediatrician check up.  Mother assumes baby is doing well - even though her nipples are sore, and may even be told that it is 'normal' for babies to go days without stooling! (not in a newborn!)  Some mothers are being told that it is 'normal' for baby to regain his birthweight at 2 weeks.  
This appears to be another of these abnormal "norms".  Because of poor breastfeeding management, many babies lose a large amount of weight and very slowly regain to their birthweight by 2 to 3 weeks.  I have heard several LC collegues attest to the view that in a "normal setting" with breastfeeding going appropriately, baby should begin to regain weight as soon as mother's milk "comes in" around the 3rd to 5th day.

And although thrush is also quite common in this area, I have seen not a few moms with babies needing a frenulum clipped which does not receive much attention for weeks.  Since the mother assumes sore nipples are 'normal', she then attempts to adjust positioning (which a well-meaning BF friend or helper recommended) and apply Lansinoh to correct the soreness and when it gets to the point she can no longer tolerate this "normal" breastfeeding situation - she calls for help!

Frustrated Both Past and Present - Sharon Mattes, IBCLC, AAHCC
Private Practice LC - Dallas Suburban Area

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