Respectfully (as I deal with this very issue for 95% of my practice now),
Nipple pain is abnormal - regardless of the birth. In fact, the abnormal
birth may very well be a very large part of the problem. The only time
nipple discomfort is 'normal' is those first few days when the nipples are
getting used to being stretched. That should go away within 3-4 days. And
it should never HURT - tender, sure. PAIN? No.
If nipple pain were normal throughout the history of womankind does one
really think we would suffer like that? Unless we are programmed to enjoy
pain (and not all of us are) we are not going to put up with that kind of
discomfort for the normal nursing period of time (2-7 yrs). Why would we?
It doesn't make sense. Yes, some moms do (I have a couple who did but they
are another story) but they are the rarity. Most moms when faced with
chronic pain with nursing WILL QUIT, typically within the first few weeks.
And, honestly, I don't blame them. Been there - lived it. If I had had to
live with my pain for the full 3 yrs I nursed my son, I would NOT have. Not
on a bet. We got through it, but only because I had a couple LC's (Chele
was one) who told me unequivocally - It should NOT Hurt and THIS is why it
does. Now, here is how we fix it.
Mothers are frustrated by the "It's not supposed to hurt but hang in there
it will get better" comment because it does hurt and no one is able to make
it stop. The comment is patronizing and depressing. Saying, "It's not
supposed to hurt, but hang in there it will get better,' is a trite comment
when coming from anyone - and even more anger causing when coming for the
supposed 'expert' who cannot figure out why it is hurting and how to make it
stop.
So, why can't we all figure out why it hurts? Lack of education on how to
determine the much more subtle causes of pain with latch and nursing is the
reason, in my opinion. What needs to happen is a few things: First - we
need to end the over medicalization of birth NOW. Ok - now that you are
done laughing because we all know that isn't going to happen any time soon -
what next? WE need to educate ourselves on the structural issues (tight
muscles) and super sneaky tongue-ties (and how to evaluate them properly -
can't find them if you don't also feel for them and do the range of motion
testing) that have a detrimental effect ranging from minor to severe for
babies and breastfeeding. Then we need to educate ourselves about the
resources in our area who can FIX those structural issues. We also need to
be well educated on how to recognize when there may be an underlying
bacterial infection (or yeast) due to chronic trauma. This happens fairly
regularly and can be difficult to separate from a baby issue. But it can be
learned.
Once we can ALL do the above effectively then there will be NO reason for
ANY of us to be telling ANY mother to "hang in there, it will get better."
I do not believe it is appropriate for us to tell any mother that some pain
is to be expected for any longer than the first few days as the nipples are
getting used to being stretched with the baby nursing. She needs to know
that it should NOT hurt and if it does something is wrong. Her nipples are
normal - regardless of density or elasticity. It should NOT HURT. And if
LC 1 can't figure it out, move on to LC 2 - and if she can't figure it out
start asking around for who the best LC in the area is who can figure out
the really tough cases and fix the train wrecks.
If we as IBCLC's start to believe for one second that chronic nipple pain is
becoming the 'new normal' because of our abysmal birthing - then we are
going down the path of moms quitting due to that abnormal pain, and babies
who need help not getting it and having other lifelong issues as a result,
and babies not getting breastmilk - and the ABM companies getting more $$.
We do we want to go backwards when we are finally really moving forwards??
Warmly,
Jaye
Jaye Simpson, IBCLC, CIIM
Breastfeeding Network
Sacramento, CA
www.breastfeedingnetwork.net
-----Original Message-----
From: Westra, Mary [mailto:[log in to unmask]]
Sent: Thursday, June 23, 2011 5:31 AM
Subject: nipple pain in early breastfeeding
Hello Wise ones,
Yesterday in the breastfeeding support group I posed a question to the
mothers,"What was a piece of unconstructive or bad advice that you heard
from healthcare personnel during your early breastfeeding experience?"
I thought as a nurse who has been working in the field 30 plus years
that I couldn't be surprised. Unfortunately, I was mistaken. I won't
take up space with some of the absurd 'advice' but several mothers
surprised me with their response. More than one mother mentioned that
hearing a nurse say,"It is not supposed to hurt" was unhelpful. These
mothers had seen lactation consultants in the early days for latch
assistance and infants were thriving and nipples showed minimal signs of
damage,if any. I had been schooled in the theory that no nipple pain is
ever normal. I am beginning to rethink this. Some new mothers have
poor give to the areola and dense tissue. Most babies are born in our
hospital medicated and suctioned and heavily stimulated before going
skin to skin. I am wondering, given the abnormal state of birth,
whether some nipple pain in some women for the first few weeks may be
considered normal, even when latch appears adequate and milk transfer is
good. I find myself telling these mothers (after evaluating for sneaky
tongue ties etc.) that we've tried to minimize the pain as much as
possible and most mothers in these instances get relief in time. What
are your thoughts?
Mary Westra RN, IBCLC
Miami, FL
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