Dear Lactnet,  It is interesting and thought provoking reading the responses
to the ideas concerning nipple pain, nipple trauma and emotions.  Maureen
you are so right (as always!:-) in your post mentioning.....

>Ann Oakley's comment that post-natally depressed women are neither bad nor
mad, but sad:
>and for many the circumstances of their lives are such that they would have
>to be psychotic not to be sad; sadness and depression are the appropriate
>human response to their lives. Which raises doubts about the wisdom of
>using medication to suppress appropriate human distress rather than
>providing supports to fix the problems that make women sad.


I reread my post and recognised that it was all too simplistic and obviously
gave the wrong impression, especially when Louise said

>And, please, don't ask her if she really wants to be a mother:
>she probably feels miserable enough, without having to feel guilty or
>inadequate.
.

I realise that what I am on about is the lack of emotional care for women.
Now, before you all get ready to jump on my comments, I am being very
general here,  I am very aware that many have a style of working which
encompasses the total woman, ie physical, social, pyschological, emotional,
spiritual and cultural/familial aspects (Hope I've covered it all ;-) My
concern is with the way we as 'health professionals' don't (generally!) know
how to care for women in a way that addresses the emotional side of an
experience.  for example, during the pregnancy, whilst dealing with all the
basic informational and physical checking needs of women, we don't (as a
rule) check out how she is really doing, what does becoming a mother mean to
her, on  every level and at the soul place of who she is and assist her as
she explores who she is, how she is feeling, what it means to help her to
reorient herself, like a ship (analogy) whose course is constantly being
subtly adjusted by the person at the helm (ie, the woman in her pregnancy)
to keep 'on course', so that the ship doesn't end up somewhere else.   I see
us as the 'stars and navigational skills' (analogy) that can be utilised by
the woman as she charters her course through pregnancy and childbirth and
nuturing/parenting her baby.  Of course, each person's journey is uniquely
her own.  My interest is how can we help to optimise a woman's innate
abilities to joyfully and healthily integrate a new person into her life.
(as an aside, this is and can be great fun - not just heavy stuff, although
of course, sometimes it is :-(.  This is where those other tools are
helpful, the body therapeutics (kinesiology, massage etc) because we are
such cerebral people these days, we tend to live outside our bodies most of
the time.  At the Midwives conference in Oslo, May '96, an historian,
Barbara Duden, gave a paper discussing how pregnancy had been taken outside
the woman's body, such things as ultrasound, dopplers etc, all made the baby
a reality distinct from the womans body.  She said that modern medicine had,
by alienating the experience from an internal process to a medically managed
event, mentally disabled women to give birth normally.  Created a lot of
controversy and discussion, as you could imagine. I agree with her and as a
health professional, I feel the 'system' fails women, fails to provide women
with the opportunity to explore what being pregnant means to them and, them
in relationship with other loved ones.  And I believe this exploration to be
crucial to healthy adaptation and integration.  This exploration used to be
done within the context of the extended family and social groups, but with
the changing patterns of social relationships, the health facility is
providing the place where the process of childbearing (not just birth, but
the whole continuum of childhaving) is experienced.  Ante natal care is
often just that, with the 'e' replaced by an 'i' (as so many people write
it).  The skills and abilities of the health worker are often perfunctory,
time crunched and utilised looking for problems, rather than celebrating the
normalcy of the process.  I am all for health promotion, avoiding illnesses
and problems and much prefer to assist someone else to avoid them,
recognising that health is more than the mere absence of disease, it is a
lifestyle, political and social issue. This is one of the reasons why the
research I mentioned by Elizabeth Duffy is so exciting. Her research was
looking at an intervention of one hour's experiential input to pregnant
women at 36 weeks on positioning and attachment and the effect on the post
natal incidence of nipple pain, trauma and soreness.  Matched groups. The
rates were dramatically different - in favour of the intervention. It is
health promotion at its most elegant.  The social and pyschological journals
rebound with papers on the effect of (dis)stress on physical functioning.
We know muscular function is affected by stress.  There is starting to be
some efforts made to address the emotional side of childbearing, (after the
horse or is it zebra has bolted) for example the 'debriefing after
childbirth' initiatives that are being evaluated at Oxford, England and
Perth, Australia and probably elsewhere. It seems that core distress
(whatever the cause) creates muscular tension, which, in the case of
breastfeeding nipple pain, trauma etc not able to be alleviated by
correction of physical things and the infectious things and when every other
aspect has been thoroughly investigated and corrected :-) in my experience,
can "disable" the elasticity of the areola and nipple, causing it to remain
tense in the baby's mouth and therefore not elongate over the tongue and
therefore create a mechanical malfunction between baby's tongue, palate and
mouth, the peristaltic milking action and the nipple shape, causing friction
and pain and subsequently trauma.    I recognise what you are saying.    I
certainly don't like 'blaming' someone for not being 'together' enough to
fix themselves - we are interdependent beings and need each other to provide
balance, warmth, kindness, support and a sense of belonging. Not to mention
our professional skills and abilities. Dumping stuff on someone doesn't help
at all, it seeks to make wrong and is ultimately alienating, not embracing.
OK, off my soapbox,  I look forward to your responses - I think :-)  warm
regards, Carolyn