I, too, thought this was an odd focus for an inservice on breastfeeding, but
as Laurie Wheeler points out, it is a golden opportunity.  'Outright Pain -
the sure sign that BF is NOT going normally' could be the title.  If BF were
meant to hurt so much that we dreaded doing it, we would have been created
so that one feed was enough, for life.  Sort of like birth.  I don't think
this is the grand plan; my theory is that BF should resemble making babies
more than giving birth to them.  It's supposed to be pleasant enough that
doing it many times a day for a long time, seems downright alluring.

If I had a quarter for every time I heard a mother with typical
malpositioning soreness tell me that 'they checked while I was feeding and
said he was doing it right', and whose baby was very obviously incorrectly
positioned and/or latched, I would be able to park anywhere for the rest of
my life without searching for change ever again.  (This will probably reveal
how long it's been since I used a parking meter in the US.)  There is little
or no content in any of the professional educational curricula which gives
nurses (or midwives, or even mothers) the special skills they need to assess
technique.  Emphasizing what to look for, step by step, and how to correct
flaws - see a post from Winnie Mading on this in September this year - would
be a great boon to the women using your facility.

You can tell them that here in Scandinavia we never withhold pain meds from
mothers who need them for perineal sutures, afterpains or fresh CS
incisions, or really, acute pain for any reason.  We use paracetamol and
codeine or non-steroid anti-prostaglandin drugs, but do give some IM
narcotics immediately post-op too.  About 100% of mothers initiate
breastfeeding.  It is vital that mother be made comfortable before a
practical learning session on breastfeeding, or she won't be able to take
anything in.  Also, MER is inhibited by pain.  Lest anyone think we have no
problems, not so!  Epidural rates and other birth intervention rates are
rising steeply here and we are seeing more and more babies who don't have a
clue what to do at the breast, and we don't have a uniform, well-founded
strategy to help them.  Hardly a week goes by without me having to bring out
our reference book on BF and maternal medication, to prevent a baby being
deprived of breastmilk needlessly.  And there are plenty of experienced
people around here who honestly don't believe BF can be initiated without a
period of soreness far beyond a slight tenderness, because they have never
seen it happen.  When it comes to BF, ignorance knows no limits and it seems
woefully hard to correct.

Rachel Myr
Kristiansand, Norway

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