I have been following the thread of discussions on sore nipples for a
few days and feel the need to make some comments.  As someone who has
had homebirths, I would dearly love to believe that a home birth
delivery would save women from sore nipples.  But I have done home
visits as an LC to some women who had homebirths and they had sore
nipples. I, myself, experienced sore nipples with my first and third
babies.   I  never experienced sore nipples with my second baby--at
all.  So personally I know that sore nipples do not have to be a part of
the breastfeeding experience.  I think we do not know enough about the
causes of sore nipples.  I believe that most sore nipples are fixable
but some don't have a quick fix. Those that don't have a quick fix have
to do with the structure of the infant's mouth or the size of the
mothers nipple in relationship to the infant's mouth.  Time eventually
heals these problems.
I am disturbed by suggestions that an outsider(the LC) can determine the
amount of pain a mother is experiencing.  The negation of a person's
experience of pain, not only makes the person experiencing that pain
feel "crazy" but is likely to result in that person not seeking the help
they do need.  I believe that asking the mother to rate her pain from a
scale of 1-10 is counter-productive.  Why? I believe any pain during
breastfeeding is not a good sign.  The rating is subjective and mothers
may think that you are trying to dismiss her pain by rating it. I think
it would be far more informative to ask, whem the pain occurrs, how long
it lasts, and what has the mother been doing about it.  Watching a
mother breastfeeding, looking at the nipples will give you a good
indication of the problem. I can tell rather quickly by watching a
mother breastfeed that she is suffering--she flinches, her body
stiffens, her toes curl over, her hands are white-knuckled or she
absolutely refuses to breastfeed. Also I'd like to ask, does the amount
of pain suggest the problem?
I think suggesting that American women are wimpy is a generalization
that cannot be proved one way or another.  I have seen many American
women who I considered to be enormously strong and brave during birth
and breastfeeding.
I think prenatally we must be honest with mothers about sore nipples.
That means that we must tell women that like labor there is a whole
range of experiences.  Women are very much aware of the horror stories
about sore nipples.  If they get sore nipples, they need to be aware of
the ways to correct the problem and ways to cope with the pain. Valerie
W. McClain, IBCLC

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