Nikki Lee asks "Is it really true? That even when a nipple is grievously
damaged,
correcting the latch will enable a mother to nurse without pain?"

To that I will answer: yes, **many** times correcting the latch is
sufficient.  In those cases where it isn't, I support them maintaining milk
supply by other means and feeding the baby preferably by cup, but if they
want to use a bottle I don't tell them it is the end of breastfeeding,
because I expect them to get through the crisis.  The most important thing
to do is radiate confidence that the solution to their problem is within
their reach.  Also, I acknowledge the fear that makes them cringe, making
good latch even more difficult.  I do let them know that the odds of the
baby going back to the breast with a good latch, seem to be improved if they
avoid bottles with artificial nipples.

I emphasize learning hand expression of milk, because when nipple damage is
at the tips of the nipples, pumping may be just as painful as breastfeeding.
Also, I feel better if the woman has several methods to choose from, AND if
she is sore it is more comfortable to stimulate the MER by hand before
applying a pump.

This week I saw two mothers who had babies under a week old, with truly
grievous nipple damage, so much that I cultured the sores.  Both grew large
amounts of S. aureus, which was as expected.  Correcting latch fixed the
pain completely in the one case, and didn't help in the other.  The one who
was still sore, received antibiotics, and was maintaining supply by hand
expression and pumping, with no problems.

I can't tell by looking, who will need more than correcting latch, I just
try that first and go from there.

Rachel Myr
Kristiansand, Norway
where I am working all weekend and having a field day with sore nipples :-(

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