I find that I generally agree with the discussion of early, transient sore
nipples but with a different perspective.

It is true that many mothers, experienced and inexperienced breastfeeders, have
sore nipples for the first few days postpartum.  However, I do not think we need
to throw out the relationship between nipple pain/damage and infant
position/attachment at breast.

New skills take practice.  We improve with repeated exposure and practice in the
new activity.  Babies are no different.  They may nurse a time or so in an
"iffy" position--not attaching just so.  With additional practice, they improve
their skill.  The not-quite-right times may cause the nipple tenderness;  the
improvement allows healing and pain-free feedings.  This makes sense to me as I
relate the literature to my practice experience.

In working with new mothers, I apply this understanding to a practical
"formula."  1. Watch the infant feed with special attention to position at
breast, attachment to breast, & shape of nipple when infant first detaches.
2.Suggest changes if needed.  3.Talk a bit about how we all learn new
skills--practice, do it okay one time, not-so-great another, and so on.
4.Suggest that the mother continue to watch infant's position and attachment at
breast and if her nipples are not okay, or at least better, in 48 hours she call
the lactation center for help --OR-- if her nipples start getting worse, she
call us for help.  This 48 hour rule has worked well and it lets mothers know
that she does not have to hurt to breastfeed--it reminds her that help is
available.  The ones that are not at least better by this time tend to be the
ones who really need intervention of some sort as the pain & damage has gotten
progressively worse.

This perspective prevents me from telling mothers that they can expect nipple
pain.  I find that I relate pain to something not being right--position or
otherwise.  If there is nipple or breast pain, they are to let us know.  At this
time, I go to the above plan -- just a different view of the same discussion.

Pardee Hinson, MPH, IBCLC
Charlotte, NC      [log in to unmask]