Virginia wonders about a situation in which a mother has such exceedingly
sensitive nipples that neither direct nursing nor pumping are tolerable for
her.

I had a case last month of a mother with exceedingly sensitive nipples --
far more so than I had seen before.  The mom was nearly hysterical with
pain when the baby would even *begin* to attempt to latch.  She was
screaming and crying.  She had no history to explain such an unusual nerve
response, so my first thought, too, was sexual abuse, which may or may not
have been the case (I did not have the opportunity to enquire as other
family members were in the room during the consult).

Since direct feeding *was* such an impossibility for her at that time, but
as she had a very strong desire to breastfeed, I proposed a treatment plan
to "desensitize" (acclimate) her nipples.  She began pumping with a Lactina
Select on the lowest vacuum setting, using the SoftFit flange (both
products provided by another LC in our town as I do not rent pumps).  I
told her that we had no way of knowing how long it would take to
desensitize her nipples, but that it would happen with a bit of time and
when it did she could then try to feed the baby at the breast.  She would
know when she was ready and she should trust her instincts.  So long as her
milk supply was protected and her baby was being fed appropriately, we had
a great chance of successful breastfeeding when she was ready to do so.

Pumping was painful for her, but she found it much less painful than direct
feeding and so decided to persevere.  She pumped faithfully and regularly
around the clock (feeding the EBM by finger).  By two days later, she felt
much less sensitive and decided to try to bring the baby to breast
again.  To her delight, he latched well and it was "tolerable" for her.  It
still hurt significantly, but not as much as it had.  I came back and
showed her how to latch him as deeply as possible with the asymmetrical
latch, which further decreased her pain (although it did not eliminate
it).  She was pleased, though, and felt that it was within her range of
tolerance.

She kept in close contact with me over the next few weeks, reporting that
the sensitivity continued to diminish and that her baby was gaining very
well.  She was absolutely in love with breastfeeding and was so glad that
she went to the effort of "desensitizing" her nipples.

Truthfully, I don't know what was really going on.  Did she have abnormally
sensitive nerve endings in her nipple/areolar complex?  Did she have a
history of sexual abuse?  To my mind the most important approach to address
either cause was one that (of course) fed the baby and protected her milk
supply, but that also gave her control over the process.  I felt that the
psychological component was very powerful and that she needed a great deal
of control in order to cope with the pain (physical or emotional).  Of
course, it was immensely helpful that we were working with a baby who had a
naturally great suck technique and who was very willing to go to breast
when the mother was ready.  It was also critical that the mom was motivated
and that she was willing to pump even though it was still uncomfortable for
her to do so.

These crucial aspects make this situation different than the one Virginia
proposes, but I presented it because I feel that it was the element of
giving the mother control that helped her move past her pain.  It's
possible that such an approach may be helpful for a mother who thinks she
cannot tolerate feeding or pumping, but when empowered may find that these
things are possible if begun in a way that is slow and gentle and
completely in her control.

Diana West, IBCLC

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