Hi, Lactnetters,
     It is good to see the sharing of ideas on the issue of sore nipples, and the pros and cons of consulting on this over the telephone.
    Marie Davis and others have made some excellent points on the fact that a pain scale can be a useful communication tool, and that points of reference are important to this communication, i.e. what the upper and lower limits of the scale mean.
    Kermaline J. Cotterman, and others, have pointed out that semantics can be a problem.  I agree - and not only in describing the reference points for the pain scale used.  Even such matters as asking whether the baby is lying on his side may get a "yes" answer when this isn't so - the words may not mean the same to the Mum.  I can remember a Mum years ago who assured me her baby was lying on his side, and I then got her to come round to my place and he was lying flat on his back.  When I gently turned him over, the look of relief on her face was clear - one of the easiest cases I've ever dealt with!  This led me to refine my description of how the baby needs to be (when in cradle hold): "Lying on her/his side, with *two* hips, not one, against the mother's body."  Semantics again come into play when trying to ask over the telephone whether the frenulum is short or tight, or if the tongue doesn't point or is heart-shaped.  Some "yes" answers over the telephone have proven to be unfounded when I've seen the baby next day!
     Seeing the mother/baby pair certainly beats telephone contact, when a face-to-face consultation is possible.  When it isn't, tools such as a pain scale (with clear descriptors of what 1 and 10  mean) serve to improve our ability to help the mother.
     Pain, of course, is real to the person feeling it.  We need to respect the individual differences in pain thresholds.  The Mums I've seen with the worst nipple damage - chunks out - have tended to accept that their pain, though bad, is bearable (to them).  They were also highly motivated, and willing to work through the pain, and wanted to attach the baby - otherwise with that damage they'd have quit on the spot.  I've seen other mothers who experienced severe pain in grazed nipples where I could only just see the damage, and who cried at the mere thought of latching the baby on.  Their pain was real, too.  I always respect the mother's perception of her pain, and discuss it with her.  I probably have added credibility through my (past) experience of living with chronic pain - I don't wallow and detail my experience, just empathise that pain is very real, very unpleasant.  In the face of pain, it is also so important that the mother "owns" her management plan, that the mother feels comfortable about each stage of the process.
      Can I add a further point about nipple pain, and one which is difficult to ascertain on the telephone - though not impossible.  This is the mother's coordination;  an example is the strong right-hander who can refine attachment at the left breast but can't seem to get things right on the right breast.  She often presents with damage on the nipple on that side (or the right nipple worse than the left one).  Working out ways to improve latch which work for *this* mother and baby may take creativity - and the input of both the mother and her partner can sometimes help find a different way of achieving the goal you have identified.
                      Cheers,
                            Virginia
                            Virginia Thorley, OAM, IBCLC
                            In Brisbane, Queensland, Australia

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html