Great thoughts, Jan.  I agree wholeheartedly with your first point that
some initial tenderness is very common.  Not sure if I would say "most"
or "many" but that's a moot point.  It's just as was stated in Rachel's
post about first nursings being more like making than delivering a
baby.  I generally start out by saying that nursing isn't supposed to
hurt to counter the horror stories that too many moms have heard ("baby
getting more blood than milk", "nipples nearly falling off" etc.).  I
follow with, "That having been said, some women may feel a little
initial discomfort when nursing is getting started." and proceed to
mention discomfort the first few sucks of the first feedings, "chapped
lip" type soreness for a day or so.  Without the first statement about
not hurting, I think many moms who experience what may be normal initial
tenderness assume it's the first step to the horror story soreness they
have read about or heard about from friends or family.

Second point about blisters. Hmmm, I need to think about that one.  I've
also seen babies that nurse 45 minutes a side and mom has no soreness or
blisters.  Perhaps the longer the baby stays on, the more nearly
"perfect" the latch needs to be.  I've come to believe that each
mom/baby pair has a different "window of comfort" as well as "window of
effectiveness".  In other words, I've seen some latches that almost make
me cringe, yet baby gets plenty of milk and mom has no discomfort.  On
the other hand, sometimes a "silly millimeter" of difference in the
latch can make a world of difference in both comfort and milk transfer.
Perhaps variation in  the quickness and amount of milk transfer in the
early feeds accounts for some of the difference between blisters and no
blisters.  Initial "dry" sucks before a flow of milk occurs would be
more likely to be uncomfortable than those where colostrum is flowing
freely and copiously.

3-Color change in the areola-I'll have to look for a correlation.  May
be a key observation.  I agree that while the "target" explanation
sounds good, in practice I don't see evidence of it happening.  Maybe
it's more a matter of helping mom target where baby should be.

4-Tenderness during periods etc correlating?  I think this is very
likely.  Some women just have more sensitive nipple/areolar tissue with
no apparant causal factor (such as previous hx of abuse).

5-Absolutely vital to avoid language that appears to blame either baby
or mom.  It's more a matter of "tweaking" the latch, increasing the
effectiveness than "correcting".  It's a matter of mom and baby each
learning at their own speed until they come to the point where they have
developed the most harmonious techniques for that particular duo.

Assessment needs to be more than "Does it hurt?"  I prefer to start with
"How does it feel?" and not even plant the word "Pain" in her mind at
that point.  If she says "fine" I follow with "no discomfort?"  If she
says "no"  I will briefly mention that a little discomfort may be normal
and at what point she would need further assessment and then move on to
other topics.  On the other hand if she says"not too bad" or "not as bad
as with my first" or something similar, we go on to ask how she would
describe what's she's feeling-tugging, pinching, biting, burning;  when
it occurs and how long it lasts etc.

This is a very interesting and vital discussion IMO.  I agree that we've
talked ourselves into an absolute "no pain" approach which may be the
pendulum having reached the extreme opposite to the old "it's going to
hurt, you just have to get used to it" approach.  Hopefully this
discussion will bring us to the mid point of that pendulum swing.

Winnie

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