Barbara wrote, ".. interesting findings was that nipple pain was almost universal in the first week postpartum, but for most women rapidly resolved... I wish that some of the non-US members (particularly those working with indigenous populations would chime in with their perceptions about whether this is an observed phenomenon other places.).." Barbara, this is such an interesting question! And very hard to answer. I work with mothers of all racial and ethnic groups in Zimbabwe, where breastfeeding is heavily promoted. 99% of all mothers initiate breastfeeding, exclusive breastfeeding rates are 39% at 4 months, and 26% of toddlers at 20 - 23 months are still breastfeeding. My impression is that African (indigenous) mothers experience exactly the same kind and severity of *all* breastfeeding problems as mothers of other races, including nipple pain and damage. I have seen the very worst cases of failure to thrive in African breastfed babies - so severe, in fact, that I begin to wonder what percentage of infant mortality in developing countries is due to breastfeeding problems (some of which could probably have a nipple pain component). I do know too that the doctors, who have to work in the government hospitals or rural clinics before they can practice privately in the city, are extremely prompt about prescribing antibiotics at the first sign of mastitis (which can follow nipple damage) because they are all too familiar with breast abscess, and have many horror stories to tell from their stints in the rural areas. Certainly I have seen hundreds of African mothers who have positioning and latching difficulties, and these too can lead to nipple pain. This always astonishes me because I too *expect* that these moms know what to do, since they have grown up observing all babies being breastfed everywhere. Maybe living in a breastfeeding culture helps, but clearly, it is still not enough to prevent all problems. The reality is that I have seen too many African mothers with badly abraded nipples, engorgement, mastitis, and yes, even abscess when all these pre-conditions have been inadequately addressed. To make a sweeping generalization (always a dangerous thing to do!) I think the major difference that I tend to see between the African mothers and the others (Caucasians of all nationalities, Asians and others of mixed race) is that the African mothers are just much, much more persistent through the difficulties. Not to breastfeed is hardly ever an option, economically for the majority, and culturally for almost all. So because they don't have any other alternative to breastfeeding, and no-one is handing out any freebies, these mothers just keep on keeping on, through the difficulties and through the pain. I think that this is one of the reasons, too, that when really severe breastfeeding difficulties occur, and they are not addressed, they can become the worst I have ever seen. I suspect that we need to challenge the assumption that anything natural and un-tainted by western technology is automatically without problems. Somehow this has led to the belief that we only need to invest token effort into supporting breastfeeding by healthworkers in Nairobi, or into providing unmedicated deliveries and 24-hour rooming-in in New York, for breastfeeding to work like clockwork. This trivializes the importance of breastfeeding, and fails to address its complexity. Just as it is accepted that most women can give birth with minimal intervention, but all deserve to have skilled assistance, so too I think that most women can breastfeed with minimal intervention, but they too, deserve skilled assistance to prevent and resolve or work around the difficulties. So, IMHO, I don't think that indigenous mothers have less pain with breastfeeding - they just have no alternatives - and *that* is what makes the difference. Pamela Morrison IBCLC, Zimbabwe mailto:[log in to unmask] *********************************************** 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