Okay, I'm willing to learn. If negative pressure is the *big* issue, then
why does pain not usually increase or at least continue as the baby sucks?
Surely, you would expect that as the baby sucks longer, the pain would
increase if negative pressure were causing the problem. But this is not what
mothers generally describe, even in the first few days. They generally say
that the worst pain occurs *as* the baby latches on and then the pain
improves, even disappears, with time. Even when the latch is not good.

In some cases, mothers say the pain starts again as the baby nibbles at the
end of the feeding, and compression often decreases the pain if the baby
starts *drinking* again. In fact, however, the baby's suck is *more*
vigorous at this point than when he was nibbling.

As Yael said, I didn't say that negative pressure was not an issue at all. I
just said it had little to do with it. Of course, there is often a
combination of things. But this negative pressure thing is a way of telling
mothers to limit feedings, when in fact that doesn't help. In fact even if
negative pressure were the issue, that is even more reason for the people
who say that to help the mother achieve a good latch, because the better the
latch, the less the baby will be on the breast, because he will remove milk
more efficiently from the breast. Of course, let us not forget compression
so that the baby also gets more milk, a very effective technique in the
first day or two.

Jack Newman, MD, FRCPC

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