<In fact when a
women experience this type of pain I always help her through it by
encouraging her to count to ten and then wait at least a full minute or
two
before unlatching the baby to reattach (if necessary). Invariably,
nothing
else is wrong, the pain subsides and the feed progresses.>

Thanks Ruth, for your corroboration of my observation of overdistended
milk sinuses as a source of pain, especially during the early days. I
would go so far as to say that as much as 75% of any initial latch pain
in the first few days is attributable to that cause.

Of course a 100% PERFECT off center latch would place the baby's upper
jaw in front of the sinuses and allow his tongue to extend beyond the
"belly" of the sinuses and avoid this type of pain. But try as they may,
many mothers have difficulty coordinating all they're "supposed" to do to
attain it, and are really not certain whether they have or not. As an old
folk saying goes "There's more than one way to skin a cat!"

While the approach you describe is often successful in the short run, I
am always concerned about what happens in 24-48+ hours after she has left
the hospital or consult, and engorgement is worse, and latching becomes
not only painful, but difficult, and perhaps damaging.

For this reason, I like to demonstrate fingertip expression to her very
slowly, asking her for feedback to tell me when she first notices the
pain has begun to go away.

As she focuses on it, she discovers for herself that indeed, this pain is
not really coming from the nipple area, and in fact, it can be reduced or
made to disappear entirely before latching, and can be under her own
control depending on how slowly and gently she presses her fingertips.

(Also, the pain threshhod can be raised by placing a folded, hot
washcloth [that tests safe to the inner wrist] over the areola for a few
minutes till it cools somewhat. Fingertip extraction is usually easier
after doing this.)

(If the baby has been nursing in the same position all the time, the
sinuses 90 degrees away from the habitual position of the baby's jaw get
little compression and retain most of their contents, feeling markedly
firmer and more painful to compress.)

If the pain doesn't begin to subside within the first
5-6 gentle fingertip compressions over the same area, I consider that an
indication where Reverse Pressure Softening would be helpful in
repositioning some milk back up out of the sinuses into the contributing
ducts. I find it useful for this purpose alone, even if there is no
visible edema. (See archives if this term is new.)

I often ask moms if they've ever had the experience of being in a car
with a seatbelt on, with their bladder getting fuller and fuller, when
suddenly, the driver slams the brakes on!

Anyone who has ever had that experience can identify completely with the
pain when sudden firm compression is put on an overdistended body
compartment!

I know there will be many whose approach is diametrically opposed to
mine. But these insights have been so valuable for mothers that I wanted
to share them for what value anyone may find.

Jean
******************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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