I say to a pregnant women who asks, exactly the same sort of thing I say
to anyone who asks about anything: there is a huge spectrum of
experiences, and no one knows where you will lie on the spectrum, until
it's happened to you.
I then lay out the spectrum: on one end, an emergency c-section where
the mother is knocked out, and wakes up several hours after her baby has
been born and baby may have already been supplemented with formula - on
the other end, a mother who labours with no medication and delivers in
her own time and has an active suckling baby before the cord is cut.
Both can happen, who knows which one it will be?
On the establishing breastfeeding, it's the same thing: active suckling
baby, little more than 'stretch' discomfort for a few days, no pain,
excellent relationship from the outset versus disorganised and sleepy
baby, or motor issues, bad advice, extreme pain and mangled hamburger
nipples.
Then it's a dicussion of odds, and likely hood. My pitch is that the
vast majoirty of births are very good, and the vast majoirty of mothers
have some pain but no significant problems on first breastfeeding.
However, the vast majority of breastfeding support at birth is crap, and
they need to be well armed with info and have made contact prior to
birth with someone who can come out and help if It Goes Wrong. I
encourage all pregnant mothers to visit with a La Leche League group
prior to birth, to sound out the mothers' local experience of that
maternity hospital/services, and so they have a face to a name if they
need to phone. I also say that regardless of how bad a 'bad' scenario
gets, breastfeeding can be established with support. So if any mother
does wake up several hours later, their second thought isn't "Oh my god,
breastfeeding has failed"
I also tell them that agony isn't normal, and whilst some discomfort can
be normal at first, if the pain is bad enough to need to do anything
about - Then There Is A Problem, and that needs fixed asap. I do spend
time discussing that the fiddly business of latching baby on and off
etc, is as much about mother's fine motor skills as anything else, and
is a skill that will be learned, not something that is automatic, nor
'maternal' - just juggling! Pain isn't the only issue that makes
mothers feel they are failing, as I can testify: sometimes just getting
the baby and the nipple in the same post code can be challenging! ;-)
I then always give them baby led latching resources, so they can see
what the baby is capable off, and suggest they prepare for the first
latching, by preparing for their baby to do the work, whilst they
concentrate on keeping outside intervention down to a minimum.
The message I give on pain is expect some, rejoice if there is none, and
if it's a lot - COMPLAIN, for that is a sign they have not been
supported enough. And if anyone poo-poos their pain, COMPLAIN and PHONE
FOR HELP. One of my personal friends, who had agonising pain at latch
for six weeks (until, I presume, the motor issue righted itself through
the right muscles doing the right thing enough times) was actually told
by her midwife to bite down on a stick, to get her over the 'hump' -
which is actually what she did. She said it stopped her from screaming
out loud....few mothers will get through that.
The pain issue is, to me, a reflection of lack of knowledge, training
and support. So many 'counsellors' are trained in basic techniques -
and if baby is showing a good asymetric latch from the outside, they are
totally floored on what to suggest next if the mother is then in pain.
So I tell mothers upfront that pain issues are about poor support and
knowledge in their supporters: I fix them on how they will deal with
that if it occurs, not on how to cope with agony should it happen.
So, to sum up, my approach to all things is: prepare for the worst, hope
for the best, in between will usually happen. In terms of
breastfeeding, that is to alert mothers that some pain/discomfort is to
be expected, but they may have none whatsoever and won't that be
wonderful - and if they do experience real pain that means something has
to be done; there is a problem and they and their baby deserve help.
Mother Nature did not design the system to include pain - pain is a sign
something isn't working. On this, I'm going to add in some stuff that
Diane Weisssinger said at a talk last week - about you need to have pain
to know there is a problem, for if you don't know there is a problem,
you may not know your baby is struggling to get enough milk. The pain
is a protective mecanism on behalf of the baby - the signal you need to
Do Something About It and find a better/more effective feeding
position. And if others refuse to pay attention to your baby's pain
signal, KICK ASS on behalf of your baby.
I find the biggest thing that makes a difference on this, is when I say
it can hurt for a couple of weeks whilst it all gets settled out. But
that in context of giving birth, and having that relationship, it's not
much of a pain to bear. I genuinely felt quite fond of my little
'stretch' pain for the first couple of weeks - for I knew he'd latched
on properly when I felt it. Just saying it _can_ hurt appears to
validate their fears. And when you hear women talk about how much it
did hurt, and how no one listened to them, I usually want to throw
something through a wall...
Morgan Gallagher
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