I have several thoughts.  One is that I once saw a woman who had excessively
sensitive nipples.  It took very little stimulation for her to be quite
bothered, pregnant, nursing or not.  When I saw her a few days postpartum I
was amazed at the fuss she was putting up over absolutely insignificant
appearing nipples (they were slightly pink.) She had no hx of sexual abuse
that she was aware of, and there was nothing I could see wrong.  I just
decidec to affirm that, yes, she was hypersensitive, and tried to come up
with a plan.  What we did was just give her permission to take pain relief,
to use a pump while establishing bfg so she could allow the initial (prob.
hormonally mediated) postpartum sensitivity to pass.  I suggested she go
braless, expose her breasts to sun for very brief periods of time.  We
worked carefully with positioning and made sure her pumping technique was
good (low pressures, well centered, and these days we'd look for the right
size flange.) The fall-back position was she'd pump and bottle feed if she
couldn't tolerate direct bfg.  Because she felt she was well-supported,
affirmed, and wasn't expected to do anything "perfectly" she persisted.
Ultimately she adjusted and bfed that baby 18 mo.  She breastfed baby no. 2
for 3 yrs, and I am fixing to go see her with her new twin boys.

On a slightly different note, somehow US women have gotten the idea that "no
nipple preparation is necessary" means that their nipples are never to be
rinsed or washed.  I keep seeing women who have several layers of skin build
up on their nipples during pregnancy.  The skin underneath these plaques
(sort of like cradle cap of the nipple) is very tender.  Pregnant moms who
secrete, sweat, and then get some crusty grime on the nipples might need to
be reminded that gentle cleansing during daily bath or shower (and maybe
even VERY gentle toweling) might help keep the nipple skin healthier. There
is always some kind of wisdom in the lore that surrounds birth and
breastfeeding, and maybe the whole 'nipple preparation' deal was a way to
address the issue of moms who have this kind of situation.  Carried to
extremes, nipple preparation or nipple cleansing is  just one more nutty
piece of busy work.  But over-shielding, protecting, and never cleaning the
nipples creates problems, too.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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