I totally agree that the idea of breastfeeding hurting has been a big  hurdle 
for both us in the lactation field and poor mothers to undo.
Change is so slow and sometimes feels like it will never occur.  I  keep 
teaching the staff what is current in the literature.  I get all of  them to nod 
their heads to me but there are many who just don't want to give up  "the way 
they have always done things."  
I keep learning and evaluating what I see and how I help a mother.  My  
theory on why some moms still have pain when all looks correct are either she  has 
deep nipple damage that needs to heal and until it does heal there will be  
some pain, the other is a mother who has very sensitive nipples and or skin and  
they have discomfort no matter what.  I still try to find a way to make the  
breastfeeding less painful for them.
I want to add one more thing about "latching" and positioning at the  breast. 
 I continue to see nurses and mothers "putting the baby on the  breast" 
verses the baby going onto the breast on their own.  In getting the  baby on the 
breast the Mom or who ever is helping her is pushing the baby's  head.  I have 
finally gotten to the point of putting my hand on the  mother's head and asking 
her if she is comfortable with me holding her  there.  None of the mothers 
like this.  Than I move my hand down to  their neck and back and ask the same 
question.  Now they do not  object.  I tell parents no one likes their heads 
pushed and this includes  babies.  I tell them to GUIDE their babies to the 
breast and hold them  securely along the neck and spine but DO NOT PUSH THE HEAD.  
I am going to do a little exercise with the nurses and pair them up and  have 
them take turns putting their hand on the other's head and get their  
feedback.
The process is ever evolving and interesting.  :-)
Ann Perry, RN IBCLC
still snowing in Boston, MA

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