Perhaps there is another fact that we need to identify with regard to nipple
pain:  It appears to be pretty ubiquitous.  When Zeimer proposed this idea
(on the basis of her research in the early 90's) I was quite resistant to
the idea, because I assumed that with skilled lactation management, all pain
could be prevented.

M Ziemer and J Pigeon.  Skin Changes and Pain in the Nipple During the 1st
Week of Lactation, JOGNN 1993; 22(3):247-256.



 However, Mary's observations have been followed by many other studies that
observe that most women report some nipple changes and increased sensitivity
during the first days of lactation.

I was especially interested in the observations from this paper:

Cox D, Kent J, Casey T, Owens R, Hartmann P:  Breast Growth and the Urinary
Excretion of Lactose During Human Pregnancy and Early Lactation:  Endocrine
Relationships, Experimental Physiol 1999; 84:421-434.



The authors identify urinary excretion of lactose as a marker for elevations
in the concentration of prolactin in plasma of pregnant and lactating women.
They observed "that nipple growth was related to prolactin concentration."
They go on to speculate:  "...it is interesting that several of the subjects
felt breast tenderness in early pregnancy and this changed to nipple
tenderness after about 20 weeks of pregnancy.  This latter time coincided
with an increase in the excretion of lactose in the urine which ws also
related to prolactin."  Prolactin, as we know, again surges following
delivery.  It would be biologically plausable to link increased nipple
sensitivity at that time, as well, to normal hormonal changes.  This would
mean that anticipatory guidance about identifying early nipple sensitivity
as normal would be reasonable, along with assuring women that this is very
different from having cracks that don't heal (evidence of infection.)



Improved positioning greatly assists most cases I work with, however, it is
my experience that many moms do experience some transient nipple tenderness
even with great latches.



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

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