Pat,
If I understand you, the client's pain starts at latching but continues
on throughout the feeding. Doesn't this interfere with MER?
Here is something I have found helpful for moms in the early postpartum
period, at least for painful latch on undamaged nipples. It would be
interesting to see if it is of any help for your client, even now.
1) Wet a clean washcloth, folded in fourths, with the hottest water she
can stand, testing the washcloth against her wrist to be sure.
2) Apply it to her nipple and areola for a full three minutes (clock,
eggtimer, song on the radio, whatever).
3) Then, SLOWLY AND GENTLY, compress (pinch?) the nipple button with
thumb and forefinger for about 30-60 seconds. (My guess is that maybe
this must be removing outward into the lymphatic circulation any
remaining lactic acid and other cell waste that may be effecting nerves
that are bathed by the interstitial fluid of the subdermal tissue. I hope
someone corrects me if they have a better explanation.)
I have found that this elevates the pain threshhold in the nipple,
although I believe I read in Guyton recently that anesthesiologists do
not believe that any such thing as a pain threshhold exists. Semantics
again. I only know I've seen it work countless times.
Also, at this point, after testing a latch to see if this makes a
difference, the next time, it might also be interesting to see what would
happen if she would add manual extraction on the milk sinuses to remove
5-10 drops from several quadrants before latching.
At least in the early postpartum period, it is my impression that though
everybody ASSUMES any latch pain is originating in the nipple, especially
if there is visible damage to draw our focus, in REALITY, at least 50-75%
of the pain experienced from latching comes not from the nipple itself
but from the overdistended walls of the milk sinuses when the extra
stress of compression is applied. The pain goes away after just several
drops of milk are slowly and gently removed from each quadrant.
In my experience, having performed manual extraction on many hundreds,
perhaps several thousand mothers over more than a quarter of a century,
it seems to me that the walls of the sinuses have the capability to
gradually expand a little more from the pregnant state. With time and use
(nursing, or pumping, or even prenatal "nipple rolling" done grasping
well behind the base of the nipple, or even Dr. Bradley's suggested
prenatal preparation), they can comfortably hold a little more milk.
Distention then becomes relative, and compression no longer causes pain.
Unless in cases such as extra distention on the first night the baby
sleeps through the night, and the first latch that morning is -WHEE--OOH!
My nearly 40-year old memories of painful latch, for a month after
visible damage was healed, are of supporting my son on a pillow, tensing
one quadriceps while lifting the foot at least 6 inches off the ground,
clenching my teeth and one fist while moving him close enough to the
breast to do his thing, then trying deep breathing for the next minute or
two till it eased. My 5 year old daughter thought it quite hilarious at
the time. She didn't think so 21 years later when it was HER nipples!
K. Jean Cotterman RNC, IBCLC
Dayton, OH
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