Hi Lactnetters,

I'm late in reading the digests so I just read a post from Karen saying that
she was amazed at how many moms have bleeding or scabbed nipples after only
24 hours. Yes, it is in fact quite amazing and as an LC in private practice
I had almost convinced myself that a good "positionning" and "latching"
start would eliminate any problems. But now, as an LC working in a hospital
that serves mostly high-risk pregnancies and sick babies, I discovered that
MOST mothers will suffer a certain degree of nipple pain in the first few
days. I also came to realize why that was: The babies where I work are
mostly born from a medicated birth ( high percentage of C-section). These
babies are obviously sleepy, and sometimes completely drugged out for the
first few days. Most of them present with a weak suck or a certain
dysfunctionnality in their sucking pattern. Some others are competely
unresponsive for a couple of hours (sometimes as long as 72 hours). They
would swallow milk from a bottle (which we do not use...)as it is forcefully
inserted into their mouth and it flows freely but they do not demonstrate
any rooting reflex or any desire to open their mouth. When these babies wake
up from their drug induced "inerteness" they also usually start off with a
weak or dysfunctionnal suck for a couple of hours or days. If we combine
this with the lack of ability some mothers show when handling their babies,
and yes we have a "social" problem with this because women are not exposed
to babies anymore. Many of them have never touched an infant before she has
her own. They are afraid of hurting their babies, they are slow in their
motions to position and latch their babies. So yes, when you combine even a
minimally drugged baby with a first time (some multi demonstrate a behaviour
very similar to primi...)mother or a very "uncertain of herself" one, you do
get positionning and latch-on problems even though the mother has read and
received information on positionning and latch, and even though you have
spent countless hours teaching and guiding her through each step. It is just
as if mother and baby are not synchronized enough to eliminate the problems.
With time, the pain does resolve but rarely in the first few days, unless
mother and baby catch on real fast.

I never did understand why so many women had breastfeeding difficulties and
I was sure it was only because of lack of information and help. Now I know
better and I rarely judge a situation where a visit (or more) from an LC or
other very generous and supportive person did not resolve the problem. It
takes patience, time and...a "society" change...

Dany Gauthier, IBCLC
Lactation consultant at Ste-Justine Hospital, Montreal
Quebec
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