So I've been thinking about this for the last few weeks and, man, the whole painless breastfeeding frenzy thing seems like a bit of a scam. I don't get why there is so much literature out there talking about how easy and painless it is, and how if it's not both of these things, there is probably something wrong. That does NOT seem right to me - I wonder if it's actually that way for most people? ... WHY does the entire "industry" or whatever you want to call it not acknowledge this fact? Why don't people talk about the fact that it can be excruciating to have a previously innocent rack suddenly suckled within an inch of its life? It makes a gal feel like she's not doing it right or something is the matter or it wasn't meant to be or whatever.
After reading the discussion where Jacquelyn and many others recounted the pain they experienced while breastfeeding (some felt pain only initially and for others it lasted much longer), Shannon e-mailed me. She recapped the question and discussion and then said:
So I wanted to throw this over to you. What about the statement that "it shouldn't hurt" and what do you think it means, first of all (does it mean it should NEVER hurt? Does it mean that after an adjustment period it shouldn't hurt? Does it split hairs between "discomfort" and "pain"?) And second of all, what do you think it does to women trying to breastfeed to hear that statement, when they are obviously struggling with it? It would definitely be discouraging, to hear that it shouldn't hurt if you're "doing it right", kwim?
I know it's kind of a big question, hee, but I think it's an important one and i thought you'd be the perfect person to spring a discussion about it.
What do you think?
What do I think? I think it is complicated! But I'll give it a go...
Is pain normal?
The number of women who experience no pain or discomfort at all while breastfeeding is probably equivalent to the number of women who have experienced orgasm during birth. It is rare enough that everyone has heard the horror stories. It is rare enough that people tend not to believe women who say they experienced no pain at all.
So pain while breastfeeding is frequent, but it is normal? According to breastfeeding expert Dr. Jack Newman:
Though some tenderness during the first few days is relatively common, this should be a temporary situation that lasts only a few days and should never be so bad that the mother dreads nursing. Any pain that is more than mild is abnormal and is almost always due to the baby latching on poorly.
Moms who have been there and done that will tell you that you just need some time to let your nipples toughen up. Lactation consultants and other breastfeeding experts will tell you there is no such thing as letting your nipples "toughen up" and that if it hurts, something is wrong and you need to fix it ASAP.
The reality, I think, is somewhere between the two. I don't think that you necessarily need time for your nipples to toughen up, but I do think that any new breastfeeding pair needs some time to get used to each other and to get their technique down right. I do think it is worth asking why it hurts and what you can do to manage and eliminate the pain.
Challenge 1: Finding out why it is painful
Other than the mild tenderness that Jack Newman spoke of above, the pain that moms experience when breastfeeding does usually have a cause. According to Kelly Bonyata, IBCLC, from kellymom.com in her article on Healing Tips for Nipple Cracks or Abrasions:
Keep in mind that one of the most important factors in healing is to correct the source of the problem.
In her post Does Breastfeeding Hurt? Well...Yes and No. Mostly no., Sara from Custom-Made Milk explains that:
The majority of women will feel some pain in the first few weeks of breastfeeding while her baby learns to latch, while her nipples accustom themselves to being stretched out, and while her baby’s mouth grows larger.
Some people may call this toughening up the nipples, but I think it is more mom learning to breastfeed and baby learning to nurse. As with anything in life, some people are quick learners and others are not. I think that is why it takes longer for some women to get over the pain than others. But as with learning disorders that go undetected, nursing problems that go undetected will not go away on their own. But if you find out the source of the problem, you can usually do something about it.
If a mom is experiencing acute pain or even mild pain that doesn't seem to be getting better as time passes, it is worth a call to La Leche League, a visit to a lactation consultant, and/or posting a message on a reputable message board. The most common problem is issues with the latch, which is tricky because it is not always easy to fix. I know what a good latch looks like and feels like, but it took me forever to get to that point. When my son was not able to latch on, and then later when he was able to but his latch was painful, I wished desperately that I could borrow someone else's baby to nurse for a moment so that I would know what a good latch felt like. I longed to pass my baby over to the lactation consultant and have her try to nurse him and tell me if his latch felt right. I didn't know if it was my technique, my baby's technique, my breasts, or his mouth that was the source of the problem. It was frustrating, humiliating, and painful.
Beyond the latch, there are numerous other problems that can interfere with learning to breastfeed. Just like a tight Achilles tendon may prevent some children from being able to walk properly, a tight frenulum (tongue tie) can prevent some babies from being able to latch properly and can cause pain for their mothers. A mom may be doing everything right, but that won't make a difference unless the problem is dealt with.
Other things that can cause pain or discomfort include thrush, a bite, milk blister, plugged ducts and mastitis, breastfeeding after breast surgery, being pregnant, ovulating, and more.
Whatever the problem is, figuring out the source is the most important thing you can do to prevent future pain.
Challenge 2: Stopping the pain
Finding out the source of the pain is the first step, but not the last. There are many things that you can do to relieve the pain and heal cracked or sore nipples. If your nipples are damaged, it will keep hurting even if everything else is right.
A lot of women probably aren't aware of even half of the things you can do to heal your nipples and deal with the pain. A lot of women probably suffer more than they need to. A lot of women probably give up when they didn't need to. Sara from Custom-Made Milk lists some of the things that a lactation consultant should have mentioned to help a mom to heal her nipples and prevent further damage in her post Does Breastfeeding Hurt? Well...Yes and No. Mostly no:
If you haven’t heard of soothies, if you haven’t heard of loosening up your breast tissue before nursing, if you haven’t heard of weaning the baby back onto the breast, if you haven’t heard of breast shields, if you haven’t heard of lanolin, if you haven’t heard of vitamin E, if you haven’t heard of air-drying, if you haven’t heard about the proper types of bra to wear and about breast shells that can keep your bra from chafing your nipples.. If you didn’t learn how to properly wash your breasts (hint: no soap or hot water!) if you didn’t learn different latch-on techniques and if you didn’t learn about rotating breastfeeding positions to minimize repeated irritation to certain areas of the breast…. If you didn’t learn about nursing up-hill to correct hyper-supply that makes your baby bite down.. If you didn’t learn about nipple confusion…If you didn’t learn about personal fit shields, if you didn’t learn about the symptoms of tongue tied babies, if you didn’t learn about proper fit of breast pump flanges…
Nipple pain is one of the most common things that women face. It is one of the most common reasons for early weaning. There are so many tools out there to help moms get through the difficulties. Yet so many do not make it through.
How can breastfeeding experts help moms who are experiencing pain?
There are a lot of negative attitudes about breastfeeding in society. So I understand breastfeeding advocates wanting to improve the image of breastfeeding and I wholly support that goal. I understand when they want to make it sound easy and wonderful, but I don't think that is entirely the right approach. I say that because I also know how difficult breastfeeding can be and how much it can hurt (read our story). I also know how vulnerable moms can be when they are experiencing breastfeeding difficulties and I know that saying "you must be doing something wrong" is not going to give them confidence or make them feel supported.
On the heels of a fascinating survey about breastfeeding in Today's Parent, Katrina Onstad wrote an article called Breastfeeding Sucks in Chatelaine. She wrote:
...what enrages me about my breastfeeding experience (it went terribly both times) isn't that my freedom was so surprisingly and severely curtailed, or that I was once forced to nurse in a filthy bathroom stall, or even the pain itself, it's that I was negated by the very people who claimed me as one of their own. I think that if someone, somewhere in the pro-breastfeeding camp had said: "It will get better. You are doing the best you can," then maybe those first months wouldn't have been such a crazy-making vacillation between profound joy and utter agony.
As a moderator on a breastfeeding support board, I learned how carefully you need to choose your words sometimes. I learned that answering a question by a mom on the Newborn board is not just about answering her question, it is also a therapy session and a cheerleading session.
It is hard though. Hard to find the balance between being truthful and not scaring moms away from breastfeeding (because it does get better). Hard to juggle dealing with real breastfeeding problems that moms are facing and remembering to tell them they are doing a great job. Hard to figure out what is par for the course and what needs immediate attention.
Image credit: sean dreilinger on flickr.