"It's normal that it hurts"

I hear and see this all the time.  Women have pain while breastfeeding, they ask for help, and are met with a chorus of "Oh, it's normal that it hurts!"  For many women, it does hurt, but that doesn't make it normal, just common.  Pain is an indicator that something is going on during suck swallow breathe that shouldn't be happening.  It doesn't mean that anything is wrong with the baby.  It doesn't mean that anything is wrong with the mom.  It just means that something has interrupted suck swallow breathe, and commonly it's something that can be fixed!  But not if we continue the notion that pain is normal.  

Suck swallow breathe is a neurobehavioral program.  It's sort of like a very complex reflex.  The baby gets certain stimuli and reacts in a certain way, with certain behaviors and movements.  Cathy Watson Genna and Lisa Sandora have a very thorough explanation of suck swallow breathe on page 3 of Breastfeeding: Normal Sucking and Swallowing.  There are things that can interrupt that program, like intrauterine lie, length of birth, birth interventions, tongue tie, improper positioning and latch on technique, etc.  When the pattern gets interrupted, babies compensate because they have to eat.  Usually, this means they move their tongue, or change the movement pattern of their tongue.  

Let's talk about pain during breastfeeding for a minute.  When women come to me, they usually describe either pinching or rubbing as the pain sensation they're feeling.  The pinching is compression.  That's what gets the white line on the tip of the nipple, or the lipstick shape.  Rubbing is the sandpaper or cat's tongue feeling.  So what's happening that's causing the pain?  The tongue is normally forward, over the lower gum line.  The back of the tongue drops rhythmically during peristalsis to move milk back in the mouth and down into the throat, while the tip of the tongue stays placed over the lower gum line.  When something has happened to interfere with normal suck swallow breathe coordination, the tongue tends to hump or raise in the back in order to slow or change the flow of milk into the throat.  The tip of the nipple goes back to the junction of the hard and soft palates, so when the back of the tongue raises it compresses the nipple.  Ouch!  Similarly, some babies raise the back of their tongues, but the tip of their tongue doesn't stay placed over the lower gum line.  It moves back and forth instead of staying in place and doing the wave motion of peristalsis.  That back and forth motion creates that rubbing feeling.  Also ouch!

So why isn't this pain normal?  Because it means that the tongue isn't in the right position to either seal well, move milk well, or coordinate their swallow.  Those things don't just get better.  Sometimes the pain goes away because the baby gets bigger and stronger and can do less painful things to compensate for the interruption to suck swallow breathe.  The underlying issue is still there, and for some babies it pops back up because they can't transfer milk well and stop gaining well, or when they start solids and have trouble chewing or moving food around their mouths, or even speech issues later on.   

Pain is almost always fixable if it's addressed in time.  There are many ways to help, positioning and latch on techniques are the first line of defense, suck training and finger feeding, craniosacral therapy, chiropratic, and other bodywork, or tongue tie revisions, followed by other therapies for correcting suck issues.  It is important to note that babies tend to stop wanting to do suck training and finger feeding once they hit 3 months.  They get old enough to not really want strangers fingers in their mouths! Understandable, but it makes it a lot harder to fix sucking problems after 3 months.   

Pain is a signal that something isn't right.  It's a signal that something needs to be fixed.  It's usually something that can be fixed.  Let's change the narrative around pain and breastfeeding.  Let's support women in the struggles they're having and help them resolve their issues.  Let's say "I hear you.  I understand.  Let's make it better."