Outraged by the midwife....

[June2008]

On talking to one of my friends today after her visit to the midwife, I was outraged by what the midwife had said to her and just wondered if anyone else had ever heard this.....

'you'll probably have difficulty in breastfeeding as you're blond'

Is this not just totally wrong or am I getting worked up on my friends behalf for nothing?

Bit of background: we are both due in the next four weeks - friend with DC1 and me with DC2 - I b'fed for 15 months with DC1 and am blond...

How do they get away with saying things like this?

That is an incredibly old fashioned thing to say and by old fashioned I mean 18th Century! When people hired wet nurses for babies who were not able to be fed by their mothers, a brunette wet nurse could command a higher fee than a blonde or red head as brunettes' milk was considered more nutritious and their disposition was more 'balanced' (as obviously you 'inherited' your disposition from your food ). Blondes were considered to have poor quality milk as well by some cultures/times (load of twaddle of course).

I'd suggest the mw gets a bit more training preferably not by reading childrearing manuals from 1760 though

ah yes, well obviously brunettes eat more brown food, wholegrains etc, and blondes eat more, um... lemons?!

does make you wonder what assumptions that float around these days, that in the next century we'll be saying "WTF were we thinking?"

I have strawberry blonde hair and pale skin and have a very high pain threshold indeed.

Can some link to an actual peer reviewed solid study on this or is it another old (mid)wife's tale?

oooh does that mean you eat strawberries morloth?

MathsMadMummy - Well I can catagorically say that my hair colour is entirely derived from eating chocolate so there may well be some truth to that (I have some reddish bits too - that's jaffa cakes for you )

I second Morloth - can someone please link to a credible study on this?

As a fair skinned type I'd be most interested to hear of anything that suggested I had a lower sensitivity to pain (when the opposite is true!). As surely if there were evidence for this then they'd be advising it as part of the prep for labour and the like...

I am very fair, have ridiculously sensitive skin and nipples made of kevlar never had/have any discomfort when breastfeeding. Odd.

One for cold and heat pain and response to analgesics:

Anesthesiology. 2005 Mar;102(3):509-14.
Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads.

Liem EB, Joiner TV, Tsueda K, Sessler DI.

Abstract

BACKGROUND: Anesthetic requirement in redheads is exaggerated, suggesting that redheads may be especially sensitive to pain. Therefore, the authors tested the hypotheses that women with natural red hair are more sensitive to pain and that redheads are resistant to topical and subcutaneous lidocaine.

METHODS: The authors evaluated pain sensitivity in red-haired (n = 30) or dark-haired (n = 30) women by determining the electrical current perception threshold, pain perception, and maximum pain tolerance with a Neurometer CPT/C (Neurotron, Inc., Baltimore, MD). They evaluated the analogous warm and cold temperature thresholds with the TSA-II Neurosensory Analyzer (Medoc Ltd., Minneapolis, MN). Volunteers were tested with both devices at baseline and with the Neurometer after 1-h exposure to 4% liposomal lidocaine and after subcutaneous injection of 1% lidocaine. Data are presented as medians (interquartile ranges).

RESULTS: Current perception, pain perception, and pain tolerance thresholds were similar in the red-haired and dark-haired women at 2,000, 250, and 5 Hz. In contrast, redheads were more sensitive to cold pain perception (22.6 [15.1-26.1] vs. 12.6 [0-20] degrees C; P = 0.004), cold pain tolerance (6.0 [0-9.7] vs. 0.0 [0.0-2.0] degrees C; P = 0.001), and heat pain (46.3 [45.7-47.5] vs. 47.7 [46.6-48.7] degrees C; P = 0.009). Subcutaneous lidocaine was significantly less effective in redheads (e.g., pain tolerance threshold at 2,000-Hz stimulation in redheads was 11.0 [8.5-16.5] vs. > 20.0 (14.5 to > 20) mA in others; P = 0.005).

CONCLUSION: Red hair is the phenotype for mutations of the melanocortin-1 receptor. Results indicate that redheads are more sensitive to thermal pain and are resistant to the analgesic effects of subcutaneous lidocaine. Mutations of the melanocortin-1 receptor, or a consequence thereof, thus modulate pain sensitivity.

Another on analgesia

Anesthesiology. 2004 Aug;101(2):279-83.
Anesthetic requirement is increased in redheads.

Liem EB, Lin CM, Suleman MI, Doufas AG, Gregg RG, Veauthier JM, Loyd G, Sessler DI.

Abstract

BACKGROUND: Age and body temperature alter inhalational anesthetic requirement; however, no human genotype is associated with inhalational anesthetic requirement. There is an anecdotal impression that anesthetic requirement is increased in redheads. Furthermore, red hair results from distinct mutations of the melanocortin-1 receptor. Therefore, the authors tested the hypothesis that the requirement for the volatile anesthetic desflurane is greater in natural redheaded than in dark-haired women.

METHODS: The authors studied healthy women with bright red (n = 10) or dark (n = 10) hair. Blood was sampled for subsequent analyses of melanocortin-1 receptor alleles. Anesthesia was induced with sevoflurane and maintained with desflurane randomly set at an end-tidal concentration between 5.5 and 7.5%. After an equilibration period, a noxious electrical stimulation (100 Hz, 70 mA) was transmitted through bilateral intradermal needles. If the volunteer moved in response to stimulation, desflurane was increased by 0.5%; otherwise, it was decreased by 0.5%. This was continued until volunteers "crossed over" from movement to nonmovement (or vice versa) four times. Individual logistic regression curves were used to determine desflurane requirement (P50). Desflurane requirements in the two groups were compared using Mann-Whitney nonparametric two-sample test; P < 0.05 was considered statistically significant.

RESULTS: The desflurane requirement in redheads (6.2 vol% [95% CI, 5.9-6.5]) was significantly greater than in dark-haired women (5.2 vol% [4.9-5.5]; P = 0.0004). Nine of 10 redheads were either homozygous or compound heterozygotes for mutations on the melanocortin-1 receptor gene.

CONCLUSIONS: Red hair seems to be a distinct phenotype linked to anesthetic requirement in humans that can also be traced to a specific genotype.

i.e. there does seem to be a difference in the way in which people with red hair experience some types of pain and respond to some types of analgesia (although for some analgesics redheads appear to be more sensitive).

But no suggestion from the studies I've seen that this should affect breastfeeding/nipple pain, still less that it does.

em, i take it your friend laughed and told the midwife to stop being ridiculous?

Can't see any studies showing anything similar for blondes, and doesn't appear to apply to strawberry blondes (which is what you'd expect if it's associated with mutations in the melanocortin-1 receptor gene as those don't appear to be associated with groups other than those with bright red hair).

I eat a lot of everything Orm.

I had lots of comments about bleeding more from canula sites when in labour because of my red hair, and I'm sure the midwife mentioned it when she saw the state of my bloody stumps nipples after the first few days. I'd have been pretty if she'd said it BEFOREhand though.

I also had lots of feeling during my CS so interesting to read about the analgesia studies...

On a slightly different note, I was told by the obs registrar that I should have a managed third stage, because "as a redhead you are more likely to bleed if you have a physiologcal third stage". I pointed out that my natural hair is mousy with far too much grey and that I dye my hair.... (And anyway the colour is very dark blond with chestnut lights!!) Not to be discouraged she continued saying that as I am fair-skinned, I probably have a fair amount of Celtic blood in me and that this can be associated with bleeding. Nope. Sorry. Jewish. Strangely, I'm not minded to change my birth plan....

Unbelievable! I must admit although very nice I have this feeling my mw isn't that knowledgeable! Didn't know about the fetal medicine centre or much about nt testing and cvs then last week told me not to go on holiday abroad at 15 wks as it was to hot!
More sinister was the one who lectured of for ages about breast feeding dd now 8 telling me loudly that plenty of women feed after breast cancer. She did not let me get a word in or else id have told her id had a double mastectomy! Nasty old cow

I was told that redheads have less stretchy bits than darker more melanin rich skinned women - they're more prone to tearing - and this applies to nipples also - also to strawberry blond women.

I can see where the MW is coming from: there maybe more pain involved for your friend, and this might put her off, BUT I think the MW was out of order to predict the doom and gloom scenario.

It wasn't blond joke, just a comment about melanin poor skin I think: but out of order none the less, as with help and positive support it is possible to get over the pain when establishing b/f.

I am very pasty and have a tinge of ginge naturally, and bf my DD1 didn't hurt at all.
Even if there are studies showing that women with particular colouring may have lower pain thresholds, applying that to bf assumes that it always hurts when in fact sometimes it just works and is fine.

I suppose what bothers me about MWs coming out with stories like this is that it is easy for women to give them some weight, given that it is coming out of the mouth of someone who should know their stuff. I was vaguely troubled by my MWs comments about the gaviscon. If I hadn't taken them I wouldn't have been able to eat but the thought of hurting my baby was horrid. The NHS is supposed to offer evidence-based healthcare. Old wives tales are not supposed to be part of the deal.

ProfLayton thanks for those studies - fascinating stuff! Though I agree that this becoming some sort of blanket warning about the pain of breastfeeding is a bit off.

The two studies mentioned above are surely far too small to take seriously. One uses sample groups of 30 women each, the other 10, also they don't appear to be randomised controlled studies. Not nearly good enough to draw firm conclusions, let alone base advice on BF or birth plans on, FGS!

There are other studies showing different responses to different analgesics in mice and humans with mutations in the melanocortin-1 receptor gene, as well.

But obviously those studies wouldn't be sensible to base advice on BF or birth plans on anyway, because even given the sample sizes involved one of them shows no difference between the two groups for most types of pain (only for heat and cold pain, which isn't relevant to BF or birth) and the other is about sensitivity to a particular analgesic, not to pain thresholds themselves.

I think most of the research on this is relevant to anaesthetists, who will be making decisions about selection and dosages of particular drugs for particular patients, rather than to the general public.

Zazen - obviously it wasn't a blond joke, I was being facetious.
The problem is HCPs of all people spout this rubbish and put people off BF.