You pull your little one to your breast and, ouch -- it feels as if you're nursing a baby barracuda. Breastfeeding should not hurt! Nancy Mohrbacher and Kathleen Kendall-tackett, authors of "Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers," write, "Although many mothers experience some discomfort during breastfeeding at first, the only type of nipple pain that we consider normal today is very mild tenderness at the beginning of a feeding during the first week or two after birth. Nipple discomfort that is truly in this normal range subsides after a minute or two of breastfeeding when the mother's milk is released or lets down." Persistent or toe-curling pain is not normal.
Sore Nipples: Feeding Your Baby and Expressing Your Milk...
You pull your little one to your breast and, ouch -- it feels as if you're nursing a baby barracuda. Breastfeeding should not hurt! Nancy Mohrbacher and Kathleen Kendall-tackett, authors of "Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers," write, "Although many mothers experience some discomfort during breastfeeding at first, the only type of nipple pain that we consider normal today is very mild tenderness at the beginning of a feeding during the first week or two after birth. Nipple discomfort that is truly in this normal range subsides after a minute or two of breastfeeding when the mother's milk is released or lets down." Persistent or toe-curling pain is not normal.
Sore Nipples: Feeding Your Baby and Expressing Your Milk
- Poor positioning and attachment is the number one cause of sore nipples. Early nipple pain -- as early as the first feed -- is usually due to poor positioning and attachment. In the early weeks, it's important to support your breast (thumb above and back from your areola and fingers cupped below) throughout a feed. After tickling your baby's lips with your nipple, wait until she opens her mouth wide before you bring her to your breast. It's important that she take in a good mouthful of breast, with around 1/2 to 1 inch of your areola. When your baby is properly attached, your nipple will be deep within her mouth and protected from abrasion. Breastfeeding will be comfortable -- even if your nipples are already sore.
- Try a new position. Certain breastfeeding positions, such as the clutch (football) hold and cross cradle, give you more control in achieving a comfortable latch on. Make sure whatever position you choose, that your little one is well supported at breast level.
- Express some milk prior to a feed. This stimulates your let-down reflex and gets your milk flowing. This is especially important if your breasts are engorged, as engorgement can cause your nipple and areola to flatten, making latch on difficult.
- Offer your least sore breast first. Once your milk lets down, you can gently break suction and move your baby to the affected breast.
- Allow your baby to nurse, without timing. Sore nipples are not affected by the frequency or length of breastfeeding. With short, frequent feeds, latch on is easier. Also, your breasts will be less engorged, and your baby will not be as hungry, so she will suck less vigorously. Breast "drainage" is especially important if your nipples are cracked, because this makes you more prone to developing mastitis.
- Gently break suction to remove your baby from your breast. If breastfeeding is uncomfortable, you'll want to reposition your little one. To protect your nipples, insert your finger into the corner of your baby's mouth to break the suction.
- Your nipple should be the same shape after a feed as it was before nursing. If your nipple comes out of your baby's mouth appearing misshapen or creased, you probably have sore nipples. If so, this is a clue that there's problem with nursing that needs to be corrected -- usually positioning and attachment. You can get hands-on help from a board certified lactation consultant (IBCLC).
- For expressing your milk, choose a good pump or learn hand expression. Hand expression is both an effective and gentle method of milk expression. When using a pump, steer clear of bicycle-horn hand pumps and small hand-held battery-operated or electric pumps, which are very slow in generating suction. These can all cause nipple damage. Be sure that your nipple is centered in the flange and use gentle suction. Pumping can irritate the nipples if you use too much suction, pump for too long, or if the nipple rubs against the flange of the pump (meaning it's too small). Start with suction at the minimum setting, and express milk for no more than 10 minutes at a time when your nipples are sore.
- If your baby needs supplementation, avoid bottle nipples. Because sucking on a bottle nipple or pacifier is different than sucking at the breast, your baby may develop a sucking pattern that is not compatible with breastfeeding and causes nipple soreness. You can offer your expressed milk with a cup, spoon, syringe or supplementer.
Healing Your Sore Nipples
- Use breast shells to protect your nipples. Select breast shells with a larger-size nipple opening and multiple air holes to wear under your bra. You can (generously) apply ultra-purified lanolin, such as Lansinoh, before putting on the shells. Be sure your bra cups are large enough to comfortably fit the shells without putting pressure on your breast tissue.
- Express some milk following a feed and gently rub into your nipples. Allow to air dry for a few minutes, to keep your bra and nursing pads free from moisture. Your milk has healing antibacterial properties.
- Soothe your nipples with warm compresses. Researchers studied lanolin, warm water compresses (a warm wet washcloth) and expressed breast milk with air drying to see which method was most effective for nipple soreness. Warm compresses were found to be the most helpful (Pugh, L.C., Buchko, B.L., Bishop, B.A. et al, "Birth," 1996).
- Treat breaks in the nipple skin similar to the way you would treat a wound. Though washing nipples with soap is generally not recommended, it can be helpful to wash affected nipples once a day with a mild, nonantibacterial soap and water. Because Staph aureus is quite frequently linked to moderate to severe nipple soreness, talk to your doctor about applying a thin layer of topical antibiotic to breaks in the nipple skin. No adverse affects were reported in infants when a thin coat of antibiotic cream had been applied to the mother's nipples (Huggins, K.E., Billion, S.F., "Journal of Human Lactation," 1993). Oral antibiotics have also been found to be effective in treating moms with very sore, cracked nipples (Livingstone, V. and Stringer, J., "Journal of Human Lactation," 1999).
- Try moist wound healing. Apply enough ultra-purified lanolin to keep your nipples and areola moist, or use hydrogel pads approved for use on the nipples. Both methods provide pain relief, and moist healing, which allows your nipples to heal in 50 percent less time. When applying a cream or ointment to your breast, it's important to use something safe for human consumption and allergen free.
- Talk with your doctor about using a pain reliever. While you're working on correcting the problem, discuss the use of a pain reliever or anti-inflammatory medication. Most are approved by the American Academy of Pediatrics as safe for use by nursing moms.
Safety Note
- Pain is a warning that something is wrong. If you have excruciatingly sore nipples, or nipple soreness that persists throughout a feed, you should be evaluated by an IBCLC. If nipple problems still do not resolve, consider also working with a breastfeeding-friendly dermatologist.
- With sore nipples, nipple shields are generally used as a last resort. Though they have their place in preserving the breastfeeding relationship, they generally do not prevent pain or help sore nipples heal. When using a shield, express your milk following feeds to preserve your milk supply. Closely monitor the frequency of your baby's stools (at least three to four quarter-size bowel movements a day by day three) and weight gain to be sure your baby is getting enough milk.
- Pain from sore nipples can lead to depression. This can be misdiagnosed as postpartum depression, when, in fact, it is due to physical pain. Researchers found 38 percent of women with sore nipples experienced depression. Once nipple pain was resolved, depression fell to normal levels (Amir, L., "Breastfeeding Review," 1997). If you're depressed, talk to your doctor and get the help you need.
- Sore nipples can also be caused by many other conditions, including, but not limited to:
- engorgement
- thrush (red, sore itchy, scaly nipples and/or shooting deep breast pain during and after a feed)
- disorganized sucking
- bacterial infection (sore nipples that refuse to heal)
- oversupply (your baby may clamp down on the nipple to stop your fast flow, or slide off your breast)
- nipple vasospasm or Raynaud's phenomenon (extreme nipple pain when cold, and whitened nipples following feed
- nipple blebs/blisters (white dot on nipple tip)
- anatomical conditions such as tongue tie (when the lingual frenulum, the piece of tissue connecting underneath the tongue, is short, and your baby can't extend his tongue past the gum line)
- receding chin
- high palate, short tongue, small mouth and poor fit between Mom and baby (such as large breasts and very small mouth)
- skin conditions such as eczema and psoriasis
- sensitivity to products such as shampoo, deodorants, ointments, soaps, detergents, medications, and plastics (in breast shells, nipple shields, and pump flanges)
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