By Ali Weatherford in consultation with Cassie Terrillion
You might think that breastfeeding is supposed to be perfectly painless and naturally easy. Or maybe you’ve heard people say that breastfeeding is painful and hard. For most people there will probably be some level of discomfort at some point, especially at first. But pain is usually a sign that something is wrong.
Breastfeeding Shouldn’t Hurt
I didn’t know this when I was breastfeeding for the first time, and I tolerated A LOT of pain, because I was determined to make it work. I had a very sleepy newborn who would only wake up to eat for a few minutes every few hours! I was very worried that she wasn’t getting enough to eat, so when she did finally wake up and get to the breast, I wanted to make sure she was not disturbed. I held any uncomfortable position in case moving would make her let go of the breast. I tolerated back pain, neck pain, and extreme nipple pain, because I was afraid that if I made her let go, she would give up and go back to sleep. This went on for a couple of months. I’m still not sure whether it got easier because we got better at it, or because my nipples got a lot tougher!
What I did learn eventually was that I didn’t have to go through that.
If I had gotten some support, I would have learned how to hold my baby in a way that was comfortable for both of us. I would have learned how to help my baby get a good latch at the very beginning of a breastfeeding session so I wouldn’t have to go through it painfully and deal with sores and wounds afterward. Good positioning and good latch can be even more meaningful than just helping with pain. When we get things right, it can actually mean more milk with less effort for the baby too.
How to Know if your Pain is Normal
Some nipple pain or discomfort is normal. Here are some ways to know if it’s not.
- The pain continues for more than 30 seconds after you start feeding your baby. It’s normal to have a little pain as the baby is getting latched on, but it should go away quickly.
- The pain continues even when you’re not feeding your baby.
- The pain is very intense.
- You have skin damage. Your nipples might be cracked, bleeding, or blistered.
- Your nipple is misshapen after feeding your baby. It might look bent, flattened, creased, or lipstick-shaped.
- You continue to have pain past the first couple of weeks.
It’s good to look at pain as an indicator that something is not quite right. A lot of times the cause is very simple and easy to fix like it might have been in my case. Other times, it’s more complicated. Whatever is happening for you, please don’t tough it out. A lactation consultant can usually get to the bottom of pain issues and help you make significant improvement.
Causes of Pain
- Engorgement: If your breasts are getting overly full of milk, the increased size and hardness can mean your nipples stretch out and flatten. This can make it harder for your baby to get a good hold. Try doing some massaging and even hand expression to soften and empty the breast a little before trying again.
- Bad latch: A bad latch means that the baby is not holding onto the breast correctly. They might not be drawing enough of the breast tissue into the mouth, or they might not be pulling the nipple to the right part of the mouth. A bad latch is something that you should get help with.
- Improper sucking: Babies will usually create suction when they latch on, but sometimes they get confused and try to chew or clamp on to the nipple. Sometimes they aren’t able to use their tongue correctly and can’t get good suction for that reason. There are things that can be done to fix this, so be sure to get help.
- Unusual nipple shape/size: Some people have flat nipples or even nipples that don’t stick out at all. This can make a good latch more difficult and cause pain. There are techniques to help solve this problem, so it’s definitely worth getting some help.
- Very powerful milk ejection: When a baby first starts to suckle, there may not be much milk available yet. A little bit of stimulation from the baby will soon cause a milk “let-down” or milk ejection. It might be a light trickle, or it might be a downpour. You can usually tell if you have a very strong let-down, because milk might leak out around your baby’s latch, or your baby might be gulping, gasping, guzzling, or turning away from the breast. When this happens, babies sometimes grip the nipple trying to slow the flow in a way that causes pain. Besides potentially causing nipple pain, a baby might get distressed and fussy because they can’t keep up with the milk flow and even start to reject the breast, so it’s a great idea to try some ideas for fixing this. If you have a very powerful milk ejection, you might try some of these techniques:
- Clamp down on the breast just above the nipple using your first two fingers like a scissor-hold. This might slow it down.
- Use the “laid-back” position or more upright baby positions for breastfeeding so that the milk is not flowing straight down into the baby’s mouth.
- Take the baby off the breast until the let-down eases, then continue breastfeeding. You can catch the milk spray in a towel or catch it in a container and save it for later!
- Pump or use hand expression until the flow slows down, then put the baby to the breast.
- Pumping: This can be painful for some people, especially if you are not using the right flange size or if you’re doing it a lot. Lactation consultants should be able to help you with flange fitting and recommendations for a pumping schedule that suits your circumstances.
- Infection & sores: Sometimes sores on the nipples are very painful, and can get infected or you can have a bigger infection called Mastitis. It can be very painful and even lead to illness, so please get checked if things get worse and you start to have fever, pus in your breastmilk, red streaks near the painful part of the breast, or begin to feel pain in both breasts. Before things get to that point, see a lactation consultant. They may be able to help you prevent infection from a sore, or prevent a worsening infection if you can catch it early.
- The baby’s anatomy: This might be the most complicated issue to solve. Sometimes a baby’s mouth is just shaped differently and the baby can’t get a good latch or good suction at the breast. This might mean that the baby chews or grips the nipple in frustration or trying to get more milk and causes pain. One of the more common issues is when a baby has a tongue-tie or a lip-tie. This means that the little rubber bands of skin tissue connecting the lip or tongue to the mouth are too tight or short. This might limit the mobility of the baby’s tongue or lips, making a good latch difficult. See a lactation consultant for help assessing a baby’s latch and they may be able to refer you to a specialist to have it fixed.
The best advice for managing pain with breastfeeding is to not let it happen to begin with! Prevention is key. Most people are not prepared to understand this, but you can learn about breastfeeding before you start, and this might help you avoid some of the common challenges like pain. If you can start out well, you are less likely to experience pain and some of the problems that will cause pain to worsen. I recommend taking a breastfeeding class while you’re pregnant, and then take full advantage of the lactation support that might be offered in the hospital or birth center or by your midwife. If you still experience pain, please get help as soon as possible. A lactation consultant might be able to help you solve the problem before things get more difficult.
Remedies to Try at Home
Once you have significant pain, it can be hard to get it under control. The most important thing is to figure out what is causing it, and fix that issue. That might mean seeing a lactation consultant to work on your baby’s latch or your positioning. In the meantime, some things that people might use to help with healing and pain control include:
- Nipple shields
- Cooling gel pads
- Nipple cream or balms
- Ibuprofen or acetaminophen
- Keeping your breasts exposed. It tends to feel better when the nipples aren’t rubbing against something.
- Using a cold compress on the nipple
- Using a saline rinse or soak on broken skin
- Trying different nursing positions
- Breastfeeding on the uninjured side first
- Expressing milk by hand or using a pump temporarily to bottle feed if direct breastfeeding is too painful. It’s also important to do this to maintain your milk supply while you aren’t able to breastfeed directly.
I’ve probably said it WAY too many times already, but the importance of getting help for pain issues with breastfeeding can’t be overstated. I’ve seen how much relief just a little modification can bring, and it’s VERY worth it. Remember that you most likely have insurance benefits to cover this kind of support, especially when you hire a clinical lactation specialist called an IBCLC. Breastfeeding Success has many IBCLCs on staff, and can submit those charges to your insurance company for you. You likely will pay nothing out of pocket. There are other companies that can do that for you as well, but even if you get help from an individual who is not in network with insurance providers, you can submit your receipt for insurance reimbursement and it will likely be covered.
Breastfeeding Success Care Plan for Treating Nipple Pain
Kelly Mom articles:
Help for fast milk let-down
Coping with fast milk-flow by Nancy Mohrbacher
Common Breastfeeding Challenges – Office on Women’s Health