Breastfeeding shouldn’t hurt. But someone is sure to tell you that it hurts for the first six weeks, and you just need to push through breastfeeding pain. They’ll try to warn you that you can’t nurse once your baby gets teeth, because won’t that hurt or maybe you’re one of the unlucky women who didn’t have much help in the hospital and you developed blisters even before discharge. It will take time for you to heal, but there’s definitely a solution to breastfeeding pain so you don’t have to suffer. If breastfeeding is painful, here’s what you can do:
Relief for breastfeeding pain during the early days
Consider baby’s positioning and latch: This is the most common reason for breastfeeding pain or sore nipples, and the most easily fixed. Even one ineffective latch in the early days of breastfeeding can cause nipple damage that lasts for a while.
It’s best for baby to have an asymmetric latch – which you can achieve by keeping your nipple opposite baby’s nose, waiting for a wide open mouth, pointing your nipple toward the roof of baby’s mouth, and quickly bringing baby close to you. When you look down, you should see baby’s lips flanged out on the breast, with more of the areola on the top showing than on the bottom. Baby’s jaw can be ‘squished’ into the breast, and his nose can be touching. If you pull down his bottom lip, you should see his tongue over his gums.
Baby should be positioned tummy-to-mommy no matter what hold you’re using, and his ear, shoulder and hip should be in a line. His head should be tipped back slightly so that he isn’t holding his chin to his chest.
Even once you get a comfortable deep latch with good positioning, it may take a while for any initial nipple abrasions to heal. Many moms use purified lanolin for comfort. Hydrogel pads are also available to speed wound healing. If the sores are taking too long to heal, they have become infected and a prescription cream might be needed.
Treating engorgement: Most women’s milk ‘comes in’ two to five days after baby’s birth. With this initial surge also comes swelling. This swelling can be painful in and of itself, and it can also make latching difficult which might lead to nipple pain.
Initial engorgement shouldn’t last more than a couple of days. The best thing to do is to feed your baby often. If your baby is having trouble latching because the breast is too full, hand express or pump just a little to soften the areola. Sometimes just putting pressure on the areola with your fingers is enough to displace some of the swelling so that baby can grasp enough to nurse.
Try ice packs for 20 minutes at a time between feedings to ease the discomfort (a bag of frozen veggies is perfect for this!). A warm, wet washcloth over the breast right before feeding can help get milk flowing. Stand in a warm shower and let the water run over your breasts (and don’t be alarmed if you start to leak). If engorgement continues, your baby may not be removing milk well. Work with a breastfeeding professional to find a cause for this prolonged swelling.
Pain later in the breastfeeding relationship
Plugged duct: A plugged duct – which feels like a small lump in the breast – is usually the product of milk not being removed effectively from a particular milk duct. Massage and heat directly to the area where you feel the plug sometimes helps. Try holding a vibrating toothbrush or massager on the area to break up some of the dried milk stuck in the duct. Nurse your baby with his chin pointing toward the blockage, and the strength of his suck may help to dislodge the plug.
Mastitis: If you are suffering from flu-like symptoms, and you have a warm, red, tender spot on your breast, you may have mastitis. This breast infection has typically been treated with antibiotics, though newer research is questioning whether or not that’s necessary. The best treatment for mastitis is breastfeeding often to keep milk moving and resting as much as you can.
Thrush: Thrush is a yeast infection of the breast. Often your baby will have signs of a yeast infection, too, with white patches in his mouth or a red, shiny, diaper rash. Symptoms for mom include an itchy, scaly, shiny, red areola along with nipple soreness. Some moms with thrush describe a shooting pain in the breast, as well. Thrush is treated with oral or topical antifungals for both mom and baby, but can be especially painful until it resolves.
Teething: If your baby is using you as a teething ring, try to ease some of his discomfort before putting him to the breast. Offer him a chilled teething ring or a frozen wet washcloth to chew briefly before latching. Alter your positions – you might find that he’s more comfortable (and less apt to bite) in one than another. Be sure to take him off the breast as soon as you notice he’s not actively nursing anymore so that he doesn’t bite down as he falls asleep. If your baby has used his teeth to bite you, don’t despair! Simply set him down and tell him that mommy is not for biting. Even young babies can understand tone of voice and facial expression. As you are nursing, watch for signals that your baby may start to clamp down with his teeth – and when you notice them pull him in tight against you to stop the action.
The best thing to do in any of these situations is to work with a board-certified lactation consultant to figure out what is going on in your particular situation. An IBCLC can watch your baby nurse, and help you make adjustments to positioning and latch, as well as help you solve more in-depth problems like recurrent mastitis or another type of breast infection. Breastfeeding pain is almost always treatable – and small changes can make a big difference. There’s almost never a need to wean your baby. If it hurts, get help. Your baby will thank you!