Nipple Pain in Breastfeeding

By Jessica Martin-Weber

This post is generously made possible by Bamboobies

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All kinds of advice and myths abound when it comes to breastfeeding and preparing nipples for the experience or what to do when there is pain. Dire warnings and emphasis on getting a “good latch” can make it seem as though it is tricky, inevitably painful, and consuming. (Do you need to worry about your baby’s latch? See here for more on what to look for in a good latch and what to do if it is causing problems.)

But there’s good news! While some do experience nipple pain, many do not and for those that have pain, there is usually an answer and steps that can help resolve the underlying cause. Breastfeeding shouldn’t hurt but that doesn’t mean it won’t and it doesn’t mean that if it does it is your fault or that you did something wrong. Seeing a professional breastfeeding helper such as an IBCLC (International Board Certified Lactation Consultant) may help identify the cause of the pain and find a resolution that will help you reach your breastfeeding goals.

Here are a few points on nipple pain in breastfeeding and tips for how to handle such pain. It is our hope that nobody goes through pain in feeding their babies but if you do, most of the time it doesn’t have to stay that way.

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Is it serious? Figure out if this is the type of pain that indicates an issue or is within the range of normal sensitivity with initial latch. If it lasts for 30 seconds or so and doesn’t bother you when you’re not breastfeeding or pumping then it is possible it isn’t serious and just an adjustment period while your nipples are a little sensitive. If it is toe-curling, swear-worthy pain that makes you hold your breath and try not to scream obscenities or toss your baby far, far away from you, then it is serious and you need to be seen by an expert professional breastfeeding helper. Any tissue damage, cracking, bleeding, scabbing, inflammation, bloody expressed milk, etc., will require proactive treatment and you need to see a health care provider. Keep in mind that if your pain tolerance is high, you may push through pain that is a warning sign that something is wrong, don’t wait too long to get help from a breastfeeding helper such as an IBCLC.

What is the cause? It could be a number of causes from baby’s physiology such as a high palate or tongue-tie (frenulum restriction) to your anatomy such as flat or inverted nipples, bifurcated nipples, or Raynaud’s syndrome (vasospasms), or from a pathology such as a bacterial infection or yeast overgrowth, to a damaging latch. Unfortunately sometimes the case is baby just needs to grow more and it will take time but there may be ways to improve things until that time comes and a breastfeeding helper should be able to help you with that.

What’s the treatment? Working with an experienced breastfeeding helper, once the cause is determined, the first step is to address the underlying cause. This may mean changing positioning and learning latch techniques (such as this “Flipple” technique for latching), a prescription to treat thrush or a bacterial infection, using a device to pull flat or inverted nipples out, a procedure to correct frenulum restriction, therapeutic suck training, and a number of other possibilities. We should start with the easiest to implement first, such as positioning and latch but an early diagnosis can mean resolving the underlying cause for the nipple pain quickly and getting back to reaching those breastfeeding goals.

How to heal? Pain, particularly pain that was ongoing for a while, usually means some tissue damage that’s going to need to heal and until it does, the pain will continue. Treating the underlying cause of the pain is essential for complete healing but there are ways to encourage healing even as the cause is addressed.

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Air drying is important for healing, as much as possible, allow your nipples to air dry before closing up your bra. Air is healing and having the area dry prevents bacteria and yeast from growing in a dark, damp environment. Additionally, rinsing them several times a day (not after each feeding but frequently) can also reduce possible irritation from baby’s saliva.

A good nipple cream, one that is plant based, breathable, and safe enough to leave on during breastfeeding can not only help with healing but can prevent chapping in the early days of breastfeeding as a preventative measure. Wiping off an ointment from sensitive and damaged tissue is painful and can cause further injury so picking one that is safe for baby to ingest in tiny amounts is ideal. Apply after every feeding after allowing the area to dry and pick nursing pads that won’t stick to damaged tissue and your nipple cream.

Your own breastmilk may help your nipples heal. Breastmilk is full of good things that can expedite healing, including stem cells! Be careful though, the sugars in breastmilk will feed a yeast overgrowth, making thrush worse.

Air and sunlight may help nipples healing from thrush as yeast thrives best in dark, damp areas. Make the environment hostile for yeast by exposing your nipples to sunlight and taking a probiotic and cutting out refined sugar.

Heat or cold packs can provide comforting relief, it’s personal, some will love these and others will find them uncomfortable for addressing nipple pain. For those with Raynaud’s Syndrome there is no cure or way to permanently resolve the problem but a heat pack like this one may help minimize the symptoms, apply immediately after feeding.

Cold shredded carrots in the bra (will stain!) promotes healing and is soothing. After breastfeeding or pumping, put shredded carrots stored in the refrigerator in your bra (if you don’t mind your nursing pad turning orange, they can help hold the carrots in place).

Protect the nipples with a nipple shield may be necessary. Nipple shields should be used with caution and hopefully with the guidance of an experienced breastfeeding helper such as an IBCLC because there is a risk of lowering milk supply with using a breast shield (not everyone experiences this, just a factor to be aware is a possibility), but they can be a good option for some to help with tissue healing for a short time.

Take a break if you need to. Sometimes damaged tissue just can’t heal until it has the chance to rest. Regularly empty your breast to protect your supply and have breastmilk for your baby, be sure that you’re using the proper flange size so as not to potentially cause more damage.

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What are your tips for preventing and healing nipple pain and tissue damage?

Share with us in the comments, together we can support each other in reaching our baby feeding goals.

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Drawing from a diverse background in the performing arts and midwifery, Jessica Martin-Weber supports women and families, creating spaces for open dialogue. Writer and speaker, Jessica is the creator of TheLeakyBoob.com, co-creator of BeyondMoi.com, and creator and author of the children’s book and community of What Love Tastes Like, supporter of A Girl With A View, and co-founder of Milk: An Infant Feeding Conference. She co-parents her 6 daughters with her husband of 19 years and is currently writing her first creative non-fiction book.
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How Lubrication Can Improve Breastmilk Pumping

by Kristine Phillips Keller

This post made possible by the support of Ameda

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I learned the answer to this question the hard way with my oldest son. I was not much of a reader but breastfed because both of my sisters did the breastfeeding thing. If they could do it, so could I. However, in hindsight, I pretty much did everything wrong that I could have done. I wanted a nursery (I needed sleep, right?), I wanted pacifiers (he can’t just suck on me or I won’t get any sleep) and I wanted bottles (dads need to help too, right?). I thought, surely I can make all of this work. Boy was I wrong!

Not only did I go into it uneducated, I also have flat nipples. I honestly thought they were broken as they never became fully erect prior to years of nursing/pumping. I also have really naturally dry skin. Early on, I had damage but didn’t realize how bad it was until it was visible, right at Stage III damage (which means skin is literally gone). I was in such pain that I would cry when my boys would cry because I knew what was coming. I would fear nursing them because of the toe curling pain that it took to get them latched on. For the most part, after a minute or two it became bearable. Other times, the entire feeding was excruciatingly painful for me.

At six weeks with my first, I gave into pumping full time. I asked for help from family repeatedly to try and figure out what I was doing wrong and what I could do to correct the latch. No one seemed to be able to offer me the advice that I needed to make direct breastfeeding work and I just didn’t have it in me to bear that kind of pain any more. However, I still wanted to give them my milk…so I continued on with pumping & still continued to have cracked, bloody nipples until a good 10-11 months of pumping.

Around that same time, I was talking with my sister about all of the bloody milk that I was dumping because, even though I was no longer nursing, I still had pretty bad damage on both of my nipples. I just thought that’s how it was going to be for me. She then asked me if I was lubricating before I pumped. My response to her was, “Isn’t that what you do when you have sex?” She laughed & then said yes but that the pump shields were dry. Babies have moisture in their mouth for lubrication but there is no moisture on the pump shield prior to pumping.

I mean, would you ever expect to drive a car with NO lubrication and have things go well? ABSOLUTELY NOT! There must be lubrication to prevent friction… and to prevent damage. After all, isn’t that what our healthcare is supposed to be about these days, preventative care? Well, let me tell you…the difference was night and day. I went from having constantly damaged, bloody nipples to pain free/damage free nipples overnight. It was such a relief to know that there was something I could do to prevent this pain and discomfort.

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I started working for WIC 2.5 years ago as a peer counselor and have since applied theory to moms that come to me with damaged or sore nipples. If you lubricate before you latch, you lessen the probability of damage happening from the initial suck (regardless of whether it’s baby or the pump). That lubrication gives both something to slide against instead of that reverse pressure working against dry skin.

I’ve asked numerous breastfeeding professionals and no one seemed to know of any literature that puts emphasis on “lubricating BEFORE nursing or BEFORE pumping”. The only reference that I’ve seen is to use breast milk on sore nipples AFTER nursing. If it works after, why not try it before?

Lubricant suggestions: (you may need to try a few different ones to decide which is most comfortable for you.)

  • Your breastmilk
  • Nipple cream/ointment (suggest vegan and edible, rather than animal based)
  • Coconut oil
  • Olive oil
  • Almond oil
  • Infant massage oil
  • Avoid synthetics such as traditional baby oil

Some moms have found that regularly lubricating their breasts and pump horns before pumping greatly reduces the amount of discomfort they experience which in turn helps them let down easier and respond better to the pump.  There’s no need for pumping to be a painful or uncomfortable experience, experiment with different lubricant options to find what works best for you.  I hope this simple tip helps you in your breastfeeding and pumping journey as it has helped me.  How about we pass along this little known tip and prevent the damage in the first place?

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What pumping tips do you have to share to help other moms?

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Kristine Thanks to her sister, Kristine breastfed/exclusively pumped for her two boys now 3.5 and 8 years old, she pretty much did everything wrong when it came to breastfeeding but managed to get the pumping thing right (after a while).  After experiencing discrimination she contacted WIC about becoming a breastfeeding peer counselor and begin training to become an IBCLC. She sits for the IBCLC exam this summer and looks forward to continuing to help mothers reach their breastfeeding goals.
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