How much will breastfeeding hurt? (Or Coping with pain and discomfort or Prevention is better than c
Breastfeeding should not hurt!
The best form of prevention is to get the best possible start and having a baby that latches effectively! If sore nipples were due to an ineffective latch, (since the most frequent causes of sore nipples are due to baby’s position at the breast and suction trauma), nipples should be better within a day or 2 after making sure baby latches “effectively”. During this time it might help to offer baby the least sore breast first, as most sore nipples hurt most at the beginning of a feed. DO NOT wait until breasts are very full before feeding, baby may have difficulty latching on (wake baby for feeds if necessary). DO NOT wait until baby cries for a feed. If needing to detach baby, use your finger to break suction. Place a (clean ;-) finger in baby’s mouth, push in at the corner of the mouth, and push down the bottom jaw to break the vacuum – if you really need to end the feed prematurely....
During the first two to four days after birth, the mother's nipples may feel tender at the beginning of a feeding as the baby's early suckling stretches her nipple and areolar tissue far back into her/his mouth, called a nipple-stretching-pain. If a baby is positioned effectively at the breast, this temporary tenderness usually diminishes once the milk lets down (or maybe within 20 seconds or so), and disappears completely within a week or two.(1) When nipples hurt, breastfeeding is in jeopardy. GET HELP!
What can I do to prevent sore and cracked nipples?
Well, I think you know the answer by now? Ensure effective positioning and attachment of baby at the breast and if that was not the problem, get your baby’s tongue checked by someone who knows how to assess tongue tie with, for example, with the “Hazelbaker Assessment Tool for Lingual Frenulum Function”.(2) Get breastfeeding off to a good start, before the milk supply increases dramatically by day 3 – 4 after birth, by starting breastfeeding as soon as possible after birth and staying in skin-to-skin contact with baby until breastfeeding is going well! GET HELP!
What can you do during pregnancy to prevent sore and cracked nipples? Well, breastfeeding is the natural way to feed baby and because of this, nature takes care of most of the main preparation for you, (which is the growth of milk-producing part of the breasts), so it happens naturally during pregnancy!!
Breast preparation is thus not necessary; what you could do is to wear a well-fitting bra, which gives adequate support to your enlarging breasts and this you could buy during the last weeks of pregnancy to ensure a correct fit. They should be comfortable as you might have to sleep in them for a few weeks or months after birth once your milk is “in” and you might need to wear breast pads for possible leaking. No nipple preparation is necessary, but it might help you to become accustomed to handling your breasts ;-). To protect the natural oils on your nipples, NO soaps, NO alcohol or other agents should be used on nipples, rather clean nipples by only washing them with water. Nothing should be applied to the nipples that would not be applied to the lips.
Get your mind ready for breast feeding: Educate yourself and your partner (and other main support) about breastfeeding basics by attending antenatal classes, reading good books, talking to breastfeeding mothers. Some mothers have seen little breastfeeding among their family and friends. Knowing some main points about positioning and attachment can help breastfeeding to go well. Pregnant mothers are welcome to attend La Leche League meetings where they can witness other mothers’ breastfeed ;-).
How can I treat sore and cracked nipples?
While you are working on baby’s positioning and latching, research have found that warm, moist compresses (if a yeast infection is not present) can be soothing for sore nipple.(3) The best part is you already have the best treatment for your nipples: your breastmilk!
As mentioned, feed from the least sore side first, if possible. If it is necessary to remove your baby from your breast, break the suction gently by putting a clean finger in the corner of baby’s mouth and push the bottom jaw down.
Effective latch and positioning, together with expressed breast milk, is the remedy of choice in much of the world.(4) Even though your nipples might be sore due to an ineffective latch, once the latch is correct, the pain should be much less since the nipple will be in the comfort zone, way at the back of baby’s throat, along the palate, where there will be no abrasions or frictions. Should the crack still not heal there may be bacteria or a fungi in the wound. Treatment may be needed from a healthcare provider. Dr Jack Newman has a recipe on his site(5) containing ingredients which help deal with multiple causes or aggravating factors of sore nipples. He calls it “all-purpose” nipple ointment or APNO.
What about a nipple shield?
Kathy Parkes, IBCLC, said in a LEAVEN article(6) that nipples shields, (artificial nipples worn over the mother's nipple during a feeding) have, since the 1500s, been manufactured to provide a means of assisting infants at the breast or to protect a mother's sore or damaged nipples. While nipple shields may permit breastfeeding to continue in some special cases, more often they give the illusion of solving a breastfeeding problem doing nothing to treat the cause of the soreness.
Nipple shields are frequently used (or misused) for the treatment of sore nipples (protection and/or prevention), flat nipples, engorged breasts, breast refusal, premature infants and when baby has “neurological challenges”. Problems frequently associated with nipple shield use are, a decreased in baby’s ability to remove milk from the breast, leading to a decrease in mom’s milk supply and babies may develop a preference to the taste or sensation of the shield, which may interference with proper direct latching on the breast.
When someone suggests a shield as a quick fix to the breastfeeding issues, make sure to answer these questions first:
¤ Have you been helped to get the baby to the breast correctly or is the nipple shield the "first line of attack"?
¤ Does the benefit of the shield outweigh the risks?
¤ Does the use of the nipple shield fit your breastfeeding plan?
¤ Will you be able to receive and comply with careful follow-up?
¤ Do you understand that nipple shields are a temporary measure?
When the decision has been made to use a shield, follow these precautions for nipple shield use:
Help by a knowledgeable lactation consultant through assessment of and assisting in baby’s positioning and latch.
Use of a hospital-grade electric pump (to draw out flat or inverted nipples AND) to protect the supply after every breastfeed through a shield, (offer this expressed breastmilk with a cup, spoon, finger-feeding method as an additional top-up) until we know baby is able to get what s/he needs through the shield alone. This way you are feeding the baby (rule #1) and protecting your supply (rule #2).
Monitor baby's weight gain weekly.
If you have not done so already, seek help addressing the initial problem that prompted the use of the shield.
Try to wean your baby from the shield as soon as possible, when ready.
Latch on with the shield and try to remove it when baby takes a break.
Feed with the shield on the 1st side, offer 2nd side without the shield.
NEVER cut a silicone shield to promote transition back to the breast.
In conclusion, what have we learned today? Prevention is better than cure. When nipples hurt, breastfeeding is in jeopardy. GET HELP!
1. Mohrbacher, N. and Stock, J. Breastfeeding answer book. Revised Edition. Schaumburg, Illinois: LLLI, 1997; 45-76, 387-411
2. Jeanne L. Ballard, Christine E. Auer and Jane C. Khoury. Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad. Pediatrics 2002;110;e63
3. Buchko et al. 1993; Lavergne 1997
4. Buchko, B. L., et al. Comfort measure in breastfeeding primiparous women. Journal of Obstetrics Gynecology Neonatal Nursing Jan 1994; 23: 46-52