​Nipple Pain and Breastfeeding

What am I supposed to feel when I’m nursing? Is it supposed to hurt? My friend told me my nipples would hurt for the first month. I heard that bleeding is normal in the beginning. I was told my nipples would toughen up after a few weeks. Was I supposed to prepare my nipples before delivery? Is it normal that I have damaged and painful nipples?
These are just some of the common statements and questions I hear often. I’m going to break down the common reasons for nipple pain and what you can do to get back on track.

First, let’s discuss what normal feels like in the first 1-2 weeks. In the first 10-20 seconds of a good latch, you may feel discomfort or even slight pain. After 20 seconds, that discomfort should diminish and it should feel like a tug and pull sensation and no pain. If you feel pain after the initial latch, this is a signal your baby is latched in a shallow manner.
No preparation is needed for your nipples prior to delivery! They are ready to nurse! Breastfeeding is not supposed to hurt even right after delivery. Bleeding is never normal. The initial discomfort you may feel in the first 10-20 of the latch usually fades after a week or two.

In the first week after birth as the parent and baby are learning positioning and latch, there can be some imperfect latch attempts. It only takes 1 or 2 minutes of an improper latch for a blister or crack to occur. Minor damage that occurs minimally in this way is common but not normal. What do I mean by that? This damage signifies a shallow latch and the need to work to correct it, but is fairly common in the first several days to have a few missteps. If you are struggling with repeated damage into the second day of life for your baby, please reach out for skilled Lactation help.
Improper latch is one of the most common reasons for sore nipples. If your nipple is not deep enough in your baby’s mouth and resting on the soft palate junction in his/her mouth, your nipple may become compressed (flattened like pancake), or appear pointy like a new lipstick shape. This can progress to blisters, cracks, and bleeding. Non intact skin is more likely to become infected as well. It is also important to realize that the baby gets much less milk when latched in a shallow manner. Their weight and growth is at risk and your milk supply will not be properly stimulated.

​The number one fix for this issue is adjusting positioning and latch to attain an improved latch. If you have done this well, your nipple will heal fairly quickly and you should not see a return to damaged nipples. Minor damage should heal in 2-3 days with a corrected latch. (There are many reasons that babies have difficulty latching deeply. This blog is addressing nipple pain and care. If you need assistance attaining and maintain a proper latch, seek out the help of an IBCLC (International Board Certified Lactation Consultant))

There are many other reasons for your nipples to be in pain. It is important to work with an IBCLC to discover to reason you are in pain to recommend the best treatment. Other issues that can cause nipple pain are:

1. Poorly fitting pump flanges
2. Pumping with too high suction
3. Skin conditions
4. Bacterial, Candida, Viral infections
5. Vasospasm
6. Allodynia
7. Persistent plugged ducts
8. Oversupply
9. Ankyloglossia (Tongue Tie)

Let’s discuss nipple care. Your nipples took a beating. Now what? Applying your own colostrum or breast milk is the best treatment. It has the power to prevent infection, speed healing and is safe for the baby.

1. Apply breast milk (Antibacterial, Anti-inflammatory)
2. Virgin Coconut Oil (Antibacterial, fungal and viral activity)
3. Lanolin (thin film)
4. Hydrogel pads designed for nipple care (Recommended especially if there is non-intact skin)
5. Salt water soak: ¼ to ½ teaspoon of salt added to one quart of warm water. Soak nipples in the warm water for a minute or just long enough to get water into all the areas of your nipple. Do not soak for 5 minutes or longer as this will prolong healing and cause drying of the skin. Pat dry with a towel. If your baby doesn’t like the salt taste, rinse the nipples first by dipping in plain water.
6. Allowing your nipples to remain open to air for short periods also speeds healing. Some people will use Breast Shells (Not shields) to create a space between their clothing and nipples for comfort.
7. Nipple Rest. If your nipples are so damaged that nursing is painful even with a good position and latch, consider a period of Nipple Rest. Nipple rest is simply pumping and not nursing for a period of time until your nipples are healed sufficiently to try again. It should not hurt to pump if your fit and settings are correct.

​This treatment is not an exhaustive list of all the effective remedies available. Your Lactation Consultant is uniquely qualified to help you identify the source of your nipple pain and the best tailored treatment for your needs. Consulting an IBCLC in the setting of continued nipple pain is essential to successful breastfeeding. Pain is one of the number one reasons parents stop nursing.
 
References:

Berens, P., Eglash, A., Malloy, M., Steube, A., and The Academy of Breastfeeding Medicine. (2016) ABM Clinical Protocol #26: Persistent Pain With Breastfeeding. Breastfeeding Medicine.11(2). 1-8. DOI: 10.1089/bfm.2016.29002.pjb

Bonyata, K. (2018, January 16) Healing Tips For Nipple Cracks Or Abrasions. KellyMom. https://kellymom.com/bf/concerns/mother/nipplehealing/

Walker, M. (2013). Are There Any Cures For Sore Nipples? Clinical Lactation. 4 (3). 106-115.

Witkowska-Zimny, M., Kamińska-El-Hassan, E., & Wróbel, E. (2019). Milk Therapy: Unexpected Uses for Human Breast Milk. Nutrients, 11(5), 944. https://doi.org/10.3390/nu11050944
 
This blog is not intended to substitute for medical advice and is of a general nature. Please consult an IBCLC, or MD to address your specific concerns.