Ouch! Your baby begins to nurse and it hurts! Sore nipples are a frequent complaint for breastfeeding mothers, and some assume it’s an inevitable part of the nursing experience. But lactation experts agree that pain is a sign that something isn’t right.
The most common cause? The baby is not taking the nipple deeply enough into his mouth. For breastfeeding to be comfortable, the baby needs to have the entire nipple and part of the breast in his mouth, so that the nipple is near the back of his mouth where the palate is soft. This good latch is more likely to happen if the baby latches on with his head tipped back so that his chin is pressed into the mother’s breast and his nose is away from the breast. Of course, every baby and every breast is a little different, so you may need to adjust the positioning to find what works best for both of you.
Try these ideas for preventing nipple soreness and solving the problem if it does happen.
1. Let your baby self-latch
Humans, like the newborns of other mammals, have innate breastfeeding abilities and are capable of finding the breast and latching on well with only minimal help from the mother. (Some medications and interventions in labour and birth may make this more difficult for some babies in the first hours and days after birth.) If the mother gets into a comfortable, semi-reclining position and puts the baby tummy-down on her body (gravity will help keep him there, but mom can use her hands to provide some support if needed), with the baby’s head near her breasts, the baby will orient himself by bobbing his head, and move towards the breast to latch on. This can take time, but usually results in an effective, pain-free latch.
2. Use good positioning if you need to help the baby
Some babies (for example, those who were exposed to medications during labour and birth) may have difficulty in self-attaching. If you are breastfeeding sitting up, be sure your baby is tucked in close to you, tummy to tummy, and that your supporting hand or arm is placed behind her shoulders, not her head, so that she can tip her head back and bring the chin into the breast first. Your nipple should be pointed towards her nose, so that as she opens wide and tips her head back, it will be in the perfect place to slide deeply into her mouth, aimed at the roof of her mouth.
3. Adjust without unlatching
If your baby latches on, and it hurts, you know something is wrong. Sometimes mothers are advised to stick a finger in the baby’s mouth, unlatch him, and start over. The problem with this approach is that it’s very frustrating for the baby: every time he starts nursing, he’s taken off the breast. Some get so frustrated they refuse to nurse, or begin clamping down on the nipple. It also puts you at the risk of more nipple damage if the baby latches on incorrectly repeatedly. Instead, try first to adjust the baby’s position while he’s nursing, so that the rest of the feeding can be more comfortable. Try pressing in a little more on baby’s shoulder to bring him in closer and let his head tip back a bit more, or shifting his position slightly (depending on the natural position of your nipple ? he may need to be lower or more out to the side, for example).
4. Watch for early hunger cues
Mothers with sore nipples often want to space feedings out as long as possible, and that’s definitely understandable! If something causes you pain, you want to do it infrequently. However, a very hungry baby isn’t going to have much patience, and may try to grab at your nipple, causing more pain. Feeding the baby as soon as he seems hungry will make it easier to work on getting a good latch every time.
5. Remember that not all sore nipples are caused by latch problems (although the majority are)
Some other possible causes: thrush (a yeast infection on the skin of the nipple, which can also be inside the baby’s mouth); a bacterial infection on the nipple or in the milk ducts; a nipple bleb, which looks like a tiny white blister on the end of the nipple; Raynaud’s syndrome, which is a condition where the nipple turns white after a feeding and hurts as the blood flows back in. If you suspect any of these (or some other issue) might be the problem, check with your doctor or a lactation consultant for treatment recommendations.
6. Check for tongue-tie in baby
A baby with a tongue-tie isn’t able to lift his tongue or move it forward normally and this means she can’t use it to help extract milk from the breast. Instead the baby will push the nipple up with her tongue, pressing it against her hard palate as she sucks and often causing a lot of pain and damage. Look to see if your baby sticks her tongue out past her bottom lip and if she lifts her tongue to the roof of her mouth when crying. If she seems unable to make these movements, consult with your doctor. A medical professional can clip the membrane that restricts the tongue’s movement, which can make a big difference.
7. Use nipple shields cautiously, if at all
Nipple shields are often recommended to protect sore nipples during feedings, but they can sometimes cause more problems than they solve. Nipple shields look like bottle nipples made out of very thin silicone and are placed over the mother’s nipples before the baby latches on. However, often the baby doesn’t latch well onto the shield, the nipple continues to be damaged and the different shape and feel may lead to the baby having difficulty in breastfeeding without it. If other things haven’t worked, though, it may be worth giving it a try with the help of a La Leche League Leader or lactation consultant.
8. Use your milk to heal cracked, bleeding or blistered nipples
Express a little milk onto the nipple and let it air-dry there. Be cautious about using lanolin or other creams; if you do have some thrush present, these creams can encourage it to grow. A prescription ointment (such as Dr. Jack Newman’s All-Purpose Nipple Ointment) with ingredients to fight bacterial and yeast infections can help you heal as well. You can also take over-the-counter painkillers. Another option is to apply an ice pack just before you feed the baby to temporarily numb the nipple as you latch the baby on. One piece of good news: breastfeeding nipples generally heal very quickly once the cause of the damage (such as a latch problem) is resolved.
9. Air those nipples out
If your nipples are sore and damaged, you may find that anything touching them makes them hurt even more. You can use breast shells (donut shaped plastic items with a dome top; you put your nipple in the middle of the donut hole and the dome protects it from contact) to protect them from being touched by your bra. As much as possible, expose the nipples to the air so they will stay dry and heal.
10. Seek out help!
Many people think it’s normal for breastfeeding to be painful, at least in the beginning. It’s not. If these tips haven’t helped you resolve the problem, seek out a breastfeeding expert who can look at your particular situation and give you some suggestions. Often a mother with sore nipples will have more than one problem (for example, you may have started off with a poor latch, developed a bacterial infection, and have Raynaud’s syndrome as well, triggered by the trauma to the nipple) so you may have to work through each one before the feedings become pain-free.