Is it Supposed to Hurt When I am Breastfeeding? The Painful Nipple Dilemma

Veronica Tingzon, IBCLC By Veronica Tingzon, IBCLC, RLC

The number one cause of breastfeeding cessation is painful nipples. Period. Sure, there are the moms that are afraid they haven’t got enough milk for their baby (even if they have gobs of milk) that quit breastfeeding because of the uncertainty of “how much”. Of course, you’ll also find the mom who doesn’t have her partner’s support toward breastfeeding, and that’s why she ceases to breastfeed her child. However, the oldest and most common reason for a mother wanting to stop breastfeeding is pain.

So, why, with so much information about breastfeeding in circulation, do mother’s still complain of painful nipples with latch? Simple. It takes two. The baby hasn’t read the books and articles or watched the instructional videos. And, many moms don’t attend classes on breastfeeding, either. And, practical application isn’t always as ideal as it is made out to be in classes, videos, and books. Often, the way women birth their babies and the impact of the birth on the baby, impacts the way he/she suckles. Finally, anatomy, whether it’s mom’s anatomy or baby’s anatomy (or both), impacts the breastfeeding experience too.

Let’s address each key point separately. We’ll start with education. I am a huge believer that one can never have enough information regarding the techniques of breastfeeding. Some mothers may complain that each nurse or lactation consultant has a different way of latching the baby, however, I think that each piece of information is a tool that you, as the breastfeeding mom, can arm yourself with to make your experience better. Take what you feel applies to you and works for your situation and apply it. You can always discard what doesn’t make sense for you later.

Positioning is key to a good latch; the way mom holds baby is integral as well. Understanding your baby’s and your anatomy will allow you to make better positioning choices so that you can get your baby to the breast painlessly. Two positions that help out are the cross cradle hold and the football hold, especially if you’ve had a cesarean. Trying to side lie with the baby post c-section (especially if you’re ample in the tummy department, which most post-partum moms are) might not be the most comfortable option. Cradle holding the baby after a vacuum delivery may not be the most comfortable for the baby. You need to find positions that provide a comfortable environment for you and your baby! Sometimes, that means you have to position your baby in a different hold on each breast. This won’t be the case forever; it’s just what you have to do in the beginning while you’re both learning.

Birth is a huge impact to yours and baby’s experience, as well. Babies who are born after hours of epidural, narcotic pain management, vacuum delivery, or forceps delivery can be very sleepy. If the baby was not suckled within the first hour or so of life, he/she has difficulty figuring out how to get to the breast after some time passes. This is an imprinting of sorts. Babies who have had interventions in their birth experiences (yes, an epidural can have an impact) can become very sleepy a couple of hours after birth. This sleepy period can last up to twenty-four hours. The most alert period in the baby’s first day of life is the time immediately after birth. If baby learns how to get well latched on in this time frame, chances are that he/she won’t struggle very much after the sleepy phase has ended. I think of this like I do when driving to a new place. I need directions to get somewhere the first time I drive there, but after I’ve been there once, the next time I drive there, I can get there without a map. Once I’ve driven that route several times, I let my autopilot take over. The baby will do the same with nursing. Eventually, autopilot takes over but he/she has to have the initial map to get there the first time.

The trickiest culprit of painful breastfeeding to overcome is anatomy. Whether it is mom that has flat or inverted nipples, overly large or overly small breasts, too short of arms or hands, or a large midsection; anatomy can make it difficult for baby to get deep on to the areolar tissue, as well as the nipple, when latching. Couple that with baby’s small mouth, perhaps a short tongue or a tongue-tie, and maybe even some birth trauma that misshapes the head or face (this will go down over a short period of time or may require some chiropractic or cranial-sacral therapy) and the baby truly does not have enough access to a good latch. When the baby latches to the tip of the nipple only, mom will be in a great amount of pain, and baby will receive a less than optimal feeding.

However, the good news is: when baby is latched deeply to the areola, as well as the nipple, there is virtually no pain at all! As a matter of fact, when baby nurses, feel good hormones like Oxytocin are released, making breastfeeding a beautiful bonding experience between you and your baby. I feel that your milk nourishes both your baby’s belly and his/her soul. When breastfeeding is going well, there are no words to describe the experience.

If you do run into some pain with breastfeeding, here are some management tips to help heal your nipples to allow nursing to continue…

Expressed breast milk/colostrum (colostrum is the first milk. It is thicker than the mature milk, yet packed full of immunities and protein) has healing properties. Manually express some milk or colostrum after baby detaches and spread it around the nipple. Let the nipple air-dry. This will allow the stem cells in your milk to help repair any damaged skin.

After allowing your milk to dry on the nipple you can use many different healing techniques. Some moms like to use lanolin or nipple butter on the nipple to help heal and soothe the nipple. Lanolin is food grade and won’t hurt the baby. However, please make sure that what you’re using is 100% lanolin – such as Lansinoh® HPA Lanolin and not a lanolin/petroleum jelly combination. Lansinoh® HPA Lanolin is 100% natural and is the world’s purest lanolin. Lanolin on the nipple works similarly as Lip Balm works on chapped lips. It soothes cracking skin and provides some moisture to dry, chapped nipple tissue. If you are allergic to wool, Lanolin is contraindicated for you since it is an oil substance derived from the wool of sheep. In this case, Nipple Butter may be a better more natural alternative because it is a plant based product.  Nipple Butter, by Earth Mama Angel Baby®, is made from soothing organic Calendula and non-sticky plant butters to comfort and protect sore, cracked nipples.  Purchase Lansinoh® HPA Lanolin and Natural Nipple Butter here and keep your nipples pain free!

Another great way to soothe painful nipples is with hydrogel pads, such as Soothies®. These wonderful strips of congealed gel were brought over into breastfeeding from burn healing technology. They’re what is referred to as “wet wound healing”, and they really help soothe cracked or damaged nipples. A tip for these is to wet with cold water and/or place the gel pads in the refrigerator. The coolness of the hydrogel will settle down achy, throbbing nipples. Purchase your Soothies® hydrogel pads here!

Some moms will opt to pump the most painful nipple and latch baby to one breast to allow the affected nipple to heal. Believe it or not, nipple tissue heals in a matter of a day or two because it is comprised of smooth skin, like that of your lips. Just as chapped lips heal quickly, so do nipples that have been damaged. The less damaged the nipple is, the quicker it begins to heal.

Lastly, a nipple shield can be used to protect the nipple and optimize the latch. Be forewarned, however, there is a special technique to nipple shield use. Using it incorrectly can further nipple damage. Seek the counseling of a certified lactation consultant to properly use this tool. This is a also a wonderful way to achieve a good latch when mom has short or inverted nipples or baby has a sort tongue or a tongue tie.

So, now you have a good latch and methods to overcoming painful nipples. Hopefully, breastfeeding is on its way to being pain free and pleasant. Here’s to a wonderful nursing journey!

(Please refer to our article and video on Latch and Position for a jump-start on good breastfeeding techniques)