Breastfeeding Shouldn't Hurt, Let's Troubleshoot It!

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Sore nipples, breast/chest pain and discomfort with feeding or pumping are some of the most common concerns of my clients and mama friends. Not all nursing people experience nipple soreness, but it is very common for both new and experienced lactating people to have some level of discomfort or sensitivity in the beginning of the journey. Typical discomfort associated with the first few latchings reportedly lasting within the first 30 seconds or so is often described as a mild sensation but remember pain is subjective and so some may describe this as more severe. However, it shouldn't continue throughout the feeding and there should be no pain between feedings. This sensitivity lasts about the first two weeks until you become more accustomed to your nipples and breast/chest being stimulated so often. There should never be any skin damage as in cracks, milk blebs/blisters or bleeding; the nipple should appear round or the same shape as before it went into the baby’s mouth. If your nipple is flattened, creased, pinched or the shape of a fresh tube of lipstick, then you should seek the help of a lactation professional to further assess.

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I receive communication from clients and potential clients daily with a soreness issue ranging from ‘mildly pinchy’ to ‘moderate burning’ and a few things in between, but this doesn’t always mean an immediate consult is needed. I usually provide them with a few simple tricks in my response to them and then book a consultation as needed per the results of these remedies working or not. Typically, the problem is easily resolved with these general tips and guidance from me by email, text or video call. So today I’d like to offer you a free breastfeeding lesson to explain some possible reasons for your discomfort, plus all my favorite tips for treating the most common pains.

You need and deserve to seek professional help, not internet help, not friend help, not grandma help, you need a lactation professional that will be able to work within a clinical scope of practice like an IBCLC, Midwife or OBGYN that can get you the physical help you need without making the problem worse. For instance, someone telling you to pump for 20-30 mins when you are fully engorged would be the wrong advice, as you’d be telling your body to produce more not less. This is an example from a doula who was not trained in lactation but told her client this before they called me which had created a bigger problem. If you are a birth worker reading this article, please get properly trained in lactation to best support your clients and know when and where to refer, doulas should not be diagnosing oral restrictions or checking for them. If you are seeking to become more educated in lactation as a birth worker, consider taking the Nourishing Support Breastfeeding For Doulas Class that I teach with Robin Kaplan, IBCLC. It’s available on demand and BIPOC scholarships are available!

Tit Tip: Get help from an experienced CLEC, IBCLC student and/or IBCLC if you experience the following:

• Intense, excruciating pain

• Pain that continues through the entire feeding

• Pain between feedings

• Pain that continues past the first couple of weeks

• Skin damage–cracks, blisters, or bleeding

If you are experiencing any of these issues, do NOT let anyone, including a lactation consultant (unfortunately bias can get in the way of good support), tell you that “everything looks fine” because a sign of physical damage tells us there is an underlying condition or reason for this pain and that could be as serious as an infection. So, if you dread feeding time, cringing at the very thought of pulling that boob out, then yes you need help! Excruciating, debilitating, toe curling, lip biting, squealing, cussing and eye closing are all signs that this is not typical and there is almost always something that can be done to address these concerns and alleviate some of your pain.

Don’t let your friends, family or the internet tell you to suck it up and that “this is how breastfeeding is supposed to be”. There can be many causes for severe breastfeeding pain from anatomical issues to infection. You do NOT have to suffer and it doesn’t mean there is anything wrong with you or your baby. This can be a highly emotional process of learning to latch with your baby, you are both learning together and it takes time and patience.

A few questions to ask yourself or that your IBCLC will ask and some treatments suggested:

Did breastfeeding get more painful when your milk “came in” a few hours or days postpartum?

This pain would commonly be from engorgement; Engorgement can make it difficult for baby to latch deeply, shallow latching causes nipple pain. Try Reverse pressure softening or hand expression to remove a little milk to make the breast less full which can help baby get a deeper latch, causing you less discomfort.

Does your nipple look flattened, creased, or pinched when baby unlatches or do you see a white line across the nipple when baby unlatches?

This would be a sign of a poor latch and possibly poor positioning as well. This can usually be remedied by trying a different hold or position, sometimes a different position for each breast example: football on the right and cross cradle on the left or laid back on the right and cross cradle on the right, the variations in holds are endless! Nipple appearance being misshapen or different can also be caused by anatomical variations in mom or baby, see an IBCLC for an oral assessment on baby and chest assessment on the lactating person.

Do you have skin damage…bruising, cracks, blisters/blebs, bleeding?

If you answered yes to one or more of these you need to see an IBCLC! Until you can get to an IBCLC, try these healing remedies for damaged skin on the nipple area: epsom salt bowl or hakaa soaks very warm water and 1-2 Tbsp of epsom salts, sit your breast in it for 10 mins or so 2-3x a day, coconut oil to cleanse and moisturize, give them a rest if needed by pumping or expressing into a bottle for your baby, must pump in place of every bottle feed to keep supply in regulated.

Do you have a rash on the nipple or areola?

Contact dermatitis (from breast pads, nipple creams, soaps/detergents, etc.), eczema, psoriasis, poison ivy/oak can all be present on the nipple or breast and cause sore nipples.

Are you using a breast pump?

Incorrectly sized pump flanges, too-high suction settings, or too-slow cycling settings can cause nipple pain or damage.

Are you experiencing pain between or during feeds?

Possibility of thrush, which is a yeast infection, sometimes causes nipple blanching (turning white) and vasospasm which is very painful; the narrowing of the arteries caused by a persistent contraction of the blood vessels.

Do you have a forceful milk ejection/let-down reflex?

Some babies will clamp down on the nipple to slow the milk flow which can cause varying levels of pain depending on age and suck strength of your baby.

Other questions:

How long has this pain been happening, days, weeks, months?

Did you have any other pain previous to this pain? Did this pain come out of nowhere even with no previous breastfeeding struggles?

Are you breastfeeding while pregnant?

Summary:

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The most common causes of discomfort associated with breast pain, many lactating people have sore nipples initially because of:

• Poor latch or positioning as both baby and birth giver are learning the dance of breastfeeding; more stimulation than you were previously used to.

• Plugged Ducts - from not emptying the breasts

• Mastitis - from untreated and unhealed nipple damage and if plugged ducts go untreated

• Engorgement - common early days but with going too long between feeds and often overnight will have some milk level of it

• Forceful milk ejection/let-down reflex & oversupply - seems like a good thing to have an abundance of milk with it spraying out quickly right? Wrong!

• Oral restrictions - tongue ties and other oral restrictions that range in severity requiring treatments from wait and see with frequent weight checks to simple oral procedure called a frenotomy or frenectomy

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How do I know if my baby has drained my breast/chest fully?

• If baby actively feeds for 20-40 minutes, seems satisfied after eating & can go about 2-3 hours between most feedings