One of the most persistent myths about breastfeeding is that it hurts, and you just need to push through the pain until two weeks, four weeks, six weeks, or more!
If you've got toe-curling pain every time you try to feed your baby (every hour or two for a newborn!), you may not even feel like you can get through the next six feedings much less six weeks of discomfort. But the truth is that breastfeeding should never hurt; and if it does, it's a sign that something needs fixing.
With some troubleshooting, and maybe some professional help, you should be able to breastfeed pain-free. To narrow down what the problem might be, here are 10 things to consider:
#1: Is It Baby's Position Or Latch?
A baby who is awkwardly positioned may not be able to latch deeply, and will be more likely to damage a mother's nipples. The same is true when a baby “slurps” the nipple into his mouth, rather than opening wide to latch. It's easy to fall into this pattern, but the damage caused can be uncomfortable, at best. While this is the easiest thing to fix, it often takes a while for the nipples to heal and pain to abate.
Be sure you are bringing your baby to the breast and keeping his body tight against yours when feeding ” you shouldn't see any space between the two of you, and he should have his tummy toward your body not toward the ceiling. Wait for a nice, wide-open mouth before brining your baby to the breast. Learn to get a deep, asymmetric latch ” point your nipple toward the roof of baby's mouth when latching, and allow his head to tip back a bit. Once latched, his chin can be pressed into your breast tissue, and his nose might be touching your breast. You may need to support your breast throughout a feeding so that gravity doesn't pull it out of baby's mouth ” and so he doesn't need to use his gums to hold onto the nipple to keep it from slipping!
#2: Are You Engorged?
About two to five days after birth, your milk will “come-in.” This initial surge is accompanied by swelling that can be painful, and can make latching difficult. Feeding your baby often is the best way to get through this period. If your baby is having trouble latching, you can use hand expression or a pump to get the milk flowing and to help the nipple stand out.
You can also try Reverse Pressure Softening (see here to learn how). Some mothers use ice packs between feedings, and a warm, moist compress right before a feeding to relieve some engorgement pain. The swelling should subside in a day or so, but your milk supply should remain strong.
Some women experience fullness between feedings that is somewhat painful. Nursing your baby more often can help to prevent this. In fact, if you are allowing your breasts to become too full between feeding, this can be a signal that your body should cut back on how much milk it's making. And this can lead to low supply if you do it too often.
If you are pumping because of overly-full breasts, you may be aggravating the problem ” you're tricking your body into thinking you need more milk. While this is an excellent plan for a mother who has low supply, for most mothers it can prolong engorgement unnecessarily.
#3: Is Your Nipple Misshapen Or Oddly Coloured Right After Feeding?
If you look at your nipple right after baby lets go, does it look flattened and pointed (like a new lipstick)? Or does it have a white compression stripe across the face of the nipple? This may be due to a shallow latch, or it could be caused by an anatomical variation for your baby. This might include tongue tie, a high or bubble palate, or even an undiagnosed cleft of the soft palate. A medical evaluation and the assistance of a trained lactation profession can be invaluable in these cases.
Does your nipple turn white after a feeding, accompanied by burning or shooting pain? This may be a condition called vasospasm or Raynaud's Phenomenon of the nipple. It's often caused by a shallow latch causing constriction of blood vessels in the nipple. Women with a history of circulation problems may be more likely to experience this with breastfeeding, as well. Learn more about treating vasospasm here.
#4: Do You Have Any Broken Skin, Or A Blister?
Occasionally, an improper latch can cause broken skin, and a chronically bad latch can cause real nipple damage.
If you develop a blister on the tip of your nipple, the most likely cause is a shallow latch. If the abrasions are closer to where the nipple meets the areola, it may be that your baby is chomping at the breast to hold on, rather than suckling. Any broken skin on your nipple can take a while to heal ” it's being opened each time your baby nurses.
Treatment should start with correcting baby's latch. Alternating positions or changing how your holding baby may help. “Moist wound healing” using purified lanolin or gel pads is sometimes speeds healing and keeps you more comfortable. If these measures don't help, you may need prescription medication to aid in the healing process ” see a lactation consultant or your healthcare provider to discuss these options.
#5: Is It A “Bleb”?
Does it look like you have a white spot or milk filled blister on the tip of your nipple?
This is likely a nipple “bleb”. If it's not painful, no treatment is needed and it will resolve on its own. But if it's causing pain, you can try this: soak your breast in warm water, rub with a washcloth to remove any extra skin, then try hand expressing milk from that area by compressing the areola behind the bleb. Persistent or recurrent blebs may need to be treated by your healthcare provider.
#6: Could It Be A Blocked Or Plugged Duct?
If you have a small painful lump in your breast, it may be a plugged duct.
Treatments include frequent nursing (with your baby's chin positioned in line with the plug to provide the best suction pressure to that area), massage, and moist heat. Some mothers find that a vibrating toothbrush or massager held over the plugged duct breaks up some of the dried milk and loosens the plug.
Read more about treating blocked ducts here
#7: Do You Have Mastitis Symptoms?
Do you suddenly feel like you might have the flu, and in addition, you've got a warm, red, tender spot on your breast?
You may have mastitis, or a breast infection. Most often it's treated with antibiotics, though that may not be necessary. Breastfeeding often is important during this time ” the infection won't be passed on to your baby. If it's too painful to nurse on the affected side, simply nurse on the other breast until the pain subsides enough to make breastfeeding bearable.
If you do need antibiotics, be sure to get some good quality, naturopath recommended probiotics. Antibiotics can’t tell the difference between good and bad bacteria, so they kill everything off, which can result in thrush. Thrush can be easily passed between mother and baby, which is not fun for anyone.
Learn more about treatments for mastitis here.
#8: Is It Thrush?
Especially if you or baby have had antibiotics during birth (or soon after), or if your diet isn’t great, then it is possible that you and/or your baby may have thrush.
An itchy, scaly, shiny, red rash on the breast can signal thrush, especially if it's accompanied by shooting pains in the breast when nursing. Often when a mother has thrush, baby does, too. Look for white patches in baby's mouth that don't wipe off easily, and a pearly look to his saliva. Thrush is most often treated with topical medications, but it’s ideal for both the mother and baby to get on a course of good quality, naturopath recommended probiotics. You can buy probiotics that are especially for babies.
Cut sugars and grains out of your diet where possible, as thrush loves sugar and yeast.
It is essential that both mother and baby are treated to stop the thrush cycle. Learn more here.
#9: Is It Your Breast Pump?
If you are pumping regularly, be sure that you're using the right sized flange to fit your breast. Different manufacturers have different sizes, and may have replacements you can purchase to better fit your breasts. Try pumping on the lowest possible suction setting that still prompts milk to be expressed. High vacuum pressure doesn't necessarily equal more milk, so play around with settings for your own comfort.
#10: Has Your Baby Started Teething?
Getting teeth doesn't necessarily mean it's time to wean! In fact, most babies start to get teeth between four and seven months of age, well before weaning happens. The first teeth to erupt are usually the bottom front ones ” and this area is covered by the tongue when your baby is latched well and actively nursing. But if baby has painful gums, he may use you as a teething ring!
Offer your baby a chilled teether, or even a wet, frozen washcloth, to chomp on immediately before nursing. Take your baby off the breast as soon as you notice he's done actively nursing, and pay attention to signs that your baby may be about to bite down.
In almost all cases, the best way to figure out what's causing pain is to work with someone skilled at counselling a breastfeeding mother. Whether you meet with a peer counsellor or a lactation consultant, she should be able to watch your baby breastfeeding and offer suggestions for making feeding more comfortable. Painful breastfeeding is almost always treatable, so don't be afraid to get help if breastfeeding hurts.