Many mothers experience some nipple pain associated with attachment in the early weeks of breastfeeding.
Any signs of nipple damage (e.g. cracks or blisters), severe pain, or pain that doesn’t go away after the initial attachment, is not normal, and means something is not as it should be.
By far, the main cause of cracked nipples is sub-optimal positioning and attachment to the breast.
Another cause is inappropriate use of breast pumps (e.g. using a breast flange that is the wrong size, or prolonged high-pressure from an electric pump).
Breastfeeding is natural, but it’s also a learned skill. It can take quite some time to get good positioning and attachment for every feed.
If you're suffering from cracked nipples, here are 7 helpful steps to follow.
#1: Seek Professional Lactation Assistance
Not all health professionals are skilled at helping mothers overcome breastfeeding problems, so it’s important to be particular when it comes to getting help with breastfeeding.
It’s a good idea to contact breastfeeding support organisations such as the Australian Breastfeeding Association or La Leche League, or see a lactation consultant (look for an IBCLC) They’ll be able to help you work out why your nipples might be damaged, and offer suggestions to help.
#2: Optimise Positioning And Attachment
Sub-optimal positioning and attachment is the main cause of cracked nipples.
It makes sense to take steps to improve it.
When your baby has a deep attachment to your breast, it means your nipple is far back in her mouth, towards her soft palate, where it’s protected.
If the attachment is too shallow, it means your nipple can be jammed between your baby’s tongue and hard palate while she sucks. This can cause nipple damage.
When your baby is showing early hunger cues, use a breastfeeding position that works best for you and your baby. Hold your baby in close, so her chest is touching yours. Make sure you bring your baby to your breast, and not your breast to your baby.
When your baby’s head is tipped back and her mouth is open wide, bring her to your breast, aiming for your nipple to be pointing towards the roof of her mouth.
#3: Get Your Baby’s Oral Anatomy Checked
If you continue to feel nipple pain with breastfeeding, despite optimising positioning and attachment, it’s a good idea to get your baby’s oral anatomy checked out for a tongue tie or other concerns.
Good tongue movement is very important for breastfeeding. A good tongue movement helps your baby to attach deeply and remove milk well. If your baby has a tongue tie, it could result in shallower attachment, and/or not being able to remove milk well.
If milk is not removed well, feed after feed, it can result in a low milk supply.
#4: Speak With A Lactation Consultant About Topical Treatment Options
There are many different topical treatments mothers can use to help heal cracked nipples. A lactation consultant will help you work out what might work best for you.
There isn’t a great deal of Evidence to demonstrate the efficacy of most topical treatments. Whatever topical treatment you use (if you use one at all), once the cause is found and corrected, the nipple damage will heal.
The most commonly used products are purified lanolin or hydrogel pads. Both of these keep the nipples moist, which might promote quicker healing.
#5: Healing and Feeding Tips
If your nipples are cracked, here are some other tips that can help reduce the pain while you are breastfeeding:
- Feed your baby when she is showing early feeding cues
- With a clean finger, smear a few drops of your breastmilk, or apply a warm water compress, onto your nipples, to moisten them, just before attaching your baby
- Stimulate your let-down reflex before getting your baby to attach (e.g. with hand expressing)
- Start from the least sore side first
- If you feel confident enough, change your breastfeeding position. This might help, by avoiding tension where the crack is
- Recline back during feeds. This can help make the attachment deeper
- Use nipple protectors to stop clothes rubbing your sore nipples
- Change breast pads frequently
#6: Consider Expressing Or Use A Nipple Shield If Pain Is Severe
If the nipple pain is so bad that you can hardly bear your baby attaching again (at least for the time being), you might consider expressing or using a nipple shield. These methods will let you continue to provide breast milk to your baby, while reducing the pain and assisting the healing process.
If one nipple isn’t as bad as the other, consider direct breastfeeding from one side, while expressing or using a nipple shield on the other. Some mothers find even just 24-48 hours of expressing or using a nipple shield helpful.
#7: Be Aware Of Signs Or Symptoms Of A Nipple Infection
Nipple pain and damage can be awful. Be sure to get help quickly, so you can be on the road to having a comfortable breastfeeding relationship with your baby as soon as possible.