“I had problems pretty much starting from my daughter’s birth,” says Rhondda Smiley, “including getting India latched on well and sore nipples by day three. By the time she was a week old, breastfeeding was an ordeal. I dreaded every session.”
The pain continued. Smiley’s nipples were soon cracked and severely abraded, and her midwife discovered that she also had thrush (a yeast overgrowth). And India’s weight gain was slower than expected. Only after several rounds of antifungal medication and expert help in learning how to latch did Smiley get some relief. Acidipholus supplements finally ended the yeast problem, and she opted to pump her milk and bottle-feed for a time until her nipples healed. To her joy, India returned happily to the breast.
What went wrong here? “In hindsight, I see that most of the problems were due to a poor latch,” Smiley says.
Lactation consultant Sandra Yates of Vancouver says that, in fact, latch problems are the most common cause of breastfeeding pain. “Breastfeeding is not supposed to hurt,” she assures mothers. “When it does, it’s usually a signal that something is wrong and we need to find a way to fix it.”
New mothers sometimes hear that it’s normal to experience pain in the early days or that things are fine if just the first minute or so of the feeding is painful. Not so, says Yates. Yes, breastfeeding may improve as the baby grows and gets better at latching, but even a short time of initial pain can cause nipple damage and decreased milk production.
Yates offers this troubleshooting guide to common reasons for breastfeeding pain.
The symptoms: The nipples hurt. Breastfeeding is uncomfortable, even painful. The nipples may look squashed or sculpted when they come out of baby’s mouth. The nipple skin may be cracked or blistered. The baby might be fussy and not gaining well. Baby sometimes bites or chomps down on the nipple.
The causes: When baby is latched well, the nipple goes deep into baby’s mouth, right to the back. The baby’s tongue does most of the work in getting the milk out; if the nipple is not far enough back, the tongue will rub or press on the nipple and cause pain. Engorgement can make latching difficult. A baby who has been given bottles may use bottle-feeding techniques at the breast, leading to a poor or shallow latch.
The fix: Improve the latch. Sometimes a small difference in positioning can make a huge difference in comfort.
• Support baby’s weight on your arm with your hand between his shoulder blades.
• Tuck baby’s body in close with your elbow and let his head fall back a bit.
• Hold your breast with your thumb near the nipple, so it tips up a bit, and your fingers well under your breast, right down by your chest.
• Line up his nose with your nipple so his mouth is lined up with the underside of your breast.
• Stimulate his whole lower lip with your breast, keeping your nipple aimed at the nose.
• When he opens his mouth wide, like a yawn, with his tongue down, pull him in close, pushing towards the breast through the heel of your hand. His lower lip and tongue will scoop up a large amount of breast and you can help tuck the nipple in under his top lip with your thumb if necessary.
• His chin should be buried in the breast, his nose away from the breast. This will protect the nipple by placing it deep into the back of the baby’s mouth, where the tongue action won’t hurt it.
If you have cracked or abraded nipples, express a little breastmilk onto them at the end of the feeding and let them air-dry.
Don’t keep trying on your own if it still hurts — find a lactation consultant or La Leche League leader to help you.
The symptoms: Nipples are sore, often between feedings as well as when baby is nursing. The pain is often described as burning or sharp and stabbing. The nipples can develop a pink or red rash and the skin can look smooth and shiny. The baby may develop white dots or circles on the inside of his lips and cheeks or on the roof of his mouth. Baby may be fussy as well.
The causes: We all have yeast in our systems, but when it overgrows it can cause problems. It often happens after antibiotic treatments or if the mother’s iron levels are low.
The fix: See your doctor or midwife to confirm the diagnosis and to get a prescription for medication (there are several different ones) or a recommendation for an over-the-counter product. Some women find acidophilus supplements and dietary changes helpful. Early treatment is better than waiting. Both mother and baby should be treated even if only one has symptoms.
The symptoms: Nipples hurt. Often the tip of the nipple is damaged. It can feel as though the nipple is being pinched.
The causes: When you look inside baby’s mouth, you see the thong of skin under baby’s tongue (the frenulum) is tight or short, and the baby isn’t able to stick his tongue out or lift it up. That means he can’t bring it forward or cup the breast as he needs to, and his tongue rubs against the end of the nipple, causing pain.
The fix: A doctor can quickly snip the thin flap of skin and free the tongue. It is a simple procedure. Sometimes the frenulum will stretch out over time, but you may endure many months of breastfeeding pain waiting for that to happen. After the frenulum is cut, it may take the baby a little while to learn how to stretch his tongue out and nurse more effectively.
The symptoms: A sore, tender area in the breast. May feel like a lump under the skin; skin may look red.
The causes: A milk duct has become blocked, sometimes because something is putting pressure there (like a too snug bra). The milk backs up and creates pressure behind the plug. Usually this is in the breast, but sometimes one of the openings at the nipple becomes plugged — this looks like a little white dot on the end of the nipple.
The fix: How can it be resolved? Here’s a little rhyme to summarize: Moist heat, rest, massage and empty the breast.
Moist heat can mean a hot shower or bath or a hot, wet washcloth applied to the breast. Then massage the tender area from behind the plug towards the nipple – like trying to get the last bit of toothpaste out of the tube. Then put the baby to the breast. If the plug is on the nipple, you may be able to manipulate or squeeze it out. Get as much rest as possible. If this doesn’t clear up after two or three times, or you begin to feel ill or feverish, contact a La Leche League leader, doctor or lactation consultant for additional help.
The symptoms: The breast has a hot, red, very tender area. Usually you also have a fever and feel unwell. This may develop suddenly or may follow an unresolved plugged duct.
The causes: Mastitis is an inflammation of the breast due to poor drainage or an infection in the breast. When a plugged duct stops the milk from flowing, bacteria sometimes grows in the milk. Sometimes cracked nipples or untreated thrush allows bacteria to enter the breast, causing mastitis. Untreated mastitis can become a breast abscess.
The fix: Initial treatment is the same as for a plugged duct. If it has not improved within 24 hours or if it is getting worse at any time, you should see your health care provider promptly and will usually be treated with antibiotics for 10 to 14 days. Be sure to nurse the baby frequently during this time to help clear the infection, and watch for any yeast overgrowth.
Rhondda Smiley is delighted that India, now almost three, is still nursing. Despite the challenges she went through, she says: “Breastfeeding is the single most empowering thing I’ve ever done in my life.” If she has another baby, she knows she’ll breastfeed, armed with new information and experience.
“Pain that arrives with breastfeeding is a messenger; it is not meant to be a constant companion,” adds Yates. “When you understand the cause of the pain and get the help you need to deal with the problem effectively, you can get back to enjoying your breastfeeding baby.”
Who can help?
Lactation consultants work in a variety of settings: hospitals, breastfeeding clinics, public or community health units and in private practice.
La Leche League leaders are volunteers who have all breastfed their own children and are trained in providing breastfeeding help. Ask about attending meetings during pregnancy or after the birth.
Public Health Unitsmay offer breastfeeding drop-ins or clinics. In Ontario, the Early Years Centres often have breastfeeding support.
Some midwives, nurses and physicians have extra training in breastfeeding and are very helpful; you will need to see a physician if the problem needs a diagnosis and prescription for treatment.