A persistent myth about breastfeeding is that it hurts for the first four to six weeks and you just need to persevere through the pain. But the truth is far different - breastfeeding shouldn’t hurt. If it does, something is wrong. Thankfully, painful breastfeeding can usually be resolved with simple adjustments. In other cases, it may take a little time and sleuthing to find the cause and the appropriate treatment. In the meantime, some self-help can get you through.
Think about positioning: No matter what position you’re using – cradle, football, side-lying – your baby’s belly should be toward your body. His ear, shoulder and hip should be aligned so he isn’t turning his head over his shoulder to latch. His neck should be slightly extended (no chin to chest) so he can swallow. His body should be tight against your body with no space in between. You may need to support your breast underneath (with your hand or a rolled towel) so that gravity doesn’t pull the breast down and the nipple out of baby’s mouth. Use pillows under baby or your arms if you feel you need them, but not all moms do.
Get a good latch: Wait for a wide open mouth before bringing baby to the breast. Aim the nipple at the roof of baby’s mouth when latching. Baby’s chin can be pressed into the breast, with his nose touching. These steps allow for a deep, asymmetric latch, which is not only the most comfortable, also leads to the best milk transfer. Spending time skin-to-skin with your baby sometimes facilitates a more comfortable latch. In fact, sometimes the best latch happens when mom is in a reclining position with baby on mom’s abdomen and his head at breast level, and mom allows him to self-attach in this position.
Comfort measures: If you have any broken skin on our around your nipple, be sure to wash it daily with a gentle soap and warm water. Some at home treatments to give you some comfort and help your nipples heal include …
- Rub a little breastmilk into the nipple right after feeding and allow to air dry (be sure your hands are clean before doing this).
- Try a saline soak: dip a cotton ball in some water to which some salt has been added (1/2 tsp. salt to one quart warm water) and leave it in place for 10 minutes.
- Use a protective barrier that keeps the skin supple, such as purified lanolin, extra virgin coconut oil, or extra virgin olive oil.
- Use a hydrogel dressing for wound healing. You can buy these specifically for breastfeeding moms – they simply fit like a breast pad and can be worn inside your bra. You can even use lanolin along with the hydrogel pad.
- Try breast shells: these hard, dome-shaped shells fit inside your bra and over your nipple, keeping clothing from rubbing against your skin while at the same time allowing air to circulate (which may speed healing).
- If the nipple is damaged and feeding is excruciating, you may decide to ‘rest the nipple.’ To do this, you will need to keep your supply up by pumping on the more sore side until it is healed while feeding on only the other side. Or you may decide to use a nipple shield as a protective barrier (though nipple shields do come with their own set of side effects). Additionally, you may want to talk to your healthcare provider about a topical prescription to help your nipples heal.
Could there be something else going on? Unresolved pain may mean that there is a problem with baby’s oral anatomy or with your own physiology. For instance, if your baby is tongue-tied, the way he is able to use his tongue is not only painful but doesn’t get him enough milk. If your nipple changes colors with feeding, is compressed when baby unlatches, or aches between feedings, it may be due to vasospasm, thrush or a bacterial infection. Breast pain may be caused by unresolved engorgement, plugged duct, thrush, or mastitis. Working with a knowledgeable breastfeeding professional can help you rule out causes and pinpoint a solution.
As with any breastfeeding problem, the right helper is your best resource. While your mother and your sister may have lots of opinions, you need someone with the skills to get you feeding comfortably. A board certified lactation consultant (IBCLC) will be able to observe your baby at the breast and, along with a full medical history, figure out what is happening to cause the pain. Working together you can find a solution that works best to get you and your baby on the way to pain-free feedings.