Soreness is one of the main reasons women stop breastfeeding. While some mild discomfort may be normal in the early days as your body adjusts to feeding, prolonged soreness and broken skin are signs that something needs to be changed.
Start by checking your positioning. Your baby should be tummy to mommy, with no space between your two bodies. When you look down, your baby’s ear, shoulder and hip should be aligned, and his head should be tipped back a bit so that his chin isn’t tucked into his chest (which can make swallowing difficult). When he opens his mouth wide, bring your baby to the breast rather than leaning toward your baby when latching. When latching, aim your nipple at the roof of his mouth, and bring him to the breast chin first. Once latched, his lips should be flanged out on the breast and the corner of his mouth should make a wide angle.
If your body is tense because you are expecting pain when your baby latches, that tension can make your baby tense, too. It can also cause you to only latch your baby shallowly (because you are pulling back expecting it to hurt). A deep latch, however, shouldn’t hurt. There are two opposing thoughts about what to do when the latch is painful. You can continue through that feeding, and try to get a better latch next time. Or you can unlatch your baby by breaking the suction with your finger in the corner of his mouth (be sure to get between his gums, too, so he doesn’t clamp down), and then attempt to get a deeper latch.
Short but frequent feedings may be more tolerable than long feedings when you are experiencing nipple pain. Start feedings on the least sore side as baby’s suction will be strongest at the outset of a feeding. Starting the milk flow with a pump or hand expression can keep baby from being too aggressive at the start. Even numbing your nipple with an ice cube immediately prior to latching can help.
Once you have broken skin on your nipples, they can take a while to heal (after all, baby is breaking disturbing the healing every couple of hours!). Ideas for healing sore nipples include:
- after a feeding, express a bit of fresh breastmilk, gently rub it into the nipple (with a clean finger) and allow it to air dry.
- lanolin or other creams made specifically for breastfeeding can provide a barrier and keep the nipples supple as they heal. Coconut, grapefruit seed extract and olive oils are another option. No need to wipe these off before feeding (which may cause more pain).
- try a salt water soak - dissolve ¼ teaspoon of salt in 16 ounces of warm water, and dab onto the nipple with a cotton ball.
- apply peppermint gel
- try hydrogel dressings - these pads fit inside your bra and provide a moist wound healing environment
- if all else fails, a prescription cream (like Dr. Jack Newman’s All Purpose Nipple Ointment) may be necessary
Nipple shields are typically not recommended for sore nipples, but breast shells may be helpful. These hard plastic domes worn inside the bra allow for air circulation around the nipple while protecting the tender area from clothing friction. If the pain of breastfeeding is unbearable, you can “rest the breast” - pump on the sore side and feed only from the other breast - until the nipple is healed. If you’re pumping, use the lowest effective setting to be sure you’re not causing additional damage.
Friends and family may tell you that breastfeeding sometimes just hurts for the first 6 weeks, and you should power through. But there’s no reason to suffer through painful feedings when relief may be easily at hand. The path to pain-free feedings is sometimes difficult - working with a lactation consultant can be helpful. A lactation consultant can also help rule out an infection - whether yeast or bacterial - and can assess your baby for any oral problems (like tongue tie) that could be causing the nipple pain. Breastfeeding shouldn’t hurt - if it does, seek help so you can enjoy your baby’s feedings!