Pain and discomfort of the nipple associated with breastfeeding is common, especially during the first few weeks after delivery.
One of the most important factors for healing is to determine the source of the problem.
WHAT COULD BE CAUSING THE PAIN?
Some transient soreness is normal the first week after delivery, it usually peaks the 3rd-6th days and resolves after that. The discomfort occurs as your baby latches and lasts about 20-30 seconds.
Prolonged pain or pain that increases or remains unchanged beyond the first week is abnormal. This pain is often associated with the baby’s latch.
- How can you be sure your baby is latching properly?
- What does your nipple look like when your baby comes off the nipple?
- Is it round, shaped like the end of a new lipstick, flat, or white?
- If it is round most likely the latch is fine. An informative video on latch can be found at this following link: http://www.ameda.com/education/ba by-knows-latch/
You may also consider seeing a local lactation consultant to evaluate your baby’s latch and give you suggestions to improve your baby’s breastfeeding skills. You can find board certified consultants at http://www.ilca.org/why-ibclc/falc
Signs of a good latch include: Wide open mouth, flared lips, sustained rhythmic suck/swallow/breathe, and you and your baby are comfortable.
The most common source of nipple pain is a poor latch. But what are some other reasons? There could be some form of infection, your baby may have a tongue tie, lip tie or high palate, or you may be using your pump incorrectly or using the wrong size flange.
Skin conditions like eczema or psoriasis can be factors or a change in blood flow to your nipples (often also seen in fingers and toes and especially when exposed to cold temperature).
It is very important to discuss all of this with your Corporate Lactation Services lactation consultant and follow up with your doctor if advised to by your consultant.
WHAT COULD BE DONE TO HELP THEM HEAL?
During breastfeeding:
- Until things get better try beginning with the uninjured or less injured side first, as your baby will generally nurse gentler on the second side offered.
- The initial latch generally hurts the most, so a brief application of ice (wrapped in a thin cloth) right before latching can help numb the nipple.
- Experiment with different positions to determine what is the most comfortable. Laid back or reclining positions often result in a deeper, more comfortable latch. This is an informative link on laid back nursing: https://www.youtube.com/watch? v=ZJan8xCNgY4
- If breastfeeding is just too painful, it is very important to express milk from each breast-in place of every missed feeding to reduce the risk of mastitis and maintain your milk supply. If pumping is too painful, try hand expression. Here is a helpful link to show you how: https://med.stanford.edu/newborns /professional- education/breastfeeding/hand- expressing-milk.html
- There are other ways to feed your baby besides using a bottle, you can discuss them with your CLS Lactation consultant.
After breastfeeding:
- Use a Salt Water Rinse. This is a special type of salt water called normal saline, and it is the same concentration of the salt that is in normal body fluid and should not be painful to use. To make your own: Mix 1⁄2 teaspoon of salt in 8 oz of warm water. Make a fresh supply each day to avoid contamination, or you can buy prepared individual-use packets of sterile saline at the drugstore.
After breastfeeding, soak the nipple in a small bowl of warm saline for a minute or so. Just long enough to get into all the creases of the nipple. Or, put the saline into a squeeze bottle and squirt it on gently being sure to cover all the broken skin areas. Do not soak the nipple for a prolonged period (more than 5 min). Soaking longer does not make them heal faster. Pat the nipple very gently with a soft paper towel. If baby objects to the taste of the residual
- salt, then rinse with plain warm water before nursing by dipping the nipple in small bowl and gently pat dry.
- Some women find that using a skin barrier helps to protect and heal their nipples. The research is variable on the results of using different products, but some you can consider using are: medical grade lanolin ointment (Lansinoh, Purelan), soft paraffin/Vaseline, organic coconut oil, nipple creams without lanolin (Mother Love Nipple cream with organic olive oil and soothing herbs), or Medical grade Manuka honey (Medihoney). These are all applied in small amounts after a feeding or saline rinse. You may also choose to wear a hydrogel dressing (ComfortGel, Soothies). Be sure to follow the directions for use.
. After a salt water rinse, apply expressed breast-milk to the nipples to promote healing.
Between breastfeeding sessions:
- Expose your nipples to air when possible. When wearing a bra, use fresh disposable pads (change when they are damp). You can also use breast shells to protect the nipple from the dampness and friction of the bra.
- Ibuprofen or Acetaminophen are compatible with breastfeeding and may be used as directed for pain.
- If the skin is broken, use a regular, non- antibacterial, non-perfumed, gentle soap to gently clean your nipples once a day and rinse well under running water. Using soap on the nipple is not recommended unless the skin is broken.
Talk to your doctor or Midwife if:
- You notice your nipple is not healing after a few days or if you are running a fever, inflammation/redness, swelling, oozing, pus, or other signs of infection. It is possible to have multiple kinds of infection at the same time (both fungal and bacterial). If yeast is suspected, please refer to CLS handout “Information on the Care of Yeast Infection When Breastfeeding”.
- The nipple is obviously infected your health care provider will be able to treat you with an oral antibiotic/anti- fungal to clear up the infection.
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REFERENCES
Lauwers, J., Swisher, A.Counseling the Nursing Mother: A Lactation Consultant’s Guide, 6th ed. Burlington, MA: Jones & Bartlett Learning: 2016.
Berens, P.,et al, Academy of Breastfeeding Medicine. ABM Clinical Protocol #26: Persistent Pain with Breastfeeding, Revised 2016. Breastfeeding Med 2016;11:1-8.
Bonyata, Kelly (November 20, 2017). Healing Tips for Nipple Cracks or Abrasions. Retrieved from https://kellymom.com/bf/concerns/ mother/nipplehealing/
