Breast and Nipple Pain
One of the most common reasons that breastfeeding parents struggle is due to breast and nipple pain. What are some reasons this happens and what can we do about it?
In the early days of breastfeeding, breast pain is very often due to engorgement which is the swelling of breast tissue due to excess milk and fluid in the tissues. In the first week or so, a big part of this is the excess fluid in the tissues, especially if you received IV fluids during labor.
The best thing you can do to help this pain is mobilize the fluids - so extra fluid needs to be drained through your lymphatic system and milk needs to be removed from the breast. A very effective and easy way to do this is to perform therapeutic breast massage and then feed your baby or express milk by hand expressing or pumping. This two part approach helps address both issues that are at play and has been shown to decrease breast pain effectively on it’s own.
Here is a video showing therapeutic breast massage: Maya Bolman's Breast Massage
Other relief measures
It may help to relieve symptoms with oral analgesics such as ibuprofen or acetaminophen (both safe to take while breastfeeding).
Heat and ice therapy can also be helpful. In this situation, you would want to use ice BETWEEN feedings to help bring down the swelling and heat BEFORE and even during feeding/pumping to help the milk flow.
As breastfeeding progresses, engorgement is more likely because of breasts that are full of milk (not tissue swelling) and so removing milk effectively by feeding or pumping is the priority. But comfort measures like massage and heat can still help to mobilize and get the milk flowing!
How engorement affects your milk supply
One other thing to know about engorgement, is that your body is determining how much milk to make by how much milk is removed. Part of the reason it knows how to do this is by gauging how much pressure there is in your breasts - and so if your breasts are very full and engorged often, that is a sign to your body to stop producing as much milk. Sometimes this may be intentional, such as in cases of oversupply, but if this is not your goal, be mindful that you may need to remove milk from your breasts more often if you’d like to keep your production at the same level.
Over time, your breasts will become better regulated and you may not experience engorgement anymore, this is not a sign that your milk supply is dropping (don't panic!), just a sign that your body has figured how much milk it needs to make.
Plugged Ducts and Mastitis
If your breasts become overfull for too long or too often, you may experience other issues that cause breast pain such as plugged ducts and mastitis.
A plugged duct is when a milk duct becomes blocked and milk flow is restricted. It can happen close to the skin surface where you can see a white spot on the nipple (a nipple bleb) or farther back within the breast. You will often feel a hard lump that is tender and sometimes red or swollen.
Mastitis is inflammation of the breast that is caused by obstructed milk flow, infection or allergy. It can be caused by plugged ducts but the pain, redness and swelling is often more severe and mastitis can include whole body symptoms such as a fever, chills and body aches.
There are a lot of great resources already available on these topics.
Here are a couple of my favorite links for infomation on plugged ducts and mastitis:
Kelly Mom - Plugged Ducts and Mastitis
Pump Station - Plugged Ducts and Mastitis
The most common cause of nipple pain is trauma to the nipple tissue, which most often occurs in the early days as you and baby learn to breastfeed. Breastfeeding is a new skill for babies and their parents and unfortunately, some behaviors and techniques that are commonly used or even encouraged don’t always allow for the right mechanics of breastfeeding to be established which leads to nipple damage.
When breastfeeding is working as it should, your nipple should get deep enough into your baby’s mouth that it sits where the hard and soft palate meet. There is plenty of space this far back in your baby’s mouth that allows the nipple to move freely without rubbing on anything. This also allows the baby to create the appropriate vacuum with his/her mouth and effectively massage the breast with the tongue to remove milk efficiently and comfortably! If this doesn’t happen, babies have to compensate by compressing your nipple between their tongue and the roof of the mouth (hard palate) which creates friction and leads to nipple damage and pain.
So how do I prevent nipple damage?
Using good latch and positioning techniques is the first and most important way. I have an entire page dedicated to this, here.
Outside of latch technique and positioning, if nipple pain and damage continues, a baby should be assessed for oral restrictions such as tongue and lip ties, which can make it hard for baby to use the tongue properly as described above.
Babies can also have underlying muscular or structural tightness that can contribute to latching difficulties including a painful latch. This is especially true for babies with difficult deliveries such as when forceps or a vacuum was used. Bodyworkers such as a chiropractor or physical therapist may be helpful in these situations.
There are also a number of easy and effective techniques that a trained lactation professional can teach you that can help improve a baby’s ability to latch and suckle effectively such as tummy time, infant massage and suck training exercises.
Beyond nipple damage other potential causes of nipple pain include: vasospasms (constricting of the tiny blood vessels of the nipple causing a lack of blood flow and pain), nipple blebs (which are plugged ducts that occur right at the nipple opening), thrush (a fungal infection of the nipple and breast tissue), dermatitis (skin inflammation often as a reaction to something in the mother’s environment).
Healing Sore or Damaged Nipples
If nipple damage has already occurred, depending on the severity - they may need some time to heal before direct breastfeeding can resume and not be painful. While healing occurs, some women will try nipple shields which may help, but have the potential downside of your baby coming to prefer the nipple shield and then needing to be weaned from that down the road. Other women may choose to pump, if that’s more comfortable (though that might not always be the case!) and give the milk to their baby another way. A lactation professional can help you come up with a plan that works for you.
If your nipples have open cracks, scabs, are bleeding, etc. You will want to do some things to help them heal and prevent infection. I recommend a moist wound healing process. Keeping the tissue moist, while taking care to prevent infection by gently cleansing and changing breast pads frequently, allows the tissue to heal quickly. If your nipple dries out and scabs form between feedings, every time you go to nurse or pump - the tissue breaks back open and delays healing. This is what we're trying to prevent with moist wound healing.
Here is an excellent video that explains the process: How to Heal Sore Damaged Nipples
This video recommends using common oils such as olive or coconut oil to moisturize the nipple. These are great because they're something you probably already have in your house!
If you want to buy a nipple cream, I recommend Motherlove Nipple Cream or Earth Mama Organic Nipple Butter. Both contain high quality ingredients and healing herbs.