While not uncommon, nipple pain should not be a regular part of your nursing experience. To have a wonderful breastfeeding experience, I highly recommend that you pick up a copy of Breastfeeding Simply; this handy guide has dozens of helpful breastfeeding tips for the new mother.
To solve the problem of painful and sore nipples during nursing, follow these steps:
Identify the type of pain and find some immediate relief.
Nipple sensitivity.
What you experience: With normal nipple sensitivity, your nipples feel more sensitive or tender than usual. There should not be continual pain during or after nursing. Some nipple sensitivity is normal in the beginning. As a friend once told me, "Don't worry, one day you will be able to get out of the shower and dry off without wincing!" If it's just normal sensitivity, this statement is true.
The likely cause: Your nipples just aren't used to this much stimulation.
What do to: Wait it out; it just takes time for your nipples to get used to nursing. In the meantime, using pure lanolin should help ease normal nipple sensitivity (Medela's PureLan and Lansinoh's Ointment for Breastfeeding Mothers are two options). While nipple sensitivity is normal, chronic nipple pain is NOT. The following types of breastfeeding problems and pain are not normal.
Cracked or bleeding nipples.
What you experience: Sometimes moms don't realize their nipples are cracked because they've been that way since baby started nursing. Sometimes moms don't realize their nipples are bleeding until they see some blood in baby's diaper or a pinkish color in the milk after pumping. Though you can't always see these problems, you can definitely feel the pain resulting from them.
The likely cause: Bad latch/suckle, bad positioning, thrush, problem with the breast pump, or baby bites.
What to do: Don't worry, it's safe to nurse the baby and/or give your breastfeeding baby pumped milk even when your nipples are bleeding. Don't be alarmed if blood shows up in your baby's diaper because of this. In general, cracked or bleeding nipples may be relieved by:
Moist wound healing, which includes pure lanolin and products such as "Soothies gel pads" (Note: Some people have concerns about the use of gel pads since it may encourage bacteria by creating a moist and dark place).
All-Purpose Nipple Ointment (see details below).
Salt-water rinse.
Good old breast milk, since it's a natural antibiotic. For this remedy, just express a little milk and let the nipples air-dry.
Tenderness around the nipple or areola.
What you experience: Achy, tender feeling around the nipple or areola (the darkened circle around the nipple).
The likely cause: Baby biting or clamping/chomping while nursing (a specific type of bad latch/suckle).
What to do: You can dull the pain by applying ice wrapped in a soft cloth or by using other cold treatments. You can also try an over-the-counter pain reliever such as Ibuprofen, Motrin, and Tylenol, which are all safe to take at standard dosages while breastfeeding.
Shooting pains that start in the breast and go into the nipple.
What you experience: This type of pain either goes away within a few minutes or lasts during and after the nursing session.
The likely cause: Normal let-down or thrush.
Normal let-down is often described as "pins and needles" or a brief shooting pain that goes away once the milk lets-down. You can tell that the milk has let-down by a change in baby's suckle (it goes from small, frequent tongue and jaw movements to long, slower jaw and tongue movements along with the sound of baby swallowing).
By contrast, thrush pain lasts throughout the nursing session and even afterward; it does not go away with let-down.
What to do: If this type of pain is caused by normal let-down, try counting or breathing deeply and know that it will pass quickly. Over time, the pain associated with let-down should fade and possibly even disappear entirely. If it persists, it could be caused by thrush and you need to treat both yourself and your baby aggressively. Follow the tips that appear later in this article.
Pink or red nipples, or nipples that itch or burn.
What you experience: You may not feel it, but if you look into a mirror at yourself, you may notice that your nipples are pink or red. It's also possible that your nipples will itch or burn.
The likely cause: Thrush.
What to do: Treat both yourself and your baby aggressively, following the tips below in the article.
Now that you've identified some of the common causes of nipple pain, it's time to begin treating your nipples. Follow these steps:
Correct the Problem At Its Root:
Thrush. Thrush is another term for "yeast infection". It's usually caused by mom or baby having taken an antibiotic, which creates an imbalance of bacteria in the body. Help avoid this by taking probiotics whenever you or your baby is on an antibiotic. Symptoms include shooting pain that lasts long into the nursing session and/or after baby's done nursing; pink/red nipples; and itchy or burning nipples. There are also symptoms that could appear in your baby, such as a bad diaper rash or white patches that don't wipe off in his or her mouth.
It is very important that both you and your baby are treated at the same time. Otherwise you will keep passing the yeast back and forth to each other. There are a variety of treatments -- some are natural home remedies like gentian violet, and other remedies such as Nystatin or All-Purpose Nipple Ointment (APNO) require a prescription. APNO contains both antifungal and antibacterial ingredients, as well as a steroid for inflammation. It sounds like something you wouldn't want your baby to ingest, but in fact it's perfectly safe and doesn't even need to be washed off before nursing. Note that it has to be made by a pharmacist and not all pharmacies make it. If your doctor or midwife doesn't know, your local pharmacist should be able to get you in touch with the nearest "compounding pharmacy."
Bad latch/suckle. The "latch" is just the term to describe how the baby's mouth is on the breast. A baby's latch will affect the way a baby suckles. Common problems with latch include a baby who does not have enough of the breast in the mouth, subsequently sucking on the nipple as if sucking on a straw; or chomping and clamping down while trying to suckle. This kind of latch/suckling will be painful and also won't do a very good job of delivering milk. There are many different types of bad latching. The link on this page will help you see what a good latch looks like and give some tips on how to get it.
Bad positioning. If the latch looks right but baby is not well-positioned, you could also end up with nipple pain because the baby's body relative to your body causes pulling or pinching on the breast or nipple. There are several good ways to position your baby. Follow the link on this page to pictures and videos that demonstrate good positions.
Breast pump problem. Many moms mistakenly believe that turning up the strength of the suction on a breast pump will get milk out faster. This is just not true and, in fact, stronger suction can create pain in the breast. Always start out with the lowest setting and gradually increase the suction setting, reducing the suction when it grows uncomfortable. Additionally, many moms don't realize that the part that fits over the breast, called the "breastshield," is not "one-size-fits-all". Using the wrong breastshield can cause friction against the nipples, which is painful.
Baby biting. First, determine when the baby is biting:
If it's happening because baby wants to use you as a teether, use whatever teething remedies you find work best (e.g., teething tablets) and unlatch the baby when s/he bites. Say something like, "Mama's not for biting. If you want to bite, use this," offering the baby a cold teether. If baby really does prefer a teether, he or she will happily gnaw away on it. If baby really did prefer to nurse, baby will let you know! Try re-latching and starting over. You must do this every single time baby bites. Consistency is the key. Be sure to give baby lots of praise when he or she nurses for a while without biting ("Good job, you're nursing nicely!") to reinforce good habits. Baby may not understand your words, but he or she does respond to your tone of voice.
If it's at the end of a nursing session, it may just be that your baby is tired and is instinctively reacting to keep the breast in his mouth. You can anticipate this and unlatch your baby before any biting begins. When baby's fallen asleep or changed suckling pattern, unlatch him before he gets a chance to bite by putting your finger between the corner of baby's mouth and your breast and then gently breaking the suction.
You may find that because initial problems weren't resolved, you are now in so much pain that you can't nurse on one or both sides. If you need to take a temporary a break from nursing, you can stop nursing or nurse less frequently just on one side or on both sides. But if you choose this route, be sure to pump to keep your supply up. This is especially critical in the early stages of nursing, while your milk supply is being established. Also, be aware that if baby's not nursing well (likely the cause of your pain!), introducing a bottle may cause nipple confusion, so consider alternatives to bottles such as finger or cup feeding.
Get help if you need it (and you probably do).
Latch and positioning can be explained in words and there are even some good pictures and videos online, but ultimately you may need some help in-person. Check with a lactation consultant (usually at hospitals and sometimes at doctor's offices) or your local La Leche League. A lactation consultant or La Leche Leader can also help you fit a breastshield for your breast pump and offer support and more ideas for dealing with a biting baby. For thrush, a lactation consultant or La Leche Leader can help with home remedies, but you'll need to see your doctor or midwife if you need prescription medication.
