Breastfeeding

Sore nipples

Sore nipples were a topic where people had different experiences and opinions. Many women didn't experience sore nipples or experienced only brief feelings of discomfort. Some were expecting pain that never occurred. Many women, usually lay (not medically trained) breastfeeding experts, said that breastfeeding should not hurt and if it did, then something was wrong and needed attention. This was usually the positioning of the baby at the breast and latch-on. Slight adjustments could lead to rapid relief from pain. 

Many other women said that their health professionals (midwives and health visitors) told them that soreness in the early days of breastfeeding was normal and their nipples required hardening.*1 A few women spoke of cracked nipples that they were not aware of because they were not sore, possibly because they were taking painkillers after a caesarean section. Some women wished that they had been told how painful breastfeeding could possibly be at first and that they would get through it, including a woman who felt that family and friends had deliberately not told her so that she wouldn't worry (see Interview 31 below).

The descriptions of nipple pain ranged from minor, temporary soreness at latch-on, caused by surface grazing and lasting a few days at most, to 'absolute agony', caused by poor attachment or infections such as thrush that lasted for weeks and sometimes resulted, reluctantly, in premature weaning. Words used to describe the minor pain included dry, raw, grazed, grating and like a cat's tongue, while the words used to describe the more serious pain indicating that something other than positioning was wrong included 'excruciating', 'burning' and "like he had glass in his mouth". Several women said that they dreaded the baby waking up and needing another feed. Some said that they didn't want to resent the baby for hurting them and “considered giving up”. They could understand how easy it would be to do at that stage. 

The women dealt with their pain in several ways. To cope with it they curled their toes, bit into books, gritted their teeth, cried, used their labour breathing exercises and even held onto the wrought iron bed head. To treat their sore nipples they drew upon a variety of remedies including:

  • persevering with breastfeeding through the pain, with someone holding their hand, until the pain subsided,
  • using painkillers prior to a feed,
  • resting the nipple and expressing milk from the affected side while continuing to feed from the unaffected side,
  • seeking professional help from midwives and lactation consultants regarding positioning,
  • using a variety of nipple creams and ointments including Vaseline, Kamillosan and Lansinoh, which some wiped off before the next feed and others left on.
  • using paraffin gauze or breast pads kept in the refrigerator or freezer.
  •  
  • Some women spoke of expressing a few drops of milk and rubbing that into their nipple. (There was a time when air drying nipples was recommended but that advice has now been replaced by the instruction to keep the nipples moist.) Some women used cabbage leaves (see 'Positioning & attaching/latching the baby at the breast') for sore nipples as well as for engorgement.

Finally, several women resorted to using nipple shields*3 and in the same breath as saying how fantastic they were at the time acknowledged their future limitations. Some said that the nipple shields made the baby windy and affected their milk supply. Their baby began to lose weight or did not gain weight as expected. Others said that the nipple shields had no effect on their milk supply and that they would have given up breastfeeding without them. Either way, all of the women were anxious to dispense with using them as quickly as possible mostly because they were a fiddle to use ('Positioning & attaching/latching the baby at the breast'). One woman used nipple shields (because she had them to hand) in desperation to get her baby to attach and feed even though she did not have sore or inverted nipples and then continued to use them because she didn't have the confidence to do without them. Other unusual uses of nipple shields included one woman protecting her nipples from the pain caused by the stitches in her baby's mouth (used to repair his cleft palate) until those stitches dissolved. Another woman used them to encourage her baby to keep her tongue down during feeding. Some health professionals advised women not to use nipple shields while others recommended them.

*Footnote 1: Minor brief pain at the beginning of a breastfeed in the first few days is fairly common. However, constant or long-lasting pain or pain after or between breastfeeds, especially of the burning or itching kind, is not normal and requires attention. Several studies have compared various treatments for the prevention or treatment of common nipple pain but nothing has been shown to be the best. The value of nipple creams is controversial. Correct positioning of the baby at the breast is essential.

*Footnote 2: Breast shells are hard plastic hemispheres worn inside the bra to encourage inverted or flat nipples to protrude. Their use is controversial and their effectiveness has not been proven. Flat and inverted nipples are not a barrier to breastfeeding as a baby feeds from the breast not the nipple. Skilled help with correctly positioning and attaching the baby may be required.

*Footnote 3: Current research shows that the use of modern, thin, flexible, silicone nipple shields can be temporarily helpful in the transition to full breastfeeding for babies with attachment problems, mothers with inverted nipples or premature babies. However, their use is controversial. 

*Footnote 4: Raynaud’s phenomenon of the nipple or nipple vasospasm is the condition where blood flow to the nipple is reduced. The nipple can change colour to white or blue and is painful. Nipple vasospasm pain can range from minor discomfort to severe pain and so may or may not affect breastfeeding. (See ‘Medical conditions that could affect breastfeeding’ and ‘When breastfeeding doesn’t work out’).
 

Last reviewed September 2015.
Last updated September 2015.

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