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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. 

 

She developed very sore nipples on day three. She got help with positioning her baby and used a...

She developed very sore nipples on day three. She got help with positioning her baby and used a...

Age at interview: 26
Sex: Female
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I had a couple of difficulties, I was expecting, I must admit, I was slightly cocky, for want of a better word, about the fact that I didn't think I'd ever have any problems, you know I've got people who would help me and I thought I had all the background and knowledge I needed but over, I had a caesarean birth, so, I was on a lot of morphine, I was quite, well drugged up basically, I had quite a lot of pain killers going through my system so, on about, I think it was day three I was supposed to stay in hospital for six days but I only stayed in for three because I just don't like hospitals at all, that wasn't really the birth that I'd planned, so on about day three I found that I was getting really sore, really sore nipples, just right on the end and obviously I had my mum there and I had another La Leche League Leader who funnily enough I asked, I felt more comfortable asking for help, so I asked her and she basically talked me through positioning, and within about, I think within two or three feeds it was completely pain free again so, well I thought it had been pain free all along but obviously I'd had a lot of pain killers, so, within two or three feeds, definitely by the next day it was completely pain free, I remember changing positions, like the rugby ball under the arm and things like that, to kind of try and adjust it.

OK and for your sore nipples did you apart from the football hold changing position and stuff, did you use anything else?

Mainly for my, for the soreness, I used just positioning I did you know tried things like pulling her chin down a little bit making her open her mouth a bit wider and things like that, I also did use creams, I used Lansinoh.

Did you find it helped?

Lansinoh was excellent it meant that the end of the nipple which had been going a little bit white on the end because obviously now I know that was positioning and your nipples should pretty much come out as they went in and it was coming out with like a white tip and it meant that white tip didn't ever scab over or you know become irritable and it didn't rub on anything because the Lansinoh was there it was like a barrier and also it meant that I didn't have to wash it off before I latched her on and it was just easy.

 

Zainab’s nipple cracked badly but she continued breastfeeding from her less affected breast and expressed the milk from the other. She used cabbage leaves to help with the pain.

Zainab’s nipple cracked badly but she continued breastfeeding from her less affected breast and expressed the milk from the other. She used cabbage leaves to help with the pain.

Age at interview: 33
Sex: Female
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So when I had her, when I had my first son I had really bad cracked nipples, I was all sore, luckily enough my mum came to stay with me but she couldn’t do anything because it was, it’s the first time she’s seen something like that in my situation. I could remember there was a day I was breastfeeding my baby and I end up seeing blood come out of his mouth so I had to stop that one. I was so determined to give him breastmilk I didn’t want formula so I end up pumping one breast and leaving the other one untouched.
 
To rest?
 
To rest yes and I, because of the breastfeeding classes that I went, it was quite helpful so I remember she said if you have cracked or sore nipples you can put cabbage which I did.
 
The cabbage leaves?
 
Yes the cabbage leaves and even my mum was like really cabbage, I said yes she, I was told it gives you a bit of relief and it doesn't dry up the, the nipples. I used the nipple cream but it was all in vain there was nothing, it wasn’t helping. I went to the GP they said because I’m breastfeeding they cannot give me any antibiotics I can only go on paracetamol that’s it. So I was pumping one breast and leaving the other one to rest which I could even say up to now it has an impact because one breast I have more milk than the other one because I think it’s psychology with the brain isn’t it that one needs it so let me give this one. Even now I can tell one has high milk and the other one has very little amount.
 
So I call the breastfeeding help group and they came, she tried helping me quite well, they were quite good but there was nothing she could do the nipple was so cracked it even like the nipple like split almost into two you could see the, it’s a horrendous experience I can’t even like. I was all in pain for two and a half months, I was in pain but I was so determined I wanted to carry on. My first child I gave him all through I didn’t even give no water until he was six months and then I put water and formula.

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).

 

For the first week, her nipples were sore for the first couple of suckles only of a feed and then...

For the first week, her nipples were sore for the first couple of suckles only of a feed and then...

Age at interview: 29
Sex: Female
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Initially, to start with obviously it, your nipples are a little raw was probably the way I'd describe it, it wasn't so much painful, and I was fortunate in the fact that they didn't crack but then I used that Lansinoh Cream right from the beginning to prevent that from happening, and then a couple of weeks after that I think we both just got used to it really and my nipples had hardened up enough not to be an issue, you know not be a problem.

Can you describe that soreness when you first got the baby home?

The, the first, the first sort of week when you, the milk just starts coming out it's like a, a sharp pain, but it only lasts a couple of suckles and then it's gone. So I mean it's literally, you know, you get him on, you go and then it's over and then it's just like straight through to normal feeding. But now I don't get that at all now, not even the initial thing it's completely gone, it went after about a week and a half that.

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. 

 

Her cracked and bleeding nipples were so painful that she dreaded feeding her baby. She got a lot...

Her cracked and bleeding nipples were so painful that she dreaded feeding her baby. She got a lot...

Age at interview: 30
Sex: Female
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No I was I came home I stayed only a night at the hospital and came home on the fourth day it was terrible my nipples were cracked bleeding very upset hormones obviously had kicked in as well and I remember walking out of the shower in floods of tears, husband walking in saying, 'What's wrong?' and it was a pure fear of baby waking up having to feed baby 'cause it hurt so much and I never ever thought that breastfeeding would be like that, none of my friends had said it, my sister-in-law hadn't mentioned it and but when I spoke to them about it during this really problematic period it was like, 'Well yes breastfeeding does hurt,' it was like, 'we didn't talk to you about it before 'cause you weren't going through it, there was no need to discuss it with you because you couldn't give us any of your experience so we talked to people who had already breastfed so that's why and you didn't know about it', and it was a shock a real shock.

Do you have any sense of why that happened?

As in the pain?

Why you ended up with sore nipples, were they cracked, your nipples? Do you know why?

Yeah the midwife just said, 'It's just one of those things 'cause the midwife in this area visits everyday for the first ten days unfortunately I didn't see the same midwife very frequently because she, because my midwife was actually on holiday so I was seeing relief staff which was good in one way because I got the opinions of lots of different midwives of what I should be doing, all of them checked my technique because they said it was most likely your technique that's not correct. 

Okay. So then you came home and carried on for a couple of days, things seemed fine?

Yes, things were fine until the fourth day which is when things became very painful I started to ask friends who were coming over, 'Am I doing this correctly?' Asked the midwife, 'Am I doing this correctly?' lots of advice and different ways of holding baby, but nothing really worked it was very, very painful to the point where every time I wanted to feed I'd ask my husband to come in to hold my hand while the first few sucks because they were the worst get the first few sucks out of the way get the first few tears out of the way and then he could go, once he was latched on and started drinking it was okay but that lasted for a for a good two weeks, it was awful.

And you tried lots of different positions?

Yeah I think every single position, the best one that worked for me in the end was lying down and I think that was more for the fact of one of my cousins coming over saying, 'You'll be relaxed it's a lot easier', and also we've got a wrought iron bed so I could hold on to something [laughs] for the first few sucks I think that was why I enjoyed that position the most and it also meant that I could go upstairs and say, 'I want to lie down and feed and not get upset or embarrassed in front of anybody else' but resulted in my best position which I then carried on for a good month or month and a half.

Did you do anything else for those nipples?

I bought several creams ones that I would have recommended to other people they were fine but I don't think they really helped that much but the belief I bought creams I bought nipple protectors.

Do you mean nipple shields?

Nipple shields yes. 

Mmm.

I just couldn't get the hang of using them and by the time you
 

The pain of sore nipples was replaced by a sharper pain that was diagnosed as thrush*2. Breast...

The pain of sore nipples was replaced by a sharper pain that was diagnosed as thrush*2. Breast...

Age at interview: 30
Sex: Female
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But it wasn't that simple really. Then when I left hospital I [pause] he started losing weight and I think it was partly because I was tired and it was difficult having him there and not knowing how much he was drinking because he could be latched on for an hour and still be drinking, and I would just, because I was so tired I would just put him down myself. So I think a part of him losing weight was due to me not feeding him properly, or feeding him enough, and then when the problems started, the sore nipples I could handle that wasn't bad at all.

Did you tell somebody about the sore nipples?

Yeah, I got the cream.

And they checked your positioning?

Yeah they checked everything, they checked the way he was latching on, and what he was doing is not opening his mouth properly when he first latched on he was sucking the tip and then sort of sucking it all in, yeah like that [laughs].

He was slurping the nipple into his mouth…

Yeah.

…rather than opening wide?

But when we got him to open that was fine, then he was doing everything and then.

Did the pain go away when you …?

After a while the pain never actually went away, it, every time I put him to the breast there would be pain for about ten to twenty seconds, maybe, but then it would eventually go away and we'd be okay but there was always a pain there. And then there was a different pain, it was a lot of pain and I just again thought, presumed it was my nipples so I put a lot more cream on and.

How different was that pain? Are you able to distinguish the pain of a latch on from this other pain?

It was a lot sharper; it was really sharp, like glass really.

A burning?

Burning afterwards, when he came off then there was the burning, but when he, when he first went onto the breast it was like he had glass in his mouth and was biting into me.

You poor thing.

It was awful. But I didn't want to give up because I thought, I just didn't want to give up really. And after that we, I told the health visitor, and I carried on with the cream really and they just checked the way he was positioning and the way he was latching on, and told me how to do it, which surprisingly when they were there it did help, but once they were gone it was the same thing again and every time, and then I, it put me off feeding, I didn't want to, I wasn't looking forward to feeding him, sort of dreading feeding time. But then the pain got so bad, got a lot worse that, it started going from the tip of the breast, and from the nipple all the way into my shoulder, into my arms and into my hand, so I was clenching my hand while feeding him and, that was it I thought that was it, "I can't take any more”.

How old was he at this stage?

He was, eight weeks, six weeks maybe.

And what was happening to his weight?

He was putting weight on [laughs] yeah he was still putting weight on but not a lot actually I don't, yeah he was putting weight on quite well actually, initially he lost weight but after that he was putting weigh

 

Recently, Jessy learned that she has a condition called Raynaud’s that could affect the nipples of lactating mothers. She talks about how it affected her when trying to breastfeed her children.

Recently, Jessy learned that she has a condition called Raynaud’s that could affect the nipples of lactating mothers. She talks about how it affected her when trying to breastfeed her children.

Age at interview: 39
Sex: Female
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I only recently discovered - I have problems with my tissue. My tissue doesn’t heal as quick as it should. My blood doesn’t flow, I have a circulatory problems and then it affects, as much as it affects my hands it affects my breast tissue which makes it really painful.
 
…I was using nipple shields, made of silicon - well, I used them a week after, after seven days just to give it a try because my, at the beginning, my aim was to be able to get him to latch and then I managed to get him to latch properly and then tried different, different position, the rugby ball, the front facing, sideways, every position possible until I found the one, the one that suitable for me that was the rugby ball. But then, I noticed that, that no matter what, how many massages I did, I gave to my breasts they were so sore. My nipples start, start cracking even when I, my, when I was continually keeping, keeping them with nipple cream, like Lanolin cream. I then, I noticed that they start bleeding and they would not stop bleeding the milk was, I tried to press the milk just to carry it, be, to carry on giving him milk [sighs] and the milk looked like strawberry milkshake, there was so much blood in that, I wasn’t able to give him that neither. Then I try to just use the breast that was less damaged for a while and tried to let the other one heal. It, it seemed I was never, ever healing. And then it was that, that feeling of the fire, they were on fire, it was horrible. He felt like, every time they were out, I put him near my breast he felt like he was like a little shark or like a piranha [laughs] like just biting your breast, it was just oh. It was agony, agony, completely agony.
 
…No it took a while to heal actually. Like, even after when I, with the mastitis, the mastitis last two weeks. The nipples - I have to put these, the doctor look at them and say, “You might have thrush”. So he gave me a cream for thrush. But then in, it was still the blood in the like, you know - it was all, it was all broken, completely broken. I didn’t even, I could see it from above, I just promised myself not to look at it in the mirror because that would make me really freaked out [laughs].
 
The, the second time or both times?
 
Both times, but the first time I didn’t, the first time I thought I was going to lose my nipple because the nipple was really coming apart from the breast and the second time it was just the skin was just completely broken and it was blood in my shirts like, I was literally dripping blood.

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.
 

After a difficult birth her baby had trouble attaching. She took him to a chiropractor. Her...

After a difficult birth her baby had trouble attaching. She took him to a chiropractor. Her...

Age at interview: 22
Sex: Female
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Yes you could hear a clicking noise also because I held him I could feel milk dropping onto my arm where he wasn't making a full seal but also that we believe was due to the sort of birth I had [son] was forceps delivery, but he was back to back, so he was manually turned and we took him to the chiropractor when he was a few weeks old because of the problems I was experiencing with breastfeeding.

Who's suggestion was it that he go to a chiropractor?

Bosom Buddies, I went there and the, the counsellor there she suggested that we go to chiropractor because my nipples were bleeding and it was very painful [laughs] I still cringe thinking about that [laughs]. So, yeah it was very painful but she could see that he wasn't latched on properly and also when I put him to the breast he was arching himself backwards and that we believe was again down to the delivery he had. He had a lot of tightness when we went to the chiropractor they found he has a lot of tightness in his neck and his jaw so he went there sort of once or twice a week for a while and that did seem to help.

What did they do?

Just gentle, not even massage, just, just finger pressure on the areas that they felt were affected which, as I say was his jaw, his neck, and some of his back, but he loved it and it did help, it definitely helped. It didn't make things perfect but it did definitely help.

What difference did you notice?

It wasn't as painful, because of the pain obviously with [son] was experiencing as I say when I put him to my breast he would arch away, so I was having to force, so there wasn't a very good latch being made, so as he became more relaxed and this area became obviously less painful for him, he was more willing to be put to the breast and wasn't arching away from it so we got a better latch. And so, you know, my nipples started to heal because they were very cracked, very, very cracked and sore for, for maybe the first three months.

How did…

[Laughs].

…you deal with that?

The first four or five weeks was very hard because, because of my labour I'd had, it had gone completely the opposite way to what I'd wanted and I then felt with, you know, epidural and all the pain relief, and I didn't want that, and so I felt I'd failed from, by not, I didn't feel, although I did give birth to him I didn't feel like I had because I'd been assisted, so for me breastfeeding was very important and I was determined that I was going to breastfeed, but it was very hard. The first four or five weeks as I say I did, it got to the point where I actually dreaded [son] waking up and I considered quite a few times giving up because I didn't want, I wanted to enjoy these first special, you know, weeks and months with my child, I didn't want to, you know, dread him sort of waking up and resenting him for hurting me, obviously it's not his fault but that's how it felt. so I considered giving up but [son] was putting on like ten ounces a week which for a breastfed baby is a very, quite a, a lot to put on so, I felt that he was doing so well it was wrong for me to give up so. I did I cried, I [laughs], you know, I bit into books, I screamed [laughs] but I'd just grit my teeth and just got through it and I'm so glad that I did because it has got, you know, it's fantastic now and I'm really enjoying it. Products, what products to buy, I didn't know what products to buy, and I went out and just bought just nipple creams from just, chemists which I found no good. Are you a

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.

 

She thinks that her badly damaged nipples were the result of a difficult birth for her baby....

She thinks that her badly damaged nipples were the result of a difficult birth for her baby....

Age at interview: 34
Sex: Female
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Yeah she, she was slightly sleepy and she just didn't seem to want to know. But she did do a few feeds in the hospital and then we came home and obviously the midwives had checked and they said, 'Oh yes she was fine, she was latching on okay'. And then you're at home and, she seemed to feed and it was very bizarre because I wrote it down in the end because I don't think anybody believed me but it seemed to be every five minutes, every ten minutes, it was twenty-four-seven, I'd, once in a blue moon she might go two hours in between a feed. I was, at one point living in the lounge because there's no point in going to bed because she'd need to feed and my friends were cooking meals for me and bringing them round, so I'd literally, I'd have her latched on I'd have a tea towel over her and I'd be feeding over the top of her because otherwise I wouldn't feed. It was horrendous, absolutely horrendous, and I went from not thinking about the next day to not even thinking about the next feed because I was in so much pain because both my nipples cracked and I had huge scabs on them and they had to crack open for her next feed and if I thought about it, it was horrendous. I'd be feeding her and crying my eyes out because I was in so much pain, the midwife checked how we were feeding I think and, 'Oh yeah you're fine, you're okay'. You know and but I knew it wasn't right because I was in so much agony and it's supposed to be the most natural thing in the world to breastfeed and there I was in absolute agony. She was latched on and she said, 'You know luvvie, there might be a problem with her feeding which is why you were having such sore nipples, and you're in so much pain'. She said, 'I'm wondering if she's got a birth trauma'. And I looked at her as if to say 'what on earth are you talking about?' Never heard of it before, and she, she said, 'Sometimes when some babies have had quite a hard time being delivered they end up with a trauma to the neck, or to the shoulders, or to the jaw which means that they can't feed very well'. And sometimes their jaw's not working, sometimes they've got headaches, sometimes they're in pain, she said, 'It might just be worth your while just to take her over to the chiropractor's and just have her checked out, you know, just see, you know, if there's a problem there'. And I thought 'chiropractors and baby, what are you going on about?' [laughs] never heard of it before I thought, 'oh I don't know, I really don't know' but I came home and I phoned them up and, I couldn't actually get in for a week and a half but because.

It's a lovely happy noise.

[Laughs].

Let's start that again, I couldn't get in for a week and a half.

Yeah, I didn't get in for a week and a half but the lactation consultant at Bosom Buddies was very good and phoned me up the Monday night. This bit's, originally it was a Friday, and she phoned me up the Monday night and she said to me, 'Hello, hello [name], you know, how are things and did you manage to get your daughter in to chiropractors?' And I said, 'Oh I can't get in till next week'. She said, 'That's no good'. She said, it's, I can't remember the words that she used but she said to me it's, 'You really need to get her down there as soon as possible, I'll phone them up and see if we can get you in'. The following day at nine o'clock, before nine o'clock I had a phone call [laughs] and I thought 'I wonder who's phoning me up at that time?' and it was the chiropractor saying that we could squeeze you in today for midday. I thought, 'Oh my God, better phone my Mum to see if I can get a lift there', and I took her down there and usually the first session is just a consultation but because things were so bad for my daughter they did a treatment at the same time and from just being able t

*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 November 2018.
Last updated September 2015.

 
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