Nipple Pain

I’m a second-time mom who breastfed successfully in the past and have had trouble with latch-on this time. My week-old baby’s mouth won’t open wide enough. I’ve tried all positions. Things seem to be improving -- she’s getting milk, she has multiple wet and dirty diapers and the doctor said she’s doing fine. The problem is that my nipples are so cracked they are forming scabs, and feeding is extremely painful. I’ve used the cream sample I got from the hospital, put expressed milk on my nipples and have left my chest exposed while I sleep. How long will this continue, and what else can I do to help it? I don’t want to give up breastfeeding.

Question:

Nipple pain can be excruciating and is usually preventable. In spite of this fact, many mothers experience pain. As I’m sure you’ve read in many places, getting a correct latch can make all the difference in achieving nipple comfort during feedings.

Experienced nursing mothers often remember the nursing positions they used with their older babies, rather than which positions work best with newborns. Unfortunately, many texts on the subject are not effective “teachers” of correct latch. Review these signs of improper latch to determine if this is the cause of your current pain. Your nipple pain is probably due to positioning if:

  • your nipple appears pinched or compressed when your baby comes off the breast,
  • your baby’s nose is very close or pressed into your breast when latched on for feedings,
  • you are unable to see some of your areola (the dark skin around your nipple) above your baby’s upper lip,
  • your baby’s mouth on the breast looks as though her lips are pursed for a kiss, rather than her mouth being wide open and relaxed as though taking a big bite.

When your baby is latched well, your nipple may be elongated but shouldn’t be shaped by the suckling. When your baby is tucked in close, her neck will be straight or slightly extended back. This causes her chin and lower lip to be pressed into the breast deeply with her nose slightly away from the breast. Your baby’s mouth should not be centered around the nipple. She needs to milk the breast with her tongue. To do this, more of your breast should be in her mouth on the side toward her tongue (this is the inner side of your breast if she is going across the front of your body). When your baby gets a wide grasp, her lips will be splayed outward and her open jaws will create an angle that is greater than 90 degrees.

You mentioned that your baby doesn’t open wide for feedings. Some babies need to learn to open wider. Reinforcing the behavior does this. Use your breast to gently tickle your baby’s lips. Wait for her to open wide (even if it takes a while). Immediately respond to the wide mouth by bringing her onto the breast. Or, if pain has slowed down your latch-on response, offer some expressed milk from a dropper in response to her wide-open mouth.

Babies may be prevented from opening wide because their head is bent in, with their chin toward their chest. This neck flexion makes opening wide, sucking properly and swallowing more difficult, too. You may begin with your baby’s neck straight to start with (which is good). But, possibly, when you pull her onto the breast with pressure on the back of her head, an incorrect neck position occurs and her mouth closes up.

You can tell your baby’s neck position is incorrect if her nose is up against or pressed into your breast. It’s important to latch your baby to the breast, rather than pushing your breast into her mouth, but this movement should be done by applying pressure to her back, rather than the back of her head. If you are using a position where she is going across the front of your body, place her under your other breast, tucked in very close. This will also help to get her neck position correct before you latch her.

Mothers have a tendency to position their babies directly in front of them. Actually, your baby needs to capture more of the breast toward her lower lip and tongue so she should be placed with her mouth more toward the inner side of your breast and her nose at your nipple.

Once she opens wide, hug her onto the breast so her mouth gets the nipple and your areola on the inner side of your breast. You should see your areola above her upper lip if she grasped the correct part. A deep, quick hug allows more of the breast to get into her mouth.

A better latch feels better right away, even though there is already damage from previous latches. It helps to quantify the pain so you can evaluate if it is getting better or worse. Use a zero to ten scale: Zero is for no pain or pinching at all, and ten is the most pain or pinching you’ve felt.

With latch-on improvements, you should be able to get to a lower and lower number. Most mothers are not able to tolerate continuous pain levels of five or higher. If you can’t get pain levels below five on your own, you should seek professional help.

Although topical agents can sometimes provide symptomatic relief, correcting the cause of the soreness is most important. Instructions and demonstration by an International Board Certified Lactation Consultant may be needed to help you find a comfortable position. Your consultant can also identify other causes of your soreness if positioning isn’t the primary source of your pain.

Many mothers experiencing nipple pain doubt their ability to continue breastfeeding. Fortunately, there are effective strategies to help eliminate the pain. As you know from your previous experience, breastfeeding is enjoyable for you and your baby once all the kinks have been worked out.

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