One of my most horrific memories is when my husband (trying to help) put disposable nursing pads inside my bra; the problem came when I went to take them off and realized he had put them in backward, so the sticky tape was adhered to my raw, bleeding nipples. That was 27 years ago and I still cringe. Oh, the tears. Oh, the expletives. Oh, the forgiveness I needed to muster. I was so young (22), so clueless and surprised by such pain, and so discouraged that I couldn't feed my baby and dreaded the very thought of her wanting to eat (yet) again. I realize now, after training and working as a lactation consultant, that my pain was most likely due to my engorgement. My breasts became so incredibly hard around day three that my nipples literally flattened out and there was nothing she could do but cliff-hang on the tips of my nipples…which is NOT where you want your baby to be. I didn't know how to manage the engorgement – I didn't own a pump. I didn't know how to hand express. I just kept putting her on, when I could bear it, and waited for the swelling to go down. I'm pretty sure that is why my supply dipped, and I struggled so hard to get a full milk supply. Ah, hindsight.
I am not going to lie and say you won't feel something when you first start breastfeeding. In all my years being a lactation consultant, I can probably count on one hand the number of mothers who report ZERO discomfort when first starting off nursing. There usually will be a period of trial and error, a getting-used-to-this period. But there is a difference between discomfort (having to hold your breath the first 10 seconds of latching in the first 1-2 weeks) and straight up pain (that lasts the entire feeding and causes nipple skin damage). If your nipple skin is blistered, scabbed, or bleeding, it's time to investigate further—and maybe call in some reinforcement (like your OB or midwife and/or an IBCLC lactation consultant). Unrelenting nipple pain is one of the most common reasons mothers abandon breastfeeding. There are a LOT of nerve endings in the nipple, and one can only go so long in pain.
Studies show that breastfeeding pain is a major factor (no surprise here) for early breastfeeding cessation, and it has also been linked to psychological stress and postpartum depression (again, no big surprise). It typically resolves by two weeks, but one in five women report pain up to two months postpartum. In our culture, women are often told that breastfeeding pain is normal and they receive the cultural message that as mothers we just need to "suck it up" until the nipples "toughen up". But we don't typically distinguish between normal discomfort in the first 1-2 weeks, and pathological pain and damage (blistering, bleeding, cracking, etc.) that some women experience. My heart sinks when I see a mother for a consultation, she takes off her bra, and I see the kind of damage no one EVER should have to endure. As they have no other frame of reference, they reveal to me that they just thought it was normal to crack and bleed….and they fail to see what a warrior they have been. Someone needs to SEE her and acknowledge her pain. And someone needs to reassure her she is going to heal and she is going to get help breastfeeding her baby. As a community, we need to lift her up, and help her in this vulnerable situation.
The two most common reasons for nipple pain are a poor latch/positioning or restricted oral anatomy (tongue/lip). There are many other reasons for pain such as infection (bacterial or fungal), poor breastshield fit with pumping, poor nipple shield fit, vasospasms, skin disorders, or allodynia/functional pain. The first step is to call someone familiar with nipple pain and damage (such as your local IBCLC, your doctor, or your midwife) to get a healing plan in motion. Additionally, ask your pediatrician to rule out a tongue and/or lip tie, just in case that is the issue. For some, a healing plan might involve:
1.) A short stint with a nipple shield. If this is your plan, I highly recommend staying in touch with your pediatrician and (ideally) an IBCLC so proper sizing of the shield and evaluation of your baby's ability to transfer milk through the shield can be done….as well as a plan for ditching the shield once you are healed.
2.) For skin that is broken open, there is a prescription called All Purpose Nipple Ointment. You'll need to call your provider for this, but it covers the possibility of infection (any time any part of our skin is broken open, it's at risk for infection, so this ointment, plus once-a-day cleaning with a VERY gentle soap is recommended).
3.) Taking a 12-24 hour pumping break to allow the nipple skin to heal. I recommend using coconut oil or a nipple butter to lube up the breastshields for pumping, so you can be extra gentle with the skin. Pump as often as your baby would feed to stay even with her, removing your milk on a regular basis as much as possible (at least every three hours). Check out paced bottlefeeding videos for ideas on how to bottlefeed your breastfed baby.
4.) If your skin is not broken open, I like hydrogel pads, which are cooling (numbing, actually) and help heal from the inside out. And believe it or not, your own milk has healing properties, so rubbing some of your own expressed milk on your nipples and letting them air dry can be quite lovely. Lanolin, coconut oil, and various breastfeeding-safe nipple butters can feel quite soothing; they won't hurt and they might help, so go for it if the sound of it feels good to you.
Once your nipples don't hurt when water hits them in the shower, you can touch them without wincing, then it's time to try baby again at the breast (ideally, with latch help with an IBCLC). Starting out your breastfeeding journey with nipple trauma can be, well, traumatic. And it's normal to feel gun-shy about putting baby back to the breast. We are only human. And no matter how cute they are, our nipples matter, too. Women need to know there is help out there, and extreme nipple pain and damage are not normal. Common, unfortunately, yes….but not normal and most likely avoidable with good help. If you're sitting home in pain, wondering where to turn next, please don't hesitate to contact me or your care provider for options. You're not alone, and this will get better.