What You should know about Nursing Nipple Pain
Written By: Barbara Nelson, M.A. CCC-SLP, CLC, CBS; Baby Boldly Parent Educator
For this article we interviewed Catherine “Cat” Halek. Our favorite IBCLC whose mission it is to remove barriers and help mothers have the most relaxed breastfeeding [feeding] experience possible. Mother’s and their nipples across the country thank you Cat, for the valuable information you have provided for this article.
Too often the internal dialog that accompanies nursing pain is shocking and wrings at the heart when it is said out loud. But so many mothers do not put volume to these words. Or worse, when they do they are let down by our medical community who are meant to help. Here are real quotes from women who nursed their babies and experienced pain:
“I don’t think that it’s uncomfortable enough to be considered pain.”
“I am just weak or oversensitive.”
“If I just push through it will get better.”
“Breast is best. Ouch (cry). Breast is best.”
“I can suck it up because this is best for my baby.”
“Is this normal?”
“I gave birth unmedicated and I thought that was tough…this is tougher.”
“Maybe this is the last time it will hurt and my nipples are just getting used to this.”
“Maybe I should have roughed up my nipples during pregnancy like my mother
“Maybe I’m a millennial snowflake because my mom nursed 4 babies and only mentioned how great it was.”
“I am failing at the one thing that is supposed to come naturally.”
“I want so badly to quit but feel like I would be failing my son and my feeding goal, if I do.”
“Is this what others call discomfort? Maybe I’m just a crier.”
“I would give birth over and over again if I could avoid the first month of breastfeeding.”
“I will not show on my face how badly it hurts because I don’t want my baby to get a complex, so I will smile as he piranha chomps. Even as my eyes stream with silent tears.”
No doubt at some point these mother’s spoke to another mother, perhaps a close friend. When good intentioned friends offer support it can often be in the form of cheerleading to push on or to stop breastfeeding all together. While we do need our cheerleaders and those who give us permission to let something go, these are not always helpful for the mother who wants to breastfeed but is in pain. When I shared these examples with Cat, she comically pointed out that, “Those are two really crappy options. That you need to give up on breastfeeding or have to suffer.” Cat expanded further, “It is a misconception that pain with breastfeeding is normal. Pain is common with breastfeeding, but it’s not normal.” If there is pain, then something is wrong and getting help on how to fix it is both important and time sensitive.
How to determine normal sensation from pain
Pain is subjective, and varies between people, it can sometimes feel difficult to label. So when I say you should not have any pain with nursing what-so-ever, many mothers still question if the sensation they feel counts as pain.
Cat shared one way to determine the difference between pain and discomfort. “Discomfort with breastfeeding sounds like: I wish this was more comfortable. I feel it, my attention is drawn to what’s happening. It doesn’t hurt, but I wish it was more comfortable.” She says with discomfort you are not dreading the next feed, but when baby latches on you’re like, “ooh that could be better.” She goes on to share that discomfort in the first 2-3 weeks of breastfeeding is normal especially if you have extra fluid in your breasts from a medicalized birth.
Pain on the other hand, shows itself more visibly. “I can usually see pain on someone. It can be breath holding, tight lifted shoulders, or a squished face.” Cat shared that even when these are overt, many mothers still deny they are in pain. This is especially common if they identify as a tough person or have the expectation that nursing will be uncomfortable. “If you can’t speak or have to grab onto something to bear the breastfeeding, you are for sure in pain. And probably at an 8-9-10 on the pain scale.” Gritting your teeth, wincing, or crying- also all signs of severe pain and that you need help ASAP.
Then there's the middle of the road pain. “You can experience what I call middle of the road pain if you’ve had prior poor latching and nipple trauma that is in the healing process.” This is brief discomfort or pain due to a history of repetitive painful nursing or recurrent nipple trauma. Cat described that what can happen is really intense pain at the beginning of the feed which dissipates quickly as the feed goes on. “When I say dissipates, I mean if you count to five the pain should be gone and you should feel comfortable again.”
Normal comfortable breastfeeding without any curveballs, does not include pain. It’s expected that after the first 2-3 weeks of settling into breastfeeding it should feel comfortable and pretty routine. Cat went on to clarify, “When I’m talking about comfortable; I mean that most women, not all, but most women don’t even feel it.” It’s not that you can’t feel the rhythmic tug, but there is no discomfort and your attention could easily go elsewhere. If we don’t feel comfortable, that’s when we need to assess the situation to find the underlying cause. And, just a little side note: if the latch “looks good” to a professional but still feels bad- we need to keep digging. Sometimes it’s a very simple position and latch adjustment, other times it takes getting to the right person for the answer. But the answer is never that if it looks good but feels painful it’s fine.
Still not sure? Give it a number.
Another helpful tool Cat suggests is giving it a number. This can be helpful when trying to determine where you land more objectively. Here is a helpful guide for self rating on a scale of 1-10 according to Cat:
(This article is specially about nipple pain, but Cat reminded me that there are also breast pain issues that can arise. Examples would be mastitis or plugged ducts. In Cat’s experience, “Plugged ducts, poor latch, and painful nipples tend to travel all together.”)
Pain with pumping?
No. Just no. Cat stressed, “Pain with pumping is bad. Not good. Need Help. It is a red flashing light in your face telling you to call a lactation consultant right now”. We forget that breast pumps are medical devices because they are readily given out to everyone without proper fitting, instruction, or lactation support. When it comes to personal pumps, “First, there’s a lot of people pumping with the wrong flange size which causes either rubbing or sucking too much of the areola into the flange. And that can be painful. Second, too strong of a suction can cause nothing to come out.” This is because pain can be a barrier to milk let-down. She also shared that many pumping mothers are trying to breastfeed and pump. “Your nipples are not ever getting a break or feeling better for a second.” Finding the right flange size is its own topic, but I do think it’s important to share that if your nipples are inflamed from pain or damage, they may require a different flange size than a healed nipple.
How to treat your ladies (aka: your nipples)
For those experiencing pain and especially those with visible nipple damage there are some options for soothing them until you get help. And please do get help as soon as possible. Soothing wounded nipples will not target the root cause of why your nipples became damaged in the first place. No amount of nipple care products will fix the underlying culprit and you will likely be caught in a vicious cycle of pain, damage, and band-aid solutions. Okay now, on with the nipple care!
Mild sensitivity action plan
Now, “if I am just having sensitive, tender nipples; then covering them with a breast pad, being gentle with yourself, not wearing too tight of a bra [etc.] can manage it on its own.” Cat said gentle handling can go a long way for those mildly uncomfortable.
Pain or damage action plan
On the other hand, if there’s nipple damage, treatment should be managed by a professional. “In the meantime, I really like hydrogel. It’s usually my go-to. That’s what I would use if I had nipple damage until I could get to see a lactation consultant.” In her practice, Cat has used and recommended both the Medela Hydrogels or Lansinoh Soothies Gel Pads. “I see the quickest healing for nipple damage when somebody uses one of those products consistently between nursing or pumping. It usually only takes about 2-3 days to heal when using one of these products if you’ve managed whatever was causing the damage.” Dodd and Chalmers (2003) compared hydrogel to lanolin and found hydrogel to be more effective for pain management and without side effects. As an added bonus, those participants were able to stop treatment faster. To use a hydrogel, follow the brand specific directions.
Mohammadzadeh et al. (2005) compared sore nipple care using lanolin versus breast milk and found that sore nipples had better healing time with breast milk compared to lanolin. But, they did not find a significant difference between breast milk and nothing at all. Most importantly, mother’s in all three groups received proper positioning and latch support during the study. “This study shows the breast-feeding technique correction is the basis of sore nipple treatment” (p.1234). The researchers suggest that if you are going to put something on your nipples, “breast milk has the advantage of being convenient, inexpensive, and non-pharmacologic (p.1234). They also point out that use of breast milk eliminates additional trauma from having to wash your nipples before nursing your baby. If you want to give breast milk a try, put a few drops of your expressed breast milk on your nipples after the feed, and allow them to air dry before covering them with clothing.
A word about nipple shields
Nipple shields are best used as a short term tool under the guidance of a professional. Cat says she’s a fan of nipple shields if it helps a mom continue to feed their baby at the breast until the issue can be resolved. However, “I wouldn’t buy a nipple shield without a lactation consultant’s guidance. They can show you what size to get, what type to get, and how to use it properly.” Remember that normal nipple stimulation is part of the cycle that builds and stimulates milk supply, so wearing a barrier such as a shield over your nipples should only be introduced with a plan that includes weaning off of the nipple shield. Additionally, a nipple shield changes the sensory input and latch for a baby. It goes without saying that there are outliers to the norm, that require longer term use of certain feeding tools for medical reasons. These are not included in this article, which is focused on nipple pain specifically.
Face-to-face evaluations are ideal for nipple pain
Cat and I both agree that for nipple pain evaluations, in person consults are ideal. Otherwise you just can’t see as much or help in a hands-on way. In Cat’s opinion, “There are certain topics that are great for virtual consults. Nipple pain is not one of them.” She says it’s very helpful from a diagnostic standpoint to see things in person. “Sometimes I need to be able to touch or see something at a certain angle or in a certain light to know what we are dealing with; and you just can’t do that virtually.”
Standard health insurance should cover lactation consultant visits. Finding a consultant with clinical experience for post hospital discharge is where asking friends, family, or medical professionals for a referral may prove efficient. The Lactation Network is a resource that will check your insurance coverage and link you to a local lactation consultant (unfortunately they don’t work with all insurances yet). The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded program that employs lactation consultants (WIC is available to those below certain income levels only). And of course, there is also the internet search (to me this is the most daunting option, but pain must be addressed, not ignored).
If after reading this you are still not quite sure, then you would likely benefit from a consultation to gain support or peace of mind. You and your nipples deserve the best, with less stress.
Written by: Barbara Nelson, MA, CCC-SLP, CLC; Baby Boldly Parent Educator
Barbara is a speech-language pathologist. Her career predominately has focused on pediatric hospital based evaluation and treatment of infants and children with feeding disorders. This career choice makes sense, because for her, food is one of the best simple pleasures, medicine, and promoter of social connectivity available. She believes that feeding a child is more than just calories and that those connected moments stay with us forever. She strives to provide research and facts regarding the gold standard, but never chooses for a family because the parents always know their child best (even on day one). Barbara is a mother and lives with her husband in St. Petersburg, Florida.
Dodd, V., & Chalmers, C. (2003). Comparing the use of hydrogel dressings to lanolin ointment with lactating mothers. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 32(4), 486–494. https://doi.org/10.1177/0884217503255098
Mohammadzadeh A, Farhat A, Esmaeily H. The effect of breast milk and lanolin on sore nipples. Saudi Med J. 2005 Aug;26(8):1231-4. PMID: 16127520.
Catherine “Cat” Halek, IBCLC. CatHalekIBCLC.com