Why does breastfeeding hurt sometimes and how to care for your nipples
Updated December 4th 2022
Let me start this by saying you do not need to toughen up your nipples or do anything to prepare them for breastfeeding. If your experience is anything like mine, you received unsolicited advice from well meaning friends and family as soon as you shared the news of your pregnancy. The advice might not have anything to do with your goals around how you want to feed your baby.
I didn’t grow up seeing other people breastfeed in my family. My mom breastfed my siblings and I for short periods of time. Her struggles included painful latches and mastitis. Ultimately, she didn’t have access to the support she needed. Others told me about their cracked nipples and to expect it to hurt.
While it’s common to experience some nipple pain or discomfort during the first few weeks breastfeeding, this does not mean it’s normal. It’s actually a myth that breastfeeding has to hurt. Breastfeeding should be pain free and comfortable. A comfortable latch feels like gentle tugging and/or pulling. Nipple pain is an indicator that there’s an issue that needs to be addressed.
Breastfeeding, while a natural way to feed a baby, doesn’t always feel natural at first. It comes with a learning curve. It takes time for both you and your baby to get the hang of it. Think about it like driving a car or riding a bike. There was a time you didn’t know how to do this. Someone helped teach you and as you practiced and learned, you got the hang of it. Now, it’s second nature but it didn’t start out that way.
So why do some people experience pain?
As you’re working to practice the best latch, you might experience some nipple pain or tenderness along the way. Sometimes it’s a mild soreness or tenderness due to hormonal shifts. This usually fades with time provided there are no underlying issues. If you have any pain or discomfort whether mild or not, you should work with a lactation consultant.
The most common cause of pain I see, is from a shallow latch. When a baby latches to the breast they need to take in not only the nipple but some surrounding tissue as well. They use their tongue to draw it all the way to the back of their mouth, where their soft palate is. When the latch is shallow, the nipple is pressed against the hard palate which creates pain and can change the shape of your nipple immediately after a feeding. It may appear squished or compressed and be pointed or look similar to lipstick.
The shallow latch might be due to suboptimal positioning in which case it’s a quick fix. Sometimes the shallow latch is because your baby cannot get a deep latch. This is usually anatomical meaning their tongue mobility is impaired (although there are other causes). This requires an oral evaluation and feeding assessment. If you’re struggling to get a deep latch despite your best efforts, always work with a lactation consultant.
Another very common cause for early nipple pain is due to your breast pump. Specifically, the wrong size flange. This is why it’s important to have your flanges sized by a lactation consultant.
If your nipples do become cracked (which is common if you’re nursing a baby with a poor latch) you can take steps to support healing while you’re waiting to see a lactation consultant.
Should you buy a nipple cream?
If having a nipple cream makes you feel more confident about breastfeeding then please, use one. It’s important to use one that is food safe and therefore safe for your baby to ingest. Vaseline and petroleum jellies as well as mineral oil are petroleum bi-products and can irritate the skin and clog pores. Because of this, I strongly advise against these products.
Some nipple butters and creams also contain herbs and essential oils so it’s important to be mindful if you have very sensitive skin as this may cause a reaction. When too many creams or ointments are used on the nipples it can cause contact dermatitis for some. Contact dermatitis is itchy, red, inflamed skin on the breast, nipple and areola.
Your skin actually breathes and perspires through pores and this holds true for the sensitive skin of your areola and nipple. In addition, when something is placed on your skin, it’s rapidly absorbed into your skin. Another reason I don’t suggest petroleum bi-products.
What about lanolin?
Lanolin is another popular topical treatment. It is a thick ointment that comes from sheep raised for wool. Most parents I work with have already purchased this. Some parents have great success and for others, it does nothing to help with healing or pain.
There’s evidence that suggests lanolin is allergenic (can cause contact dermatitis) so it’s not my first choice for nipple care. The evidence also suggests it’s not that effective in healing damaged nipples.
Most nipple pain can be corrected by changing your baby’s latch and positioning. This does not mean all nipple pain can be corrected this way but this an important part of the puzzle. There are also those situations where the latch has been corrected but because of previous damage, your nipples are still very sore.
If at any point, the pain is too much or the damage is worsening, call a lactation consultant. You can pump or hand express to protect your supply and feed your baby with an alternative method such as cup feeding until you have your appointment.
What actually heals your nipples?
If you’re waiting to see a lactation consultant over nipple pain and need some relief in the meantime these are some of my favourites to use with clients.
Expressed breast milk. Human milk has properties that support wound healing. It protects against infection, it’s antiinflammatory and there’s evidence that demonstrates it works quickly. You can hand express a few drops directly onto your nipple and let it air dry as long as you don’t have deep open wounds. It won’t cause harm but healing a significant wound requires a different method (it shouldn’t be exposed) and a 1:1 assessment.
I also suggest the use of organic olive oil as it is antioxidant and antiinflammatory and it has some research to show it supports healing. It is also food safe so it’s ok to be left on your nipples. There’s no need to wipe it off before your baby feeds. Coconut oil has similar properties. There isn’t any clinical evidence that supports it use however, culturally, it’s used all over the world with similar results.
Another wonderful support for nipple healing is silver caps. Silverette caps are little caps to wear in between feedings over the nipple, in your bra. They are made of silver. Silver is naturally antimicrobial and there is research that demonstrates they can help heal damaged nipples. They are not meant to be used in conjunction with creams but rather, just worn on their own or with a little breastmilk.
TL;DR
- Breastfeeding may not feel natural at first
- Breastfeeding has a learning curve that everyone gets at their own pace
- Your baby should draw the nipple all the way to the back of their mouth to create a comfortable latch
- One of the most common reasons for nipple pain is a shallow latch
- ANY pain is worth investigation with a lactation consultant
- You don’t have to have different nipple creams and butters to successfully breastfeed but you can if it makes you feel confident
- Anything that you do put on the sensitive skin of your nipple and areola should be food safe and allow your skin to breathe
If this was helpful but you’re wanting more…
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References:
Campbell, S.H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core Curriculum for interdisciplinary lactation care. Jones & Bartlett Learning.
Newman, J. & Pitman, T. (2014). Dr. Jack Newman’s Guide to Breastfeeding. HarperCollins Publishers Ltd.