Breastfeeding Pain Problems

We encourage you to get help right away if:

1. Your pain is getting worse and/or not better
2. You can see visible damage, bleeding, scabbing, blanching, and redness

Types of breastfeeding pain:

If you develop a fever or flu-like symptoms, please get in touch with your health care provider RIGHT AWAY!

The most common types of nipple and breast pain are due to a poor latch, a physical or functional issue with the baby, breast tissue inflammation from engorgement, plugged ducts, or mastitis, and vasospasms. We will go through each type.

Poor latch:

Poor latching and positioning are the cause of most nipple pain!  Many families have been told they have a “great latch,” but they are still in pain. Here are what I consider the elements of a good latch: no pain and good breastmilk transfer. That’s it! If you are in pain and/or the baby’s not getting enough breastmilk, I am dubious that you have a good latch! What can you do? Get comfortable yourself. Make sure your body is well supported. We suggest laid back breastfeeding or making sure the baby is well supported, whole body against mom’s body, getting the baby’s chin off of the baby’s chest, and having both cheeks touching equally.

Physical issue with the baby:

Babies are born to breastfeed, but they can also have some physical issues that can make breastfeeding painful. Here are some physical things that could be going on:

1. The birth- Too long, too short, c-section, head being tilted funny, vacuum extraction, on and on. Being born is hard on the mother and the baby, but boy, is it hard on that baby’s head! This can cause pain for the baby when they try to latch, so they often don’t.
2. The baby could be tongue-tied. Google it.
3. The baby was born preterm, lacks fat in their cheeks, or has another physical issue.
4. Baby has had too many fast-flow bottles and is impatient.

Almost all of the above can be resolved with some expert assessment and help!

Engorgement:

There are two types of engorgement: one that occurs immediately postpartum and one that occurs when the baby is older. When a baby is a week or less old, much of the engorgement, or “when your milk comes in,” is actually not breastmilk that is making your breast hard, heavy, burning, or painful. Much of the swelling is increased blood flow and edema – extra water retained in the body. This can be exacerbated by having IV Fluids during labor and delivery. Some things that can help with early engorgement:

1. Consider breast and lymph node drainage and massage. Lie on your back. Start at the areola and gently stroke down through the armpit, up toward the elbow. Use a gentle, rake-like motion with your fingertips from your areola down to your chest wall. Gently stroke outward from your breastbone to your shoulders.
2. Apply cold packs to the breasts often throughout the day. This will reduce swelling.
3. Eat watermelon, cucumber, and/or celery in the next few days to help flush out extra fluids and edema from your body
4. Consider Ibuprofen for swelling. Ask your doctor about this!
5. Consider cold, green cabbage leaves for hot, swollen breasts unless you are allergic to Sulfa drugs. We encourage you to peel off several outer leaves and rinse them with water before using them.
6. Consider Reverse Pressure Softening if breasts are too hard for baby to latch http://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/

If the baby is older than one week, engorgement is usually due to poor breastmilk removal. The solution?  Breastfeed, hand express, or pump more often!

Remember: This is a temporary condition! However, the pressure in the breast has to be relieved, or the body will interpret it as a signal to shut down milk production.

Breast tissue inflammation:

“Plugged ducts” usually result from an area of inflammation that compresses the ducts, so milk can’t flow well. Here are some ideas that mothers have found helpful if you feel you have a plugged duct:

1. Please get in touch with your health care provider right away if you feel as if your flu-like symptoms, fever, body aches, extreme fatigue, returns and/or bright redness in the sore area appear.
2. Consider resting, eating, and drinking
3. Consider applying cold to the affected area, especially for 10-15 minutes before nursing/pumping.
4. Consider Ibuprofen
5. Remove milk often from your affected side. If you are nursing, nurse on that side first.
6. Try different nursing positions.
7. Try some lymphatic drainage. Lie flat on your back and stroke from your nipple to the outer edges of your breasts. Think about stroking from the nipple down through your armpit to your elbow. This can help remove extra fluid from your breasts.
8. Example of massage- Scroll down to the bottom for video http://pmr.med.umich.edu/bfsp
9. Consider an ultrasonic treatment.

Mastitis – inflammation of a larger area of the breast or both breasts:

This could lead to a bacterial infection. Use the above ideas to reduce inflammation, and please get in touch with your health care provider right away if you feel as if your flu-like symptoms, fever, body aches, extreme fatigue, or bright redness in the sore area return.

Vasospasms:

Many mothers can have vasospasms, and they are often incorrectly diagnosed as “thrush”, which is a yeast infection. Most mothers and health care providers are not familiar with vasospasms. A good rule of thumb is if you are having nipples that turn white after feeds, burning nipples and/or shooting pains in your breasts between feeds, if you are sensitive to cold in your hands and feet, and warmth makes your nipples and breasts feel better, you may be suffering from vasospasms.  Here is some more information and ideas for a resolution for this problem:

1. http://kellymom.com/bf/concerns/mother/nipple-blanching/

Consider:

1. Avoiding cold, caffeine, alcohol, and nicotine
2. Consider Ibuprofen
3. Wool nursing or fleece pads
4. Covering your nipples and breasts immediately after taking the baby off
5. Dry warmth on breasts right after feeding and between feeds.
6. B-6 and magnesium
7. L-arginine 500mg 3 x per day usually resolves pain within 24 -48 hours.

Yeast infections/Thrush:

More and more research shows that nipple thrush, or Candida albicans overgrowth, is actually very, very rare!

I may get a lot of hate mail for this, but in all the years I have been practicing, I feel I have seen only a few cases of mothers having a yeast overgrowth. Remember, we all have yeast all the time. It is a matter of whether the yeast is growing at a healthy level. The other thing that drives me crazy about yeast is that IF you do have a yeast overgrowth, it should be easy to get under control. If you have a vaginal yeast infection, what do you do? Use some topical or oral medication, and it goes away. Do you need to boil your underwear? Do you usually pass it back and forth to your partner? I have been thinking about this a lot, and it seems to me that if your yeast levels are in balance, how can someone else make them go out of balance? When they research mothers with confirmed yeast overgrowth (Yes, they use science!), they all clear up with one course of Diflucan. Science! If you are being treated repeatedly for a yeast infection and it is not clearing up, I will ask you to consider whether it could be something else. Food for thought!

If you are a person who suffers from a diagnosed, chronic, yeast overgrowth problem, here are some ideas that may help:

1. Consider taking a probiotic. Ask which ones have live cultures that need to be refrigerated.
2. Consider taking Grapefruit seed extract. 250 mg three times per day is a suggested dose.
3. Consider reducing sugar and dairy product intake
4. Consider adding Garlic, Zinc, and B vitamins to your diet
5. Consider being tested for diabetes and anemia- These conditions can make you more susceptible to yeast overgrowth. 

If you work with breast/chestfeeding families and are passionate about lactation support, or you want to turn your passion for nursing into professional practice, check out LactaLearning.com and consider following us on social media!

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