Why does breastfeeding hurt? What can help?

Breastfeeding your new baby can be one of the most amazing experiences of your life! 

But when it’s unpleasant, uncomfortable or down right painful it can feel anything but amazing.

If breastfeeding is painful for you, here are a few things to consider. Always seek support from an international board certified lactation consultant (IBCLC) if painful feeding is ongoing.

Rowena Gray IBCLC is the Parents You've Got This Lactation Expert. She teaches at the Parents You've Got This Baby Basics Masterclass which is proudly supported by Lacevo, Parents You've Got This favourite breast pump, and you can download the Breastfeeding Basics video here.

Tender nipples

Pregnancy hormones create enormous changes to your nipples and areola in preparation for breastfeeding.  You may have found your nipples were already quite tender by the end of pregnancy.  Breastfeeding hormones can create even worse nipple tenderness!  When your baby suckles you get a greater rush of hormones which can make the sensation feel stronger. This discomfort should settle within a few seconds after your baby latches.

When you let down (when your milk starts to flow) your hormones make your nipple go erect which can sometimes feel quite painful.  You can often feel this in the opposite nipple just before milk starts dripping!  

Nipple tenderness, in the absence of damage, will eventually settle down once your breastfeeding hormones regulate at around 6 weeks (hang in there mamas!).

Poor Positioning

It can take some time to find a feeding position that works best for you and your baby.  Encourage your baby to lift his chin to the breast by draping him down and across your body and aiming his hips towards your opposite hip. Angle your nipple to his top lip. Avoid ‘pushing’ his head into the breast as this makes him tuck his chin down. Using pillows across your lap also encourages a chin tuck position and a more hunched posture for mum.  If you have larger breasts, try rolling a hand towel under your breast for support.

Poor Latch

It can be normal to have discomfort or pain in the first 10 seconds after baby first latches due to hormonal surges.  Pain after 10-15 seconds is not normal and can be a sign that baby is not latched well.  A good latch means that the nipple is drawn right to the back of the baby's mouth and therefore no friction from baby’s mouth is possible.  If you’re experiencing pain, change of shape to your nipple or damage with feeds then your baby is rubbing his tongue on your nipple. This shouldn’t be happening and you should seek support from an IBCLC.

Damaged or Squashed Nipples

Nipple damage or shape change from feeding should not be considered a normal part of breastfeeding! Both are signs of a poor latch whether that be from awkward positioning or difficulty in baby achieving a good latch.  

Damaged nipples can be incredibly painful! Get help with adjusting positioning and latching, try gently rubbing some breast milk on your nipples after feeds to help with healing. 

Tongue Tie / Lip Tie

Tongue tie and lip tie are oral restrictions that can cause nipple pain, damage and shape change.  Positioning can help ease nipple discomfort but further support and a management plan from a skilled IBCLC are crucial to helping you to continue to breastfeed.

Baby Discomfort

Nipple pain can also be caused by an uncomfortable baby, pulling, tugging and fussing at the breast.  Consider your birth experience and whether he might have some tender areas around his head or neck?  Are you placing your hands or fingers in a place that makes it uncomfortable for him?  Or he may have some body tensions from the birth that make it difficult for him to be held in a particular position.  Ask your IBCLC for some support.

Vasospasm

Have you noticed your nipples blanching white for about 30-60 seconds at the same time you feel nipple pain? Then the colour comes back and the pain disappears?

This is vasospasm - when the blood supply to the nipples momentarily goes away and causes the muscles to spasm which causes pain.  This can happen at any time before, during or between feeds. For many women this is completely painless and they are often unaware of it but for some it can range from a mild discomfort to extreme pain.

Vasospasm will come and go randomly, can be in just one or both nipples or can swap sides! It is exacerbated by a poor latch and exposure to cold air.  It does not affect your baby in any way or interrupt their feeding but it can make feeding hard going for you.

Vasospasm usually goes away on its own over time.  Some tips to manage the discomfort are warmth to the nipple before and after a feed to encourage blood flow (a warm flannel is great), fish oil to help circulation and magnesium supplements to reduce spasm pain.

Nipple Thrush

Nipple thrush pain is an incessant itchiness and/or burning of the nipple that is felt all the time, not just whilst feeding. It’s actually not very common despite many GPs ‘diagnosing’ nipple pain as thrush.  If you have never had any type of thrush before, your nipple pain is unlikely to be from thrush.

Whilst general nipple tenderness and some discomfort or pain when baby first latches can be considered normal, all other nipple pain or discomforts should not be ignored. Seek help from an IBCLC who can sit with you, assess your baby’s mouth, watch and assess a full breastfeed and spend time working out what’s going on with you.

The information provided above is general in nature and is not intended to replace the advice from your healthcare professional. Please seek the advice of your healthcare professional for tailored information that is right for your circumstances.

Rowena Gray is a mother to 3 amazing daughters, nurse, midwife and International Board Certified Lactation Consultant (IBCLC) and has been both a consumer and giver of copious amounts of breastfeeding advice!  She is the author of ‘Born to Breastfeed - the first six weeks and beyond’ - available online (booktopia) and as an e-book through amazon.

Mother breastfeeding baby