Breastfeeding is not supposed to hurt. Poor positioning and latch-on is the most common cause of nipple soreness in the early weeks of nursing. Sometimes only a minor adjustment of positioning and latch-on is all that is needed. However, if after 48 hours of conscientious attention to this area, your nipples are no better or worse, or if you are past the newborn period and you suddenly develop sore nipples after a period of pain-free nursing, you should contact a lactation consultant or La Leche League leader for one-on-one support in determining the cause of your soreness.
In the meantime certain measures will make nursing more comfortable for you as your nipples heal:
• Nurse frequently – at least every 2 hours. This will ensure that your baby does not become too hungry between feedings causing him to nurse ravenously and aggressively at your breast.
• Hand express or pump a few minutes before the feeding. This will elicit letdown and elongate the nipple for the baby so that he does not nurse so aggressively.
• Nurse on the least sore side first as this is the side that your baby will nurse more aggressively on.
• You may want to take a mild pain reliever such as Tylenol or Advil about 30 minutes prior to nursing or around the clock until your discomfort lessens or disappears. Both of these drugs are compatible with breastfeeding.
• Open both sides of your bra during the feeding.
• Consider applying warm, wet tea bags to your nipples for a short time after nursing. Many moms report that this can be very soothing.
• Warm, moist compresses (wet washcloth works well) often bring relief to nipples both before and after nursing.
• After feeding, pat dry your nipples and express some breastmilk to rub into them (this should be avoided if you have thrush as it thrives in milk). Breastmilk has Vitamin E in it which is very healing to the skin. Note: Avoid applying Vitamin E oil from a capsule to your nipples as this can be toxic to your baby!
• You also may want to apply a 100% USP modified lanolin preparation, such as Lansinoh, to your nipples after nursing. Apply enough to thoroughly coat the entire nipple/areola area. This does not need to be washed off prior to nursing as it is safe for baby to ingest. Recent studies seem to indicate that using 100% lanolin may hasten the healing process by maintaining the internal moisture of the skin. Avoid other creams and ointments sold for the treatment of sore nipples as these may actually impede healing by preventing air circulation and drying out the skin. Some of these other preparations may also be toxic to your baby and will need to washed off prior to nursing. Over-washing of the nipple area results in a loss of the natural lubricants that protect it and provide it with antibacterial properties.
• Some moms find a hydrogel pad soothing and healing to nipple trauma.
• Change your nursing pads immediately once they become even slightly damp. Moisture up against your nipples can prolong healing. If your pad sticks to your nipple moisten it with water before attempting to remove it. Also avoid nursing pads with plastic linings. They prevent the flow of air which is essential to healthy nipples. Stick with 100% cotton pads or pads made of plain paper
• If your nipples become so sore that you cannot tolerate the pressure of your bra or clothing on them and it is painful for you to hold your baby, you might want to consider wearing breast shells inside your bra to protect your nipples as they heal.
• If you find it impossible to nurse your baby due to nipple soreness, you may opt to feed him with an alternative feeding device such as an eye dropper, medicine dropper, feeding syringe, soft, flexible medicine cup, spoon, or nursing supplementer, attached to your finger, while your nipples heal. Bottles are best avoided due to the risk of nipple confusion, especially if your baby is less than 4 weeks old. If a faulty latch-on is the cause of your nipple soreness, introducing a bottle may result in an even poorer latch-on as your baby will then try to latch on to your breast tissue as he does the bottle nipple.
Contact a La Leche League leader or lactation consultant for assistance in using one of these devices. If only one nipple is very sore, you may decide to feed your baby from the well side only while pumping the other side. The baby can get all that he needs from one side as long as you allow him to nurse frequently. You will want to pump the other side as often as your baby nurses for 10-15 minutes each time. If taking the baby off both breasts and instead pumping for a few days is necessary, it’s preferable to use a hospital-grade double, electric pump which will maintain your supply more efficiently till your baby is back to nursing.