Painful breast feeding - what am I doing wrong?

[Booboostoo]

DD is 21 days old and is my first baby. In many ways bf is working well, she is putting on a lot of weight (doc said she should put on 140-160grams a week, she is putting on 200-230grams a week), she latches on easily and stays on the nipple for 10-40 minutes at a time, she feeds every 1 to 4 hours.

However, bf is painful. I am in pain during bf, as if someone is holding on to my nipples with knives, both nipples can be painful but not every time. Sometimes they don't hurt at all, sometimes they hurt at the start and then settle down, sometimes they hurt through out the session. Midwife has suggested it's normal until my nipples harden and gave me lanolin cream and then friend suggested pure alcohol - neither is helping. I was told to put up with it for 30-40 days and then things should get better.

I have read the bf advice on here and on other sites and I am beginning to think that's the wrong advice. I have tried to get her to latch on differently (take more of the nipple in) but her lower lip in particular seems to not want to take in the whole of the areola. My nipples are very elongated after bf.

Could this be tongue-tie or something else? No one checked DD for this and the midwife has not mentioned it at all (we are in Greece, but midwife trained in the UK, we are about to move back to France so will look for new midwife/lactation specialist there).

I think 3-4 weeks is how long it was painful for me - and we had a very good, easy breastfeeding relationship with no latch issues or tongue-tie. It was just an adjustment thing. I remember a friend saying that the first month, she felt like she had to bite down on a stick for the first couple of minutes of every feed.

I would keep on with the lanolin cream if you feel like you can cope with it for a bit longer - it sounds like the rest of the feeding relationship is going absolutely brilliantly.

Thanks for the support. I can definitely live with it if it's part of bf and will eventually pass.

I felt more able to put up with the pain when I thought it was normal and would eventually pass. I do want to bf so it seemed worth it. But now I feel I am doing it wrong if it's hurting and it's making me feel more desperate about the whole thing!

I tried to get her to re-latch, re-started her about 10 last night during one feed, but with no improvement to the pain (if anything it was worse) and in the end she gave up feeding.

I am in no way qualified to advise about Breastfeeding, but I alsonhad a fair amount of pain and discomfort for the first few weeks. I remember a marked improvement eith the pain at about 8 weeks, then the feeds became much shorter at about 12 weeks, so things improved again.

I am now still BF my 8mo twins (alongside food, obviously!) and I cam honestly say there is no pain and hasn't been for months and months and months. I fall asleep while feeding lying down now!

If it is unbearable, then I would consider changing to formula. In my view, it isn't worth making yourself miserable over. However, if you can make it through each feed at this stage, you really might find it all clicks into place between 6 and 8 weeks in. Then the rewards start - instant food and comfort for you baby at no cost to yourself (in effort, pain or money), no planning how many bottles when you're going out, no plastic kit in your kitchen ... oh and so cool health benefits too

Good luck! Please don't make yourself miserable about this, but it is worth the effort if the discomfort is bearable

Thanks HappyAsASanboy. No, it's not unbearable, especially if I know it will probably stop!! Bottle feeding has its own problems so I'll stick with bf for as long as possible!

Boo - it's normal to have elongated nipples post feed (the nipple/breast tissue needs to reach the juncture of the hard/soft palate so pretty far back in the mouth).

Alcohol won't make your nipples tougher but might make them sorer and more prone to cracking.

There are some good tips here on how to make bfing more comfy here

Many thanks TruthSweet, I shall read up some more and persevere!

Can I just go back to the elongated nipples? As Truthsweet says, it's normal - but they should still be rounded when they come out. If they're lipstick shaped it shows there's a latch problem.

Gosh, don't put alcohol on! That would really dry out the skin and make them prone to cracks which is nasty. Not ideal for your babe, either.

Does she do a nice wide gape before latching?

Organic - Yes, I missed that bit off Elongation is fine, lipstick/ridges are not. Must preview before posting....

For me it hurt for the first few weeks. I needed to practice getting him on with a nice big gulp and basically I think he needed to grow a bigger mouth! If it hurts take them off and try again as you may damage your nipples with a bad latch, which will take time to heal. Breastmilk is also a good thing to rub on sore nipples.

Having somewhere to go really helped me get through those early weeks. La Leche has meetings in Greece, maybe you can get to one or phone for more advice or shoulder to cry on - see here. Also in France here.

If she is tongue tied (posterior ones are often missed), putting on weight well doesn't exclude that possibility - my daughter put on plenty, but it was agony for me! But she took a lot longer to feed than your daughter, so it may just be her still learning to latch properly?

Sorry to be dim but what is the difference between elongated and lipstick shaped? Is lipstick shaped more tapered at the end? If so, I think they are elongated but not lipstick shaped but it's difficult to tell!

I tried moving her lower jaw, but it's immovable, she is firmly attached!!!

The alcohol is pure alcohol which is used for disinfecting everywhere in Greece and evaporates in seconds, not drinking alcohol, I'm not getting her drunk! It was recommended by the hospital, midwife, doc and friends. If I was to guess I would say it is helping a bit but it's difficult to say what it would have been without it.

My nipples are not sore themselves, they have no cracks, blood, etc., just the feeding bit is bad, they are perfectly fine before and after - is that any kind of clue as to what is going on?

I had a look at her mouth, her tongue looks normal shaped and not heart shaped, I can see that it is tied to the lower jaw but very far back (as far as I can tell), not anywhere near the front so I don't really know.

Lipstick shaped means the nipple has been squished flat. So if you looked at your nipple in the mirror, it would be more of a line shape (like looking at the end of a lipstick). It should be round after a feed however long the nipple has become away from your chest.

Alcohol will be drying to the skin so may cause other issues.

Dr Sears (askdrsears.com) has advice on the lower lip flip. Basically you stroke down their chain when latched on to flip the lower lip out and encourage them to get more nipple in their mouth. You're not trying to forceably move the jaw, just the soft tissue.

Have you had antibiotics and do you get pain between feeds? If so, consider thrush. It's excruciating.

DD and I both had thrush which was the most painful thing ever. We both had to be treated, me with gel on nipples after each feed and her with stuff in her mouth.

My GP was convinced it was mastitis and prescribed antibiotics. Thrush is aggravated by antibiotics so it got worse before it got better. It was my HV who correctly prescribed thrush and I ended up having to demand the rigth treatment from GP.

Do you have any yellow/white spots on your nipples?

Sorry, she didn't prescribe thrush, she diagnosed it

I don't think it's thrush, no pain between feeds, no discharge.

From what you say maybe the nipples are more lipstick shaped. She does open her mouth well but I think she then re-arranges the nipple herself and has a 'shallower' grip.

I think it may be a latching issue. I have an appointment with the paediatrician for Monday and I will ask her for the contact details of the lactation specialist.

UPDATE: I saw the lactation consultant, she thinks it's a latching issue as well. There is no evidene of tongue-tie, my nipples are not cracked, no evidence of thrush, but her bottom lip is not openning up and taking in the whole nipple as it should which causes the pain.

We tried:

• positioning her mouth correctly. I can do this but within seconds she repositions herself further out.
• stopping and restarting either results in tears or sleep, but in both cases no further feeding.
• trying to reposition the bottom lip while she is feeding doesn't work, the soft tissue can be repositioned, but her gums inside are still gripping the nipple wrongly
• all sorts of different positions, no difference.
• tilting her head back, no difference.

I am resigning myself to the pain until I can't take it anymore as I think we've tried all the obvious things, but just one last attempt...can anyone think of anything else?

Google "biological nurturing" and "breastcrawl". Babies sometimes get a far better latch naturally if they get to do the positioning themselves. And you'll be amazed at her instinctive behaviour.

Oh and re "nipple hardening" - Oh my gosh! I've been feeding for 4 years and my nipples are the softest, squidgiest part of me. If the nipple is getting to the back of her mouth then it won't get traumatised by the hard palate and will have no reason to be anything other than delicate.

Also, could it be your let down that is contributing to pain? It can be quite fierce in the early days but does settle down.

Can I hijack the thread slightly? Still in our first week and my nipples are coming out lipstick shaped (and very sore) despite me trying all the breastfeeding advice the midwives gave me.

Anyone?

@verylittlecarrot: thanks will google that. My nipples are very soft but friends have reported being in pain until their nipples hardened - I don't think that's my problem though. No the let down is a completely different thing, a bit tight and annoying but not painful.

@KeepOnSwimming: have you considered the things raised in this thread: the correct latch, tongue-tie, thrush, etc.?

Hi Booboostoo, how are things going, are you going to see the LC again? I hope things are improving for you.

Re the advice to use alcohol, I just wanted to add that glands on the surface of the areola naturally produce oils which lubricate the nipple and surrounding area to help prevent soreness and bacteria growth. My advice would be to ditch the alcohol as it will strip these natural oils from the nipple and is therefore more likely to actually compound the soreness problem, if not be one of the causes of it.

All the business about 'toughing up' the nips, buffing, alcohol, surgical spirit etc is what my mums generation were all told to do, but it's not the current advice. Didn't stop my mum extoling the virtues of these practices to me when I was preg though, best to nod smile and ignore imo!

I have also heard of bf mums who say squeezing a small amount of milk out onto the nipple and letting it air dry helps with soreness. For me it was Lansinoh, lansinoh nipple cream saved my life :)

Keeponswimming I'd definatly get along to a support group and see a Brest Feeding Councelor. Some midwifes are fantastic and know their stuff re BF. But sadly many don't (same goes for HV's too) and are reluctant to admit it or indeed do not even realise that what they think they do know is untrue. I've come across plenty of mums who've been told the latch looks good when infact it is anything but.
Getting along to a group will give you face to face support from a qualified bfc who can help you get the latch sorted out. If you can't get along to a group you could call the national helpline. Also there are some really great ladies on here who can help.

Booboostoo, my DD and I don't have a great latch.
It was tongue tie to start with but after it was snipped she could not relearn it so feeds were still a bit painful and took a long time.
She too would not do the correct thing with her bottom lip, she tucks it in and up and doesn't open wide when latching on.
Tried all the different positions, tried biological nursing, got help ect ect.
She would also readjust the latch if we got it right for once, to put it back to how she liked it.
Basically DD and I had to work out our own way to bf.
I would take her off and try again but like you, she didn't like it and in fact the latch would get worse.
I try and catch the bottom lip against the boob as I put her on.
I really shove her chin in, then catch lip and then tip her head over the top to get nip in her mouth. Hope that makes sense.
I'm not saying this is the right way to go about things but it got us through and we are still feeding at 4 plus months.
She is gaining ok (but is naturally a long and lean baby), plenty of wet nappies, very alert, sleeping well and doing all the right things at the right times developmentally.

Thanks ladies, have asked my OH to take me along to our local BF support group this week - I am sooooo tired I'm sure I'm not fit to drive!

Booboostoo - sorry to hijack, and I hope yours gets sorted...
re "We tried:

• positioning her mouth correctly. I can do this but within seconds she repositions herself further out.
• stopping and restarting either results in tears or sleep, but in both cases no further feeding.
• trying to reposition the bottom lip while she is feeding doesn't work, the soft tissue can be repositioned, but her gums inside are still gripping the nipple wrongly
• all sorts of different positions, no difference.
• tilting her head back, no difference."

• I'm in exactly the same position! If I do get her positioned well she readjusts herself, and it all ends in tears... I think my nipples are just too big for little mouth to take at the moment - she just can't open wide enough... Good luck to you!

I had this repositioning thing too and DDs gape was quite small. I also had cracked and bleeding nipples so knew things weren't right.

However, at 7wo now she has naturally been opening her mouth wider so getting a better latch more readily. This is alongside me trying out various poitioning techniques read about on here which also helped!

She also only started poking her tongue out at about 4 weeks so I was worried about TT for a bit but she seemed to just need to grow a little.

I'm all healed now and things are MUCH easier. She still does have a habit at times of pulling herself backwards and 'up' the nipple whilst keeping clamped down and sucking and Owweee that can hurt!