breastfeeding - and sore nipples

[Pupuce]

I found breastfeeding very painful for the first 4 weeks and moderately painful for the following 2. I am sure that bad positioning was partly to blame but I think my son sucked really hard and I had sensitive breasts to start with. I did breastfeed him for 8 months.
I am now expecting number 2 and am wondering if any of you had a hard time the 2nd time around as well.... should I fear or prepare myself differently ?
Any advice most welcome.
Thanks

Breastfeeding is painful! When I was expecting my baby, I read in all the books that if it is painful then you are not positioning the baby right - wrong! My baby latched on well, the midwives said my positioning was fine, but it bloody well hurt until she was about 8 weeks old, when I sort of got used to the pain.

I tried everything! One midwife told me to get a sunlamp on my nipples to harden them, I don't know if it had much effect! Her theory was that the darker your skin, the less it hurts, women who had pale skin had a harder time breastfeeding. I did get some camomile lotion that seemed to soothe them afterwards. If I were to breastfeed again I would use nipple cream before I gave birth, to see if this would have any effect. I might just sunbathe topless too for a while - no harm in trying!

Never mind Pupuce - maybe 2nd time your breasts will adjust sooner. The pain is worth it really - isn't it?

You could contact an NCT breastfeeding counsellor who will help you with positioning. Sometimes they are able to spend more time with you than a midwife and get the positioning absolutely spot on. They also have lots of ideas for helping heal any damage to the nipples. You can contact them on 0870 444 8708, the service is free and you don't need to belong to NCT.

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Funnily enough, I didn't find breastfeeding at all painful but as my baby continued to lose weight, midwives and HV's persisted in telling me that it must be the position that was wrong!.

I am glad to hear that you all experienced the same pain (glad is probably the wrong word here!!!!) but yes I do think the positioning was correct (maybe not the first few days)...
You are also right that we don't get great support when we complain about the pain... I wanted to use breast shields (which I did for 1 or 2 feeds a day when most painful) - that was not recommended as it was supposed to be less efficient but my son alays fed extremly well, gained 10 oz a week,...
At the end of the day I am very glad I stuck with it but I now dread the second baby... and can't help wonder if I'll accept the pain as much... or maybe it won't be as painful.
By the way - does anyone know if baby girls suck as hard as baby boys... my first was a boy, this is supposed to be a girl...

Like all of you, I wish people wouldn't propagate this myth that if you're doing breastfeeding right, it doesn't hurt. I had a lot of unecessary worry that my positioning must be wrong because it hurt so much - and all it was was just that if you've got sensitive nipple skin and someone's hoovering away at them six hours a day, they're going to take a while to adjust. I eventually found that lanolin did the trick, although that's another thing that's frowned on these days. Pupuce, take heart: by baby number two my nipples had toughened up and it didn't hurt at all.

Well said Lisa! I'm glad that I wasn't the only one, I totally agree with what everyone's said. Do you think that they don't tell you in case it puts people off before they've even started? I for one think that if the health professionals could just let you know that, yeah, it's bad for a few weeks but then everything will be fine and you will actually start to ENJOY feeding your baby. My friend definitely gave up very early for the reason that she "couldn't get the positioning right" - which was rubbish but what she had been told by the midwife- subsequently not even trying to b/feed baby no. 2. This has to be addressed as everyone has these daydreams during pregnancy of proudly breastfeeding your new born (least I did!) but never did I see the gritted teeth and watery eyes on my face as I did it! It's about time these myths were exposed in every maternity manual ever handed out. If I hadn't had my Mum telling me that things would get better, honestly, I may well have got out the bottle and would have known no different. Which would have been a real shame as I enjoyed all my 12 months of b/feeding EXCEPT for those first 6 weeks!

PS Bloss, a lady I know who b/fed her 1st child until a couple of months into the pregnancy of her 2nd said that it was much easier for the second because her skin was still toughened up already - just a word of hope for you!

I found that the answer was breast shields. They are very thin silicone ones (from Boots or Mothercare)which are totally flexible and don't get in the way at all. My midwife recommended them as she had used them herself although she told me that I'd get mixed reactions from professionals. I had extremely sore and cracked bleeding nipples initially - and it is very disconcerting if not downright alarming to see your newborn baby regurgitating blood.
I was able to stop using them within about 5 days as the soreness went completely

I am a breastfeeding counsellor with NCT.

I think there is a lot we don't yet know about sore nipples and what would prevent/cure them....but we are still learning ('we' meaning 'the world'!).

We do know they can be horrendously painful, enough to cause weeping and dread. That's my personal experience, and that of many women who have contacted me, too. Sore nipples are utterly miserable : ((((

In the majority of cases, sore/cracked nipples are a result of the baby's suckling ending up grazing/breaking the skin with the tongue or with the hard palate.

Now, mostly, this can be improved by amendment to the postioning and attachment.

Any bfc who has been at the job for some time will tell you she has heard from tons of mothers who have been told 'your positioning is fine'...and yet when the bfc observes, she sees things that can be improved.

A skilled bfc will manage to explain to the mother how to feed so it doesn't hurt, and I have to say, the majority of women I see with sore nipples manage to feed without pain, after changing the way they do things.

Sometimes the positioning and attachment gets better as the baby grows and opens his mouth wider.

However, I have known mothers who are unable to achieve pain-free feeding (though the worst agonies can almost always be improved). Maybe these babies have an unusually shaped palate, or a tongue that's tied, or something else that makes feeding a challenge. As I say, we're still learning.

Nipple shields can sometimes help individual women, but they can lead to their own problems as well. Anyone who uses them needs to know this, and plan to work on getting rid of them soon, in case they are among the proportion for whom they cause problems. In the main, nipple shields do not help the baby learn to latch better - though it is possible to latch with a nipple shield, if the shield fits (and often it doesn't).

I am not a member of any breastfeeding mafia, and I certainly don't pretend breastfeeding never hurts! If breastfeeding was always pain-free, the number of calls NCT bfcs get would probably halve. There are many reasons why babies and mothers may not achieve pain-free feeding to start with, but all I can say is, that in my experience, soreness can almost always be at least helped and often cured.

BTW, dry healing is no longer thought to be helpful. You wouldn't let chapped lips dry out would you? Same with cracked nipples - moist healing is the way to go, based on what we know from dematology, where moist wound healing is the usual treatment of all forms of wound.

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Pupuce,
Sorry to have to say that I found number 2 just as painful as no. 1, and that no. 2 being a girl seemed to make no difference. HOWEVER, with no. 2 I knew that it would get better eventually and be worth it in the end, so I coped far better with the pain and was more confident about experimenting with different strategies to help alleviate it.
On the latching correctly front, I had a lot of advice from counsellors when I started feeding my son. All agreed that he was latching on correctly, so that wasn't the problem. In the end I decided that it was just that my skin was very sensitive (I'm a redhead with very fair skin) and I had to grin and bear it as best I could. As I said above, it was much easier with my daughter because I knew that if I stuck with it it would eventually get easier.

Tiktok - is it true then that it is more painful for fair-skinned women? I'd like to hear from some coloured women to see if it hurt them just as much.

I too had loads of people looking at the way I was positioning my baby, they all said she was extremely good at latching, and when I complained that it did hurt a lot, they just shrugged and told me it would get better after feeding is established, which was more or less right. However all the books I read do say that if it hurts, your baby is not positioned properly - I think that is such a lie! Do they want to make new mothers more paranoid than they already are? I would suggest throwing away those books and listening to people who have been through it.

Luckily my nipples only bled once, so I didn't have much of a problem with dry or cracked nipples, though I did use cream anyway. It was just such a horrible pain when she latched on, it got a bit better after about 5 mins. But have you felt babies gums? I didn't realise they would be so hard, or the sucking so powerful, no wonder it hurts!

It's not true that fair-skinned women are more prone to sore nipples. The worst sore nipples I have seen this year belonged to a black mum from West Africa, and I have counselled many women of all ethnic groups with sore nipples over the years. The skin on the nipple is very friable - it's part of it being multi-layered and sensitive. One or two days is enough to break it.

Bloss: I can understand why it is frustrating as well as painful to be told you must be doing something wrong, but what that is remains unknown - but you said yourself they didn't say it was your fault! I hope it's part of what I bring to counselling to recognise that mothers do blame themselves and feel bad and guilty, and to help them realise they can let themselves off the hook!

Maybe some professionals and some volunteers too find it hard to say 'I don't know what it is that's wrong, sorry'. I do say it, and if anything I don't blame the mother but my own lack of knowledge - I mean, I don't feel personal about this, but rather I accept the fact that we really don't know enough yet about how to fix painful breastfeeding in every case. I suspect it is positioning, but that some babies and some mothers need different sorts of positioning. Logically, it's positioning - look at what happens to the nipples which continue to be sore without treatment, to back this up. The skin reddens, the skin cracks, the skin peels, bleeds, gets grazed, the nipple may look white, squashed, gets a blood blister on it, gets pettechiae (tiny little blood spots)....this is evidence of trauma, just as it would be on any other area of the skin.

Skin which does not appear sore is more of a puzzle, but often you can see hairline cracks or a weeping fold in the skin when you look at the nipple closely.

Sometimes, soreness is due to thrush (though there may be a history of difficulty with latch as well) and this is often missed - both mother and baby need treating,whether or not the baby has symptoms. The mother might not have any symptoms on her nipples either.

What makes me cross is that sometimes women are told that pain is normal and they should just put up with it.

It isn't normal. It isn't inevitable. But we can't always put it right (though with the right skills, we almost always can).

A practical thing which helped me was to use a breastshield (available from Boots in packs of 2) they are clear plastic covers for the tip of the breast with a preformed nipple with holes in. They look weird but babies love them as they give a big nipple to hold on to and the plus side is that feeding doesnt hurt at all as they are clamping on the teat of the breashield rather than your nipple (and the sucking action sucks the milk out through the holes.

Hope you find this useful.

Barca - those are usually known as nipple shields and they are the things with the drawbacks I outlined in my previous post. Glad they helped you though - but other mothers have different experiences, and they should carry something like a health warning, I think!

As a redhead with pale skin, I had cracked/bleeding nipples with both my children, to the extent that I used to cringe every time they needed a feed. It did get better after about 3 weeks with the first, and about 10 days with the second, although I still have scars (literally). What helped me was a completely different position. I fed my first child for the first few weeks by holding her under my arm. This was suggested by the bf counsellor at hospital, without whom I would have given up after the first 3 days. I think it just changed position enough to allow my nipples time to heal and toughen up. I also used breast shields for a while. the other top tip was to rub breast milk around the nipple area, esp the sore bits, after a feed. Not sure why this worked, but it did.

After 6 weeks of pain, I gave up breastfeeding my daughter. I was so sore, had huge amounts of milk, dermatitis on my breasts, I am fair and my skin has always been sensitive. I was beginning to dread my daughter waking for a feed, and realised that help was needed, like some others who have written, I though the pain was normal and it would get better. The NCT councillor who visited me was helpful, but nothing she suggested eased the pain, and looking back I was a bit depressed after the birth, I had a difficult pregnancy with sickness and shingles, as an older mother, my life had been work and control, and as a new mother I worried too much about so many things,(hindsight again!) I still feel sad I chose not to continue to breastfeed, and I did not try to breast feed my son when he arrived (16 months after my daughter), and though I did not feed him it took fully 5 weeks before my milk went away. I felt to be the best mother I could be to both my children, bottlefeeding was the best option - as I write I still feel a little guilt for not trying, but child and mother must both enjoy breastfeeding for it to work, and I would make the same decision again.

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I agree with Bloss.
Yes I had sore nipples initially so maybe that's due to some positioning but when they healed I still had pain for another 4 weeks... and my nipples were fine !

I found breastfeeding very painful for about a week or so when my son was about 2-3wks. Im gald I had determination because at 9 months we are both still enjoying it and I hardly know he is feeding, dont think it is going to be easy to wean at around 12 months. I can fully understand how some mums can not go on though, you dont know the pain is going to stop as a first time mum. Our position was checked lots of times and always ok.

I was in agony from breast-feeding my son after 4 days. My nipples were cracked and bleeding. I had help from our local NCT breast feeding counsellor and she was really lovely. She was warm, kind and sympathetic and she came over on a Friday evening when I was really at my wits end. However, I was in such a sorry state - had a really grim birth that I just couldn't cope with the pain or the ferocious screaming of my son as I tried to latch him on in the correct position. I gave up and expressed milk for 3 months. I am really hoping that next time around I won't have such a grim birth and may be better able to cope with breastfeeding as it is something I would like to do.
However, I do think that midwives and health visitors should encourage more women to think about the possibilities of expressing as it really can work.

I too found breast feeding painful for the first week or two, despite son no 1 and later son no 2 latching on 'correctly' according to the HV. Well I suppose if you buy a pair of well-fitting sandles and wear them 'correctly' they can still give you blisters until your skin hardens up. What's so different about nipple skin?

Anyway, what offered some real relief each time was a camomile-based ointment called Kamillosan.

Being 'natural' Kamillosan apparently won't harm your sucking baby. A friend recommended it to me. It really is good- and it didn't appear to affect either of my babies in any way. It didn't make the pain go away completely, but it is very soothing and helps cracked nipples to heal.

However what puzzled me was that nurses and HV's told me that they were not allowed to recommend it. If I remember correctly, they said that they were on principal against any concoction on the nipple because of the risk to the baby.

You can buy Kamillosan at most chemists, and if it helps you to continue breast feeding, it can't be a bad thing, can it?

I totally agree with what Bloss has said, and there are lots of you in agreement. Breastfeeding does hurt a lot of women, and it's not all down to positioning.

I have just got back from a coffee group with the NCT and spoke to another mother there who completely agreed, she was sick of well-meaning breast counsellors, HV's and midwives telling her that it must be her positioning, she tried every which way but it made no difference. Her nipples were fine too.

I think it's a combination of the let-down reflex and sensitive skin. A lot of you are saying you had sensitive skin anyway, and I guess fair-skinned women are more prone to that.

If these "officials" keep on telling women that their positioning or latching is wrong, more women are going to stop breastfeeding. Ok, maybe different positioning does help, but for the rest of us, it is going to hurt until the skin toughens up a bit, what is so wrong with that? If I had been told that, I would not have spent half my time worrying and feeling inadequate, hell, I might even have enjoyed feeding a bit more!

I didn't say that soreness is always due to positioning and I have just re-read my posts to make sure I didn't!

When there is trauma to the nipple - cracks, sores, blisters, etc - it makes sense to assume that the skin has been grazed or broken by something rubbing against it. Ruling out jogger's nipple in the immediate post-partum woman ; ) the only thing rubbing against the nipple is the baby's tongue and palate.

Now, as we're all different, it could well be that some people have more friable skin than others. Some babies may have a shorter tongue, or be tongue tied, or have a different sort/shape of palate. These variables may make pain-free breastfeeding more of a challenge to some individual mother-baby pairs.

Because we can't see what is going on in a baby's mouth, we are making assumptions that there is some friction going on inside when trauma results, but I don't see why it's controversial or confrontational or annoying to say that if we see a damaged nipple then it's very likely to be the positioning and attachment that's caused it. Unless someone else comes up with some other reason I haven't thought of.

Painful breastfeeding without visible damage to the nipple could be thrush, in the absence of some clear problem with the latch. The sort of tenderness people describe that gets better over time is, I think, the stretching of the skin and the nipple getting used to the new sensation. But tenderness does not come near to describing the agonies some women have with sore nipples, and I don't go along with Bloss's idea that we should just say some people feel pain while everything gets toughened up - and leave these poor women to the pain! The sandals that give you blisters is also a poor anaology. Blisters come about because the skin is being rubbed. A baby who is 'on' right does not rub the nipple skin. The milk does not come out as a result of friction.

Cracked nipples - like you had, Bloss - do sometimes continue to hurt after the cracks have healed. This is one of the reasons why cracks are such a must to avoid - you get 'afterpains' with them. I think it may be that just like scar tissue anywhere else, the skin becomes less elastic and feeding hurts as a result.

Sometimes, I suspect there may be some underlying infection that takes time to heal, too. Cracks allow skin infections to take hold.

Kamillosan is fine for sore nipples, and safe for the baby, but dermatological research points to moist wound healing as helpful - kamillosan is absorbed very quickly, and there could be other, better products which trap moisture in the skin more effectively. Trouble is, there is a dearth of research on all of this, and we are still learning.

Lisa mentions the let down reflex as having a role to play in painful feeding. Some women (a very, very few) do feel the let down as painful, but I can't see why it would cause sore nipples.

Painful feeding which affects the breasts with shooting pains is more likely to be thrush in the breastmilk ducts.

If someone is finding feeding painful, but the nipples are fine, then it could be mastitis or thrush.

(Both these things can be linked with positioning as well - sorry! But they need treatment other than just attention to positioning.)

I said it before, there is lots we don't know about how to ensure pain free feeding.