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

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Yeah, I hope I don't sound too strong either Tiktok, it's just one of those subjects that we get very emotive on. It's good that you are looking for the causes of sore nipples.

However, I did go through all the explanations you have given. I only bled from my nipples once, and that was the second day after her birth when the midwives were too busy to help me to position her. After that I was transferred to a midwife only unit, and there I received tremendous help, otherwise I would have given up too. The midwives would position her for me every time until I felt confident enough to do it myself, and they would check the latch every time too. Although I did use cream for my nipples (the midwives gave it to me, I don't know what it was), my nipples were generally ok, a little sore but not cracked. My babies mouth was checked for thrush and she was fine.

I too, had lots of milk. I used to think it was because I had small breasts so no-where for the milk to go! But very often my baby would pull off and choke after the initial latch as there was milk spurting everywhere, this happened right up until the day I stopped feeding her. Also, the other breast would leak so much I would fill up a whole breast shell! I don't know if this is anything to do with the pain.

I did get mastitis, and this was just awful, much more painful than I normally experienced.

I do have sensitive skin so why, as Bloss said, can't it be down to the fact that the most sensitive area of your breast is being sucked on and pulled? As the pain does get better over time, surely this confirms that theory? The let-down reflex was quite painful for me too, but it was the sharp pain when she started sucking that took my breath away. The midwives didn't seem too concerned about it, they just sat with me and told me to count to ten when it would ease off a bit. If it wasn't due to sensitive skin around the nipples, why was I offered a sun-lamp for my nipples?

It's true that it is not good enough to say to a woman, "It's just painful and that's that", but you could say, "Yes, it is painful now, but not because of anything you're doing, it will pass as your nipples become used it." Assuming that everything else has been checked that is.

Surely myself, Bloss and one other woman I know of aren't the only ones to suffer from "unexplained pain whilst breastfeeding"? Oh, and there's my sister too.

I don't know how often I have to say I accept that painful breastfeeding without a satisfactory explanation is a reality! But just in case, I'll say it again! I offered positioning, thrush and mastitis as explanations....Bloss, you are right to remind me to add oversupply to the list, too, as this is also known to cause discomfort and sometimes real pain; it is probably caused by engorgement. This is certainly known to be linked with pain on let down in some mothers.

There are no doubt other causes we don't yet know about.

Lisa, I already said that stretching (you call it pulling, but it's the same thing) is a probable cause of tenderness.

They gave you a sun lamp for treatment because they thought (probably rightly, as you had bled) your nipples were damaged (in fact, sun lamps are not used as much now for this, as it's now felt we should keep damaged skin moist, not dry it out).

I said in previous posts that the tenderness that comes with stretching gets better. One way I suggest to mothers they differentiate between this and damaged nipples is if the pain gets better or worse over time. If it's initial stretching, then the pain should diminish. If the skin is damaged/grazed/cracked, it gets worse. Like you say, everything should be checked, though, to see if latch and position can be improved, before just putting the whole thing down to the new stretching/pulling.

BTW, looking for thrush in the baby's mouth and finding none doesn't rule it out in the mother. Though from what you say, I am pretty certain you didn't have thrush.

Just to repeat : ) Anyone who says all bf pain is down to poor positioning is either very inexperienced or unnecessarily dogmatic. There's a lot we don't know. But poor positioning and attachment is very, very common (far commoner than pain due to oversupply, for example). It's also true that the mystery pain (or even the non-mystery pain) does tend to get better with time.

Tiktok, I bet you wish this thread hadn't started now(!)but I would just like to hear your opinion on what Jmt said. She said that she gave up after 6 weeks with her first (because of the pain) and so didn't try to feed her second. She says that child and mother should both enjoy b/feeding for it to work. I was just curious as to your views on this because my friend feels exactly the same way and I can't imagine ever feeling like that - I just couldn't bring myself to use formula however much pain's involved( but saying that I had no major feeding problems just v sore for 1st 6 weeks). I was wondering as a b/feeding counsellor how you might tackle this opinion which appears to be quite a common viewpoint? Is there anything you can do to help change that viewpoint, or is it not part of your role to get involved in the mother's decision making process?

PS I'm not singling you out Jmt - you just happened to highlight my friend's point perfectly

Lizzer, it's a good question. But no, we don't try to make anyone 'feel' differently about breastfeeding. We give people information, and support, and that might well include information about support around a decision to stop breastfeeding. If someone has decided that breastfeeding is too painful to continue, we'd find out what they had and hadn't tried, and then help them work out how to stop with minimal fuss.If someone is sad to stop, we try to share that, not by saying 'it doesn't matter' or 'you're much better off bottle feeding', and not by telling them what to feel and what not to feel.

Personally, I would put myself at the same end of the spectrum as you - wild horses would not have stopped me breastfeeding : ) But there are plenty of shades of opinion and motivation, and we accept that.

I think it is really important to enjoy breastfeeding, and it's sad when mothers can't get the full enjoyment of it when it's not working for whatever reason.

Bfcs make a clear distinction in their roles as counsellors and their roles as promoters. With individual mothers we are careful to centre our approach on their needs.

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Thanks for that Tiktok, I think you are doing a marvellous job! I was just curious as I read a odd sounding statement by a man from my local health authority in a discussion about breastfeeding in our area which basically said that while bottle feeding was a trend in the 60's and 70's it would virtually disappear eventually as breast feeding has become popular again . I thought 'what rubbish', as if feeding babies is a 'trend' and more importantly what a ridiculous answer to cover the fact that actually the health authority wasn't going to do anything to help support or promote breastfeeding - or, more to the point, spend any of it's money on counsellors or advisers I reckon?!

Bloss, just read your msg after posting mine and I feel it's such a shame for you not enjoying feeding but hats off to you for lasting so long you deserve a round of applause! I'm not sure I could have stood the being in pain part for much longer than I did, which was only 6 weeks. I fed my baby til nearly 12 months and by the end I was just plain sad that it was over.It became obvious that she didn't need her last feed, her last one was the 4am one and when she started sleeping through there seemed no need and she didn't seem interested after that. My one wish for my next (hopefully - but not for 10 yrs!) baby is that I can feed for longer, my friend is still feeding her little one at 18 months and I can honestly say I'm jealous of her! I wish you more luck with the second but I'm not suprised you are worried given your first experience, I hope tiktok has some ideas for you to try.....

It is a shame that some women don't consider breastfeeding their 2nd child if they have had problems with the first. So much of breastfeeding is down to the baby him/herself as each baby is different in their size, strength of suck etc. It is always worth trying as you can never go back if you don't.

Personally I would have been happy to have had more pain in order to get my little one to suck properly (that probably sounds rather perverse). Anyway he just wouldn't open his mouth and had a very weak suck for the first month. With supplementing and perseverence he was finally totally breastfed and still is at nearly 2 years. Boy I get plenty pain now with him tugging, but that's another story...

Bloss - I have had times when b/f was not enjoyable but other times when it was. I have tended to view it much like any aspect of upbringing in that some of my son's behaviour is easy/difficult to deal with. On balance for me I find it a useful way to calm him. I've had plenty feeds with kicking and struggling though!

Tiktok - I wish all counsellors were more like you. You seem to be both very knowledgeable, supportive and understanding. Keep up the good work!

Eulalia, I think that in my friend's case she was kind of relieved not to have to try to breastfeed her second as she had the excuse of 'tried it, didn't like it' where as with her first she was encouraged to by her antenatal class though I'm not sure was entirely convinced that she would. From what my friend said I think sometimes people are very worried about breast feeding and that doesn't help, then when the first feeding problems start to occur in the first few days and weeks it is a good excuse to give up and never try again no matter how different the 2nd baby is. I was wondering (going back to my earlier posting on what a man from my local health authority said) if a woman is more likely to breast or bottle feed depending on how her mother (or main carer) fed her? I have the advantage of living with my mother who is a midwife (-NOW she tells us!) so have been blessed with a wealth of baby knowledge. But I was wondering if any statistics have been shown to prove or disprove this, anyone know?

Sorry Eulalia! I just read that last msg again and it looks like I'm asking you to find out for me, honestly that wasn't meant to sound like that at all, you've done so much valuable research already I wasn't trying to harass you

Lizzer, the quote from the man at the health authority is a bit of a cop out. For a start, there is a whole lot more to feeding decisions than just fashion...and the stats show we are stuck at more or less the same level as the late 70s. In the UK, there is a large study published 5-yearly, and we can tell from that. About 65 per cent of mothers begin feeding, and it's been the same for a generation. The next study is due to be published next year, and from that we will see the current picture.

We know from these stats that early bf experience makes a real difference. We also know that the reasons why women give up indicate a lack of support and good information - that is, most of the problems might have been resolved.

If your mother bf, you are more likely to bf.If your friends bf, then you are more likely to do it, too.

Bloss - yes, if you had a lot of milk first time round, enough to cause problems, then you are likely to have the same thing next time. But there are ways to manage this so it's easier. One way is to deliberately feed 'one side at a feed', and if things are very bad, stick to one breast every few hours. I have known this to be very helpful to mothers who feel as if they and their babies are just drowning in milk : ( You'd need to talk it through with a bfc, and she would have some further suggestions which you could think about.

Eulalia - thanks for the compliment! I think most bfcs are like me - at least NCT ones are and they are the ones I know more about, as I work with them and train 'em, too! I suppose like any other group of people we do vary, and again, because we are human, there might be the occasional off day. But a totally useless bfc would probably be rumbled, because of our support and supervision systems, currently being overhauled, as it happens. When people have a bad experience with a bfc, I would want them to take it further so we could have a chance to put things right.

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Just to add to what everyone else has said Tiktok, you do sound remarkably caring. My bfc just talked to me over the telephone - I didn't know you visited their homes too, I wish I had had that support when I was breastfeeding.

All of my family (apart from one sister) bottlefed their children, my mother and grandmother both bottle fed, but I married into a breastfeeding family, I don't know if this made any difference, probably, but I just wanted to give my baby the best start possible and hoped that I would bond with her more if I breastfed.

I did it for 3 months and then gave up, because it just seemed so restrictive. As I mentioned earlier, my breasts were very full, so every time I fed her I had to use a breast shell on the other breast, making feeding in public difficult. Plus she would very often come off as she choked on the milk, which meant my milk came gushing out in all directions, I once nearly hit my husband in the eye with it! This too, is not much good for feeding in public, so I had to feed her in private, which was a real pain.

Then even when I wasn't feeding her, I had to wear breast pads. I tried to take up badminton again but couldn't as by breast pads would keep falling out, and if I didn't wear them, my breasts would leak.

This just became so restrictive in the end, I almost felt like I was still pregnant! If I ever did have another child, I would like to breastfeed again, but probably no more than 3 months as it just got too much to take. This on top of the pain!

I would be glad to hear your opinion on this Tiktok. Apart from Bloss, I don't know anyone else who had such leaky and full breasts.

And I'm glad you say that some pain is just 'unexplained'. I do think that mine was partly the let-down reflex, partly stretching and partly sensitive nips. But I wonder if this is more common with women who have full breasts? (and I don't mean size with that!)

You all sound like you overcame your problems to feed your children for quite a long time, you put me to shame! I really admire you all for doing that!

On a more humourous note: I was watching Good Morning a while back and they were doing a feature for breastfeeding week. This woman was trying to explain the different types of milk that come out, such as the fore milk, hind milk and so on. She was trying to make the point that women should try to feed for around 20 mins to make sure the baby got all the milk. John Leslie then cut in with the comment; "Why can't she just give the breast a good shake beforehand to mix it all together?" I thought this was hilarious - typical blokey comment!

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Lizzer/Bloss - Tiktok I'd say has answered your questions. I would say that the reason rates are so low in this country is purely for cultural reasons and a general lack of knowledge and support. There is a good American article entitled "If breastfeeding is so wonderful, why aren't more women doing it? " at medicalreporter.health.org/tmr0199/breastfeed.html

Breasts in our society seem to be primarily sexual objects and secondly fulfill the role of feeding babies. A lot of the reason women don't do it is embarassment. I feel that is ironic that women's rights have extended into the workplace and most aspects of their lives but it is still difficult for them to do something as basic as feed their children. We are ushered into 'special rooms' which are portrayed as fulfilling our need for privacy but what I really think is that it is to stop us embarrassing other people. Also I've said this before but breastfeeding rooms are always co-joined with nappy changing facilities- breast milk some kind of waste product? In some societies the mother can sit in a cafe and just feed her baby there and then, probably continuing her discussion instead of rushing off to the mother and baby room or even worse the toilets.

I believe that you can gently press your breasts in a certain way to stop the oversupply. Tiktok will probably know. A good book on breastfeeding should discuss these issues. Also there are plenty of great websites. www.breastfeeding.com/ has got lots of info and even video clips on positioning.

Leaking is a real nuisance, but yes, there are ways to reduce its impact.

And sorry, Lizzer, wearing breast shells can make it worse. Hope this suggestion didn't come from a bfc : (

Breast shells are designed to evert inverted nipples (though a trial of them compared to other methods, including doing nothing, showed they were no more likely than anything else to help with bf). The physics of it are beyond me, but they work by sort of sucking the nipples out...and that actually creates leaking, which is why they are designed so they catch milk. It just doesn't make sense to use them to cope with leaking either during or between feeds.

You can stop leaking by pressing the heel of the hand against the nipple - this doesn't work 100 per cent, but it does help. You have to hold the baby in the cradle hold, so you have a hand free to 'stop up' the unused breast. Between feeds, there's not a lot you can do except try to cope with the flow. Breast pads are not absorbent enough for severe leaking. Mothers sometimes use sanitary pads, or in one case I knew about, disposable newborn size nappies. Obviously that is a big big nuisance, and how the heck you'd play badminton with a nappy stuck down your bra I don't know...: (

There are real diffs in countries with similar cultural environments with regard to feeding. For instance, in Norway they have almost universal bf for several months. And yes, in Australia, there is more bf than here.

One reason for the difference is how strong the hold of formula milk was, before the (partial) return to bf. In Norway, for instance, they never really got into formula. There are some interesting stats I have which show that they never ever got to a stage when fewer than about 95 per cent of newborns were bf. I don't know about Australian stats but I suspect they'd show something similar - that is, that formula feeding never quite became the normal choice at the beginning.

The US has a rate a something like ours, but a bit lower. The US embraced formula earlier than anywhere else, and the commercial formulas took over where doctors left off.

Before the commercial formulas, mothers would go to their doctors for them to 'prescribe' a particular mix of ingredients (the 'formula'). When the manufacturers took over, they already had a huge market of mothers, and the convenience of something you could buy in a shop was very attractive - it was compared to the inconvenience of getting your doctor to decide the formula, not compared to bf, which was a minority activity there long before it was here.

Then of course in the US, compared to say, postwar Europe, there was far more advertising, families had more money, and the whole retail distribution network was more advanced.

So, it's a complex thing, this feeding business!

I have learnt a great deal about bfeeding from this discussion, thanks to all of you (lucky Lizzer having a midwife mum. When I asked mine how she fed us she said she tried breastfeeding but it was like being gnawed by a little animal. Cheers, mother).
Eulalia, do you mind if I ask you a question. I don't know anyone who is in the same position as us (feeding a toddler of nearly two) so it is really helpful to see your postings, as ever. Do you know how continued breastfeeding - short feeds at night and in the morning only - might affect your ability to conceive a second child? I feel I do not want to be b/feeding my son during my hoped-for second pregnancy, and definitely NOT both of them once the baby is born. My periods have been back for a year now and are pretty regular. Maybe Tiktok might know something about this, and also about the best way to wean an appreciative, milk-loving, happy little toddler kindly and with minimum misery all round. Tiktok, I have to say, you seem like the perfect NCT counsellor. I was not so lucky with mine, but in fairness she was a busy parent herself. Why the DoH cannot chip in with funding to help the NCT and La Leche provide this valuable service I don't know.

I never knew that breast shells were designed for inverted nipples! Now that I think about, I can understand how they are supposed to work, the air around your nipple, once in the shell, works as a kind of vacuum, sucking your nipple out. No wonder I used to fill mine up! Mind you, trying to stem the flow with the heel of my hand doesn't sound too hot either. When I was in hospital I tried pressing down on the nipple to stem the flow, it does help but I still leaked. A midwife suggested I use a breast shell - and I collected the milk from it to freeze and use if I wanted to go out anywhere.

Regarding what Eulalia said about breastfeeding in public - I thank God for bf rooms! As feeding mine was such a faff, with potential spurts all over the place, the only place I could feed her was in private. I don't think that others in a cafe would appreciate breastmilk being spurted into their coffee! But I admit that I also found it embarrassing. It's just that bit of your body that no-one but your husband usually sees, it takes time to build up the confidence to feed in front of others. I could never do it personally, I'm too much of a private person. I know you say that you cannot see much, but I still didn't like the idea.

I probably will bf next time (if there ever is a next time!), but only for 3 months again as I do want my life back! Surely 3 months is ok? I figure that she's on solids at 4 months anyway, so I've done my duty. Although I have every admiration for Eulalia and Marina who keep up with it for so long!

I find it much easier to feed anywhere now my son is older (9 months now), he just does it all his self (has been for a few months now), I know when he wants a feed before he even asks, so no crying to attract attention. I feed anywhere and everywhere but always with discreation as I know not everybody likes to see it. Somebody from my massage class even fed in church. The best place I have found for facilities is Bluewater shopping complex. Push button doors for ease, glider rocking chairs for comfort with table and chairs for toddlers, water for you to drink and microwave then a seperate changing room. This was situated at the eating court with other rooms doted around. I would quite happily go the one and half hours drive for the excellent facilities, it makes shopping enjoyable and not a worry. I have also spent alot of time in Mothercare.
Marina - Like you I am going to find it a little difficult to wean my son as feeding is his favourite place, loves his milk and the security. I have started to try now and occasionally he does refuse a feed, I am hoping he will wean himself, but I dont think so.
Lisa - I think your milk reduces once you start your child on solids, I hardly leak at all now and my chest has got smaller, dont know if this would have helped your situation if you had carried on alittle longer???

Hi Lisa,
Honestly it generally becomes so much easier after the first four months, when they are on solids your milk supply eases off and that's when I really ENJOYED it. Up until that point it always seems flaffy and a real effort most days as it's such a constant thing. But, once you reach that point when it starts to calm down there really is nothing nicer than curling up with baby for a feed.I honestly know what you're saying regarding baby at three months - it DOES get better and you stop feeling as though you are just doing it for the health of the baby but for both of your emotional development too...if that makes sense. It's really more therapeutic than anything you can buy in the bodyshop!! As for the benefits for carrying on - well that's more Eulalia's turf she has done a lot of postings in other b/feeding threads which may be worth a look if you're interested. I'm not trying to lecture you I just think that you might not know what you're missing out on if you don't try...

Tiktok, what is your view on expressing? I expressed for 3 months having completely struggled with bf, despite very kind help from my local bf counsellor. I know 2 other people for whom this has also worked and yet midwifes, health visitors etc never suggest it as an option and some were even mildly hostile (i.e. "Goodness, what hard work you are making for yourself")
On Eulalia's point about women's breasts being seen as primarily sexual objects, I have to say that I think that is because they are sexual objects. We are the only mammals to have permanently enlarged breasts. The fatty tissue that we have in our breasts does not directly contribute to feeding and it is obviously there for a purpose, which is sexual attraction.

Expressing - I take it you mean long-term, fully expressing and giving your baby the milk in a bottle, rather than just occasional expressing? - can enable a mother to give breastmilk for longer than she would otherwise feel able to do, and as long as the mother feels ok about it, then that's fine by me!

Most mothers (not all), given a choice, would prefer just to breastfeed 'directly' so I think any mother embarking on expressing longer term needs to know the full story - that some of the convenience of breastfeeding is lessened; that expressing is time-consuming; that the evidence is that expressing isn't as good as a baby at really establishing breastmilk production (it's very common for the amount expressed to go down, and the mother then has to express more often to get the same amount of milk; that because bottle feeding (with EBM or formula) is not as physiological as breastfeeding, there may be drawbacks we can only speculate on (to do with the way the baby 'leads' the feed).

I don't think there's any justification for being hostile to it! Breastfeeding is a relationship between 2 people, mother and baby, and if it doesn't work out one way, and the mother wants to continue,then she ought to be supported in finding another way to make it work for her! She should be admired and praised for making this compromise, because (as you hint!) it can be hard work, and requires a lot of loving dedication and committment.

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