Pain in breasts after feeding

[NotAgain77]

Hi - 10 days into BF journey with a 10 day old. My issue is that I have pain deep in my breast tissue on both breasts in the same area (outer breast towards armpit). It sometimes happens when I am feeding, but more often the pain is worse as the feed goes on/ends and persists after it has finished. The areas where there is pain are areas of current/recent clogged ducts. The pain feels like someone has a string attached to the base of my breast and is pulling it hard through the nipple/a shooting/stabbing pain.

I am thinking the pain is related to a sub standard latch, the clogged ducts or possibly ductal thrush (I think this is unlikely as the pain is in specific regions of the breast only).

I will see a MW tomorrow when they come to weigh DS and may speak to my GP about possible mastitis but in the meantime wanted to canvas thoughts on possible causes. Thanks!

Context - bf has been up and down. I have battled through/am still battling through having clogged ducts following massive engorgement when milk came in (it is significantly better than before but still an issue on one breast in particular).I have been massaging, warm compresses, electric toothbrush, tried dangle feeding (can't do it), massaging while feeding, massaging in shower). DS has been struggling to latch for the last 36 hours (no engorgement) and has been very fussy on the breast (upping supply?) My milk supply seems good/ too much as sometimes it 'drowns' DS. I was put on a pump in hospital (days 2-3) to bring in my milk asap due to a perceived low supply.

I should add, DS has a posterior tongue tie but I have been told it will not effect feeding/doesn't need to be treated.

I was going to suggest massaging with a warm compress while feeding, but it sounds like you’re already doing all the right things! Definitely do mention it to your midwives, and keep an eye out for redness, fever, and other signs of infection. I did find with my first that we settled into a good breastfeeding rhythm around 3-4 weeks and I stopped being so uncomfortable. At 10 days, your body is still trying to figure out what the heck just happened. :p

Given that you've had/have blocked ducts, I think this is likely to be the cause and you just need to continue the massage/warm compresses. Try holding an electric toothbrush/vibrator on the ducts as this also helps release them. It could be thrush as you've mentioned...this often presents as stabbing pains towards the nipple. Baby would often get this too and would present with a thick white coat on their tongue (thicker than just a milky white coating). If the above gets ruled out by your midwife, it could be that you have pain as your breasts refill and that's why it starts midway and continues post feed. I had this and it was pretty painful and similar to the pain you describe. It went on for about 15 minutes post a feed and lasted for a couple of weeks. I used to find a warm compress on them would help with the pain but essentially it just went with time. This isn't super common and I would only consider this once you have ruled out other problems.

I wonder who noticed the tongue tie, and whether they made a full assessment of its impact. TT is so much more than the appearance of the tie, and more about what they can do with it.
In the case of a baby struggling to latch, repeated clogs and blockages and deep breast pain I would want to know a qualified TT practitioner had assessed it before assuming it wasn't the culprit.
(Deep breast pain is associated with a shallow latch compressing the nerves, which then causes shooting/stabbing pains elsewhere)
I am usually very slow to suggest TT as an option, but in your case I'd be looking for a local practitioner in the ATTP website.
I'd also look at flipple and exaggerated latch techniques in the meantime, combined with pumping to comfort to keep the milk moving.

Oh god reading your post brings back tough memories! It sounds like you’re doing all the right things though! Electric toothbrush and really strong pressure massage in a hot bath worked best for unclogging for me, but I still had pain chronically for 3 months on and off. It wasn’t thrush (tried multiple treatments), had a lump that came and went under the armpit (lymph node area) so got a referral to the breast clinic for a scan (thankfully all clear). In the end the pain faded out as DD’s latch improved - but it was a long journey, from having to always use nipple shields for 6 weeks (!) but she now drains a boob in 5 min ... I hope things get better for you soon!!

@RockCrushesLizard it was initially picked up by a midwife in the hospital. One of the infant feeding team then came and had a look and said it wasn't effecting the mobility of the tongue so wouldn't be a problem. It has been commented on by most midwives who have visited us at home. Is it possible that it wouldn't have had impact at 2 days (when it was assessed) but that it could be now?

DS seems to be having problems opening his mouth wide. I can wait ages and little happens.

Was the person who assessed the tongue tie an IBCLC though? Before I saw an IBCLC I had numerous HCPs tell me that my baby didn’t have a TT/it wasn’t effecting feeding. She couldn’t open her mouth wide or get a good latch. My nipples were looked crushed after each feed and she would suckle for over an hour and not transfer a lot of milk. As soon as we had her posterior TT snipped her feeding improved and after a few weeks it was completely comfortable.

@Crikeycroc I know the name of the MW who did the assessment and they don't appear to be an IBCLC. I will explore getting him assessed properly.
Was your assessment done on the NHS. I have been told they don't treat posterior tongue tie. We are fine to go private I'm just interested to know if it's true that they don't treat posterior tongue ties on the NHS.

Very few midwives are trained to assess TT.
NHS provision is sadly patchy and often slow, so many people who can choose to go private.
I would expect most ties not to be making much difference at day two, but when the higher volumes of milk come in that's when the restricted function becomes more obvious.
Incidentally, if multiple non specialists have noticed it, I'd imagine it's not a minor restriction. The Association of Tongue Tie practitioners website will allow you to find someone qualified to assess near you. Often they are also IBCLC, so can support with feeding afterwards.

A deep pain continuing after feeding is often a sign of nipple thrush.

I would try and get a nipple swab for this as if it is it can be treated

It's a bit annoying actually, that someone has decided on a visual assessment that all is fine - a Doctor wouldn't look at a sore ankle joint in A&E and say it was fine, they'd be feeling it, moving it. TT assessment that doesn't involve a gloved hand in the mouth is unlikely to be thorough.
Posterior just means it isn't attached at the tip, which is not really meaningful - it could be really tightly tethered on the whole rear of the tongue (not necessarily in your case, but more generally). The range of movements achieved is the relevant part.

I’d second getting the TT properly looked at. It’s still an area that’s woefully misunderstood. You will hear things like ‘it’s only a slight one’ or ‘the latch looks good’. Both of those are irrelevant and someone really knowledgable will be able to help you more. I had both of my babies’ TT snipped and it was the right decision for me.

Regarding pain, could be thrush, treating fairly easy. Could be the start of mastitis. Be vigilant.

@overthrrainbow88
You're absolutely right, that sort of pain can be an indicator of thrush. The BfN suggests that it's unlikely in the absence of other symptoms.
http://www.breastfeedingnetwork.org.uk/wp-content/pdfs/DifferentialDiagnosisofNipplePainMarch2009.pdf]]

Sorry, I’m not in the UK so can’t comment directly on the NHS. I did however bypass the public system where I am and access an IBCLC privately because the hospital lactation consultant declared no TT without properly looking in my DD’s mouth let alone putting her fingers in it to assess function.

My understanding is that there isn’t a lot of research to support revision of lip and posterior TT’s however I concluded that lack of research doesn’t mean it’s not relevant, just that these isn’t a lot of political willpower to fund it.

To update. We had him reassessed and had the TT divided a week ago. Not seen any improvement yet, things have got slightly worse. But fingers crossed for good things ahead.

I had very painful breasts and was treated for thrush but it actually turned out to be a bacterial infection caused by mastitis and needed antibiotics. I had mastitis 3 times in the first 4/5 weeks. The GP only found out when I went in person for a nipple swab, please insist on this as if I had done it earlier it would have saved weeks of pain! The assumption is thrush, but for deep pain that’s obv not always the case. Good luck x