The following is in celebration of World Breastfeeding Week! Robin Wiess at About.com is hosting a blog carnival on breastfeeding topics and this was our submission. Enjoy! And click over to her blog to read other posts in this great carnival, on topics from breastfeeding basics to a dad’s perspective.
When I gave birth to my first son, I was determined to breastfeed him. Knowing that a good percentage of women have difficulty with breastfeeding, and that cesarean births have a higher chance of developing problems, I was so worried about it that I avoided latching him on after his birth until I had someone to help me. There is so much to learn in such a short span of time with breastfeeding, especially the first time. Just getting my son to latch at all was a feat! Once he was on, I didn’t care if it hurt or not, and I let him nurse for as long as he wanted. And oh, he wanted, like a hoover vacuum cleaner!
Between my inexperience, the cesarean, and my son’s tongue tie, pretty quickly I had significant pain while breastfeeding. I kept hearing It’s not supposed to hurt! from experts and the L.C. and the pamphlets I had on breastfeeding, but I didn’t know how to make it stop. Latching is this ridiculous combination of jiggly boob, flailing baby, and invisible main components that made me sweat. Yes, I know it is not supposed to hurt, but I’m doing the tickle his lip and wait for the yawn and fill his mouth and check his lips for flange and it is all so awkward. Is this really natural? Because I feel like I’m flapping around trying to be a duck when I’m clearly a human.
I looked at my son all flailing and angry red between my knees on the hospital bed, and we both cried.
We sorted it out. It took me three weeks of latch, curl toes, cry, finish feed, air dry, lanolin, repeat, before my blistered nipples healed and we got our latch figured out despite the tongue tie. What was with all that pain?!
Painful breastfeeding is more common than it needs to be. There are various theories as to why problems develop, but the fact is that they exist. It is helpful to know the more common reasons for painful breastfeeding, in order to troubleshoot when it happens and hopefully work towards that comfortable, lift, shrug, and easy snuggle latching that experienced breastfeeding moms and babies seem to have down pat.
- Some amount of soreness in the first week or so may be normal, if the nipples are undamaged and the baby is gaining weight well. The hormones of pregnancy can make nipples rather sensitive, and this effect can take time to wear off.
- Poor positioning or latch. This is the most common cause of painful breastfeeding, especially in the early weeks. Ensuring the baby has a full mouthful of breast and is not compressing the nipple at all, has his or her head tipped back, and that there are no issues such as tongue tie to interfere with the mechanics of normal breastfeeding are key.
- Engorgement. This can contribute to painful breastfeeding by making latching difficult. Engorgement changes the shape and texture of the breast, making taking a full mouthful of areola and breast difficult for a very new baby to navigate well. Also, engorgement is painful in and of itself, as it is a combination of fluid overload and tissue irritation and resulting inflammation.
- Poor fit. Sometimes a woman’s nipples will be a poor fit for her infant’s mouth. This is particularly true for small babies, and premature babies. Long or wide nipples can be hard for even term infants to latch onto. This problem will resolve over time, as the baby’s mouth grows.
- Nipple confusion. If a baby receives bottles or pacifiers while learning to breastfeed, it can affect his or her latch.
- Lip positioning. Baby’s lips ideally need to be flanged outward. If either lip is sucked in, it can cause pain during breastfeeding.
- Sucking problems. Sometimes a baby is born with low muscle tone, or has some other reason for having a sucking problem, including posterior tongue tie, prematurity, Downs Syndrome, and etc. Learning to suck is a process that can be taught by an Occupational Therapist who specializes in infant sucking. Some Speech Pathologists specialize in teaching proper sucking, as do some Lactation Consultants.
- Latching off improperly. A baby should always have the suction broken before being removed from the breast. Either the baby will let go, or the mother can insert her finger in the corner of the baby’s mouth and gently break suction that way.
- Inverted nipples. Inversion can make latching on difficult, and the inverted tissue is particularly sensitive and prone to breakdown. It can also take longer to heal, because between feeds the tissue inverts again and doesn’t have the benefit of oxygen and air to help it get better.
- Tongue tie. A short tongue or frenulum can prevent the baby from pulling enough of the breast into his or her mouth to adequately latch, causing friction, damage, and pain.
- Unusual infant palate. Any variation of palate shape makes breastfeeding more difficult and can cause breastfeeding problems, including painful latch.
- Clenching latch. Rarely, infants are born with a strong, biting latch response and this can cause blanching of the nipple and pain during breastfeeding. This is more common with premature babies, and is an immaturity that is likely to be outgrown.
- Infection. Mastitis, staph infection, and yeast are common causes of painful breastfeeding.
- Improper breast pump fit.
- Eczema, dermatitis, impetigo, psoriasis, etc.
- Raynaud’s Phenomenon. Some women have a condition that causes blanching and pain which is worsened by exposure to cold. This usually manifests in the hands and feet, but for some women it manifests in the breasts during breastfeeding. It is very painful and can be treated by a lactation professional.
- Pregnancy. This is a little known or considered cause of painful breastfeeding. Of course this does not apply in the early weeks, but for women with older babies for whom breastfeeding was comfortable and is suddenly painful, the cause could be a new pregnancy. Not all women experience painful nursing while pregnant, but some do. It is possible to breastfeed while pregnant, and also after the new baby is born. This is called tandem nursing. Breastfeeding while pregnant is safe for most women, although it can be painful for some.
Knowing the common causes of pain while breastfeeding is the first step to curing it. Toe curling be gone! There is hope~get help, persevere, and pretty soon you, too can join the ranks of the lift, shrug, snuggle crowd. Breastfeeding shouldn’t have to hurt, but sometimes it does. Once it is resolved, breastfeeding is wonderful and easy and sweet, and worth every toe curl and red faced cry and sweaty latching session.