For parents who have never breastfed before, breastfeeding pain is a big concern. We’ve got the lowdown on what you can expect with your letdown.
“Should it hurt this much?”
“I thought it would get better by now.”
“This is not what I expected.”
If you’re just starting your breastfeeding experience, the whole thing is a new sensation. Latching, letdowns, engorgement—if you haven’t breastfed, then you don’t have a good point of reference. So if someone tells you that breastfeeding hurts, why wouldn’t you believe them?
Let’s stop right here: Breastfeeding shouldn’t hurt.
What should it feel like? Some parents describe the feeling as a tugging or pulling sensation. Sometimes a tingly, warm, or electric sensation during letdown. Some parents describe the feeling of breastfeeding as a relief.
Depending on your baby’s latch, breastfeeding position, how full of milk your breasts are, and a range of other factors, there’s a vast range of sensations in breastfeeding. But while it can take time to adjust, breastfeeding shouldn’t be uncomfortable after the first few weeks.
What’s Normal and What’s Not
It’s normal: Sore and tender nipples in the early days of breastfeeding There’s a whole range of reasons for sore nipples in breastfeeding, and some of them require more assistance than others. We always tell breastfeeding parents to expect a little bit of nipple tenderness at the very beginning of breastfeeding—it’s something that your nipples aren’t used to yet!
Ask for help: Nipples that are cracked, blistered or bleeding
Early breastfeeding nipple pain should never be excruciating, though, nor should it involve cracked, blistered, or damaged nipples.
Nipple problems are almost always related to bad latches and the baby not getting enough breast tissue in their mouth.
Says Nest Collaborative IBCLC Lori Theisen, “Remember, it’s called BREASTFEEDING, not NIPPLEFEEDING. We want the baby to take as much breast tissue in the mouth as possible. The nipple is just the faucet for the milk, not the milk factory.”
If you see signs of nipple injury, like sores or bleeding, your baby may be struggling with a latch or tongue or lip tie problem. In those cases, book an appointment with an IBCLC to get help—it will make a massive difference in your breastfeeding happiness.
It’s normal: Engorgement
You thought your breasts had grown during pregnancy, but engorgement is a whole other thing.
Engorgement often occurs to breastfeeding parents at the beginning of breastfeeding. In the first few days, your baby will be cluster feeding, which causes your colostrum to transition into mature milk. This transition can create engorgement for some breastfeeding parents. If you experience engorgement, you’ll notice that your breasts have become tight, firm, and maybe even a bit shiny. They may be warm and slightly lumpy, and, yes, they may be painful.
But remember: the pain of engorgement is short-lived, subsiding within a few days. As you nurse or pump, your breasts will feel better. (Although they may be a little tender from the initial engorgement.)
During that time, nurse (and nurse and nurse!) and stay hydrated. To relieve discomfort, you can apply a warm, wet compress to your breasts or take a hot shower to improve circulation and milk flow. Breast massage is also another helpful technique for lessening engorgement pain.
A few important notes about engorgement
First, not all breastfeeding parents have engorgement. While it’s more common with new parents breastfeeding for the first time, some parents don’t experience it to the same degree—or even at all.
On the other hand, for parents who have had breast surgery—whether implants, reductions, biopsies, etc.—engorgement can be painful. This pain is due to scar tissue in their breast tissue.
Finally, those parents who received IV fluids during their birth can experience fluid overload. In addition to a swelling of fingers, feet, and toes, this can also increase engorgement. Pay attention to how your body feels and make sure to take extra care of yourself during this time!
Ask for help: Sore or engorged breasts with hot spots, lumps, or redness combined with fever, aches, or fatigue.
If you’re experiencing this kind of breast pain, you might be experiencing clogged ducts or mastitis.
Clogged ducts are both common and painful, but thankfully they can successfully be treated at home most of the time.
Clogged ducts are characterized by a small, hard lump in your breast. They’re usually palpable, and they’re typically sore or painful. The causes for clogs are:
Not emptying your breasts fully after nursing or pumping
Wearing tight tops or bras
Missing or skipping a nursing session
While clogged ducts can be treated at home though, it’s essential to address them quickly. Untreated clogged ducts can cause your milk to back up. This isn’t just prolonging the pain—it’s creating a situation where mastitis can occur.
The first thing to remember: While nursing through a clogged duct can be painful, it’s essential to keep your milk flowing. Milk flow helps break up the clog and return your breasts to their happy place.
If nursing alone doesn’t resolve the clog, other methods can help:
Applying a warm compress on your breast before nursing
Using breast massage, lactation massager, or electric toothbrush to break up the clog
Dangle feeding, which uses gravity to help empty your breast
On the other hand, mastitis is the inflammation of breast tissue—but it can feel so awful, you wonder if it’s not something more than that. Although it can be caused by preexisting problems like clogged ducts, engorgement, or cracked nipples, it often feels like it comes out of nowhere and knocks you over.
Mastitis is characterized by intense breast pain. Many breastfeeding parents will see hot, red, or sore spots on their breasts or even the classic wedge of redness. But more than that, parents often experience whole-body symptoms, including:
Swollen, painful lymph nodes
Mastitis can become serious, quickly. Without appropriate treatment, it can lead to infection, abscesses, and it can impact your milk supply. To get a quick handle on mastitis, make sure you do the following:
Nurse or pump as frequently as possible
Use breast massage to relieve engorgement and break up any clogs
Apply a warm compress
It’s not normal: Shooting pains in your nipple or breast If you’re getting a shooting pain in your nipple and it turns white, your first thought might be thrush. But before you pull out the gentian violet, consider that nipple blanching may be occurring.
Nipple blanching happens when blood flow to your nipple is cut off. Not surprisingly, latching issues are the culprit of the blanching. But if you check your nipple after nursing and see that your usual nipple color has returned, then blanching, not thrush, is what you’re dealing with.
Nipple blanching can be surprising, but it’s nothing to worry about on its own. However, keep an eye on your baby’s latch—nipple blanching is more common when a baby doesn’t have enough areola in their mouth. (I.e., nipple feeding, not breastfeeding!)
Nipple blanching…or vasospasm?
What about when nipple blanching hurts? Like, really, really, really hurts. You might be experiencing vasospasm. Also known as Reynaud’s Syndrome, vasospasms last for longer than nipple blanching and don’t go away when you’ve fixed latch issues.
Vasospasms can be caused by exposure to cold air, i.e., when your baby unlatches. To address them, you can gently massage your nipple to stimulate blood flow and apply a warm pack to your breast right after each feeding. If it’s an ongoing problem, consider taking a calcium channel blocker like Nifedipine.
Ask for help: Burning or shooting pain combined with cracked, burning, shiny, or flaky nipples
Thrush is a painful yeast infection that affects both you and your baby. Thrush attacks your breasts, nipples, your baby’s mouth, and bottom area—any place that is warm and moist. What’s worse, thrush is highly contagious, meaning it quickly spreads from the parent to baby and even to other household members if you’re not careful.
While thrush is entirely different from other breastfeeding pain sources, you may have to look more closely to identify it. Thrush shows up as:
Persistent nipple pain, often burning or itchy
Red, shiny, or flaky nipples
Cracked or damaged nipples
Shooting pains in the breast
You should also be on the lookout for signs of thrush in your baby. These can include:
White patches on their tongue, lips, gums, or roof of the mouth that you can’t wipe away
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