Guest Author: Dr. Kathleen McCue (DNP, FNP-BC, IBCLC-RLC)
Nipple tenderness is perfectly normal when you first have your baby and begin to breastfeed. You and your baby are both learning what is a natural act but to many of us does not come so naturally. When your baby first latches or when your breast milk starts to let down you may feel some mild discomfort.
Generally, as you and baby become more adept, breastfeeding should become more comfortable. Of course, there are always exceptions and sore nipples is one of the most common problems associated with breastfeeding.
The culprits for this are usually an infection, a poor breastfeeding latch or not using a breast pump correctly. Once you have sore nipples that condition can then snowball and lead to low breast milk supply, a difficult latch or early weaning. Here are eight ways to prevent sore nipples so you are armed with preventative strategies to address sore nipples before they lead to greater problems and some strategies for care if you are already experiencing nipple trauma.
SKIN MAINTENANCE
Your breasts are made to breastfeed so it’s not that difficult to care for them. There are even little bumps around your areola called Montgomery’s Glands that nature designed to create moisture and protect your nipples. You can always help mother nature along by doing a few extra things.
When cleansing yourself, avoid using harsh soaps that can dry and irritate your skin. Rinse with warm water. If you do not have irritated nipples a cream or ointment is not necessary as a preventative measure.
That said, If you live in a dry climate or already have dry, cracked nipples you may benefit from a nipple moisturizer such as our Lipple for Lips + Nips. Our formulation is certified organic and free from lanolin, petroleum, dyes and fragrance. Just pure ingredients to relieve any pain you might be experiencing now. For a limited time, purchase a bra from our SuperMom or Undercover Collections and get a FREE Lipple. Use code FREELIPPLE at checkout, while supplies last.
LATCH
First, one of the keys to successful breastfeeding is a good latch. It also helps prevent sore nipples. When your baby latches correctly your entire nipple should be deep inside your baby’s mouth as well as some of the surrounding areola to compress the milk ducts and encourage your milk ejection reflex. If your newborn only sucks on your nipple it can lead to a fussy baby who is always hungry. If you are uncertain on how to get a correct latch a great resource is your local la leche league chapter or an international board certified lactation consultant (IBCLC). The International Lactation Consultant Association has a directory to find an accredited professional near you. Many IBCLC’s are offering virtual consults during the pandemic and most insurance plans are required to cover lactation consultations at no cost to you as preventative medicine. Reach out to your insurance plan to understand the specific benefits to you under your plan.
BREASTFEEDING POSITION
Building upon the foundation of a good latch, finding a good breastfeeding position that is comfortable for both you and your baby, will make breastfeeding much easier. La Lache League offers a great tutorial on their website showing step by step guidance on various breastfeeding positions.
Some helpful accessories to increase your comfort are a nursing pillow and a footstool. Rather than straining your back by leaning over elevate the baby to your breast and avoid strain on your back, arms, and neck.
It’s also good to vary your routine and try different positions. This way your baby's mouth is not always putting pressure on the same spot on your nipple.
LOOSEN UP
Particularly in the early days of breastfeeding, engorgement is common. This can also be an issue if you miss a feeding or have an oversupply. Whatever the cause, when your breasts become engorged and hard it can become difficult for a newborn to latch on.
A few easy remedies to relieve engorgement and make your breast tissue softer are to apply a warm compress, hand express or try a manual pump or silicone suction pump such as a Haakaa prior to breastfeeding to express some of the milk and soften up the breast tissue.
FREQUENT FEEDINGS
Newborns digest breast milk quickly and it does not take much to fill up their tiny stomachs. They need to eat frequently. The longer you wait between feedings the hungrier your baby will be which will result in a more aggressive suck.
Going back to breast engorgement, the longer you wait between feedings the tighter your breast tissue will become. This creates a perfect storm of poor latch and an aggressive suck which can quickly result in sore nipples.
Make it a goal to breastfeed your baby on demand or at least every 2 to 3 hours, and before he/she becomes too hungry. Your nipples will thank you! Y
KEEP YOUR BREASTS DRY
If you experience a lot of leaking this may be easier said than done but do try to keep your breasts, bra and breast pads clean and dry. Put on a clean nursing bra every day and change your nursing pads often.
Moisture is a breeding ground for bacteria and fungus which can cause yoru skin to break down and lead to sore nipple, thrush or a breast infection.
GREAT LATCH? WATCH OUT WHEN BREAKING THE SEAL
If you have mastered a great latch you may have noticed the strong seal created between your babes mouth and your breast while breastfeeding. At the end of a feeding, he/she may release or stay attached as they fall asleep. If your babe remains attached take care to break the seal before pulling off of your breast. Gently place your finger into the side of your baby’s mouth to safely break the suction of the latch. Then hook your finder around your nipple to protect from an unexpected bite as your remove your baby from your breast. By taking this extra step you will avoid unnecessary trauma to your breast.
BREAST PUMP BEST PRACTICES
It’s important to understand how to use your breast pump correctly whether you pump occasionally to build up a reserve stash of milk or are exclusively pumping. One key area that many women do not understand is that size matters! Pump breast shields or flanges are available in different sizes, so don't assume that the ones that come with your pump are right for you. The area where your nipple inserts is called the nipple tunnel. You want to check to make sure that your nipple and a small portion of your areola moves freely inside the nipple tunnel without rubbing on the edges. Most pump manufacturers offer alternative sizes. We highly recommend Pumpin Pal Super Shield Angled Breast Pump Flanges. They not only have a tapered nipple tunnel that accommodates a range of sizes they also are angled to allow you to pump in a more comfortable position.
More suction is not better. Your goal with the pump is to attempt to match how your baby nurses at the breast. If you feel pain, your bodies natural response will be to suppress milk production. A gentler suction with a properly fitting flange and paying attention to cycling your pump at a faster speed with gentle suction initially then moving to a stronger suction, without pain, and slower speed is the goal. Also, pay attention to your milk flow during a pumping session. It’s normal to have multiple letdowns while nursing and the same should occur while pumping. As you see your milk flow reduce increase the speed of your pump and reduce the suction level for a few minutes. This should trigger your body to let down once again for more milk production.
As a reminder, the affordable care act mandated that most insurance plans cover lactation consultations as preventative medicine. We encourage you to reach out to your insurance plan to understand your benefits and work with professionals to make sure you are set up for breastfeeding success before you start to experience issues. An ounce of prevention is worth a pound of cure.
