Rx and Stethoscope showcasing clinical background on Will Breastfeeding Hurt.

ASK THE DOC: Will Breastfeeding Hurt?

 Guest Author: Dr. Kathleen McCue (DNP, FNP-BC, IBCLC-RLC)

"Will Breastfeeding Hurt"? Great question, because the answer is, as you might have expected, not a simple “yes” or “no.” So, I would say “sometimes.”  It’s important to manage your expectations. Let me give you a few thoughts about what I know based on working with literally thousands of women and babies. My bio is only important in that it reflects both education and experience.

Women and their partners spend a lot more time preparing for the birth than the they do for breastfeeding. That has always left me wondering “why?” When I asked a breastfeeding class that question, they explained that the presumed pain of childbirth, outweighed all else. Yes, of course, birth preparation is important, but I think it’s analogous to preparing for a wedding and not your life afterwards. The next morning, one looks at their baby and says “I thought this would be more natural.” Perhaps it would if we all lived in very tight communities with other women (elders) and if we were socialized more to breastfeeding. We’re definitely moving in that direction, but we’re not there quite yet.

Like everything else in life, breastfeeding is a learned activity and art, that is steeped in personal thoughts and beliefs, plus your anatomy and baby’s anatomy. Working with women for the past 48 years has taught me that no two mother-baby couples are alike. There are a myriad of factors that come into play including; mom’s desire to breastfeed, other children at home, support network, glandular tissue and nipple anatomy, expectations, size of the baby(ies), number of babies (twins, triplets) any prior breastfeeding experience whether positive or negative, baby’s anatomy and presence of a tongue tie or cleft lip/palate, normal infant physiologic jaundice, breast sensitivity and the list goes on. Unfortunately, there is no breastfeeding epidural, as one of my patients jokingly said.

Let’s start with your anatomy. Do your nipples evert? Meaning, do they stick out when you’re in the frozen food aisle of the super market? If you were braless, wearing a silk blouse, would you be able to see the outline underneath. You could do the “pinch test,” which would be squeezing down on both sides of the areola to see if the nipples stick out more. This is important because baby will compress the areola in much the same way, and need to latch onto the nipple, in order to bring it far back into the mouth.

If your nipples do not evert, (or maybe one side does and one doesn’t), that just means you may need to compress the nipple area a bit more to feed it into baby’s mouth or you may need a nipple shield. A lactation consultant can help you determine whether or not there are things you can do before birth to prepare yourself for breastfeeding. My recommendation would be to see someone about two to three weeks prior to giving birth. You can manage your expectations AND ask for a breast exam. There are factors that can be addressed prior to delivering that will help you make an easier transition into what is sometimes called “the fourth trimester.”

At my practice, Metropolitan Breastfeeding, we offer 1:1 breast exams that can be conducted remotely while you are in the privacy of your home. In many cases, this exam is covered by your health insurance. Scheduling is easy through our online appointment calendar to choose the day/time most convenient for you.

When baby is born, there’s a golden hour where you’re going to want to keep baby on you or next to you, preferably latched onto the breast.  This skin-to-skin helps turn on the hormones you’ll need for breastfeeding. But, what if baby needs to be attended to for suctioning or go into an isolette (incubator) due to circumstances beyond your control; not a problem, in all probability, you will still develop a beautiful milk-supply. We will recommend some changes to our usual recommendations, but again, the lactation consultant will be your best resource of “how-to.”

After the first golden hour, many babies recover from the birth and can be fairly sleepy for the next 23 hours. Even so, you should hand express your milk and spend some time latching. Many babies are born with sleep-wake reversal because when they’re in the swimming pool (womb), we’re rocking them all day. When we lay down to sleep at night, it’s not unusual for a baby to start to wiggle around asking for more of that rocking. One of the things I’ll teach you all in a later blog is how to calm a newborn by simulating a maternal heartbeat, but I digress. I get really excited to teach parents all the baby tricks I know. Perhaps some videos will follow at some point.

OK, so now what. If you sucked on one of your knuckles, eight to ten times a day for 20-30 minutes, even your knuckles may feel a little uncomfortable. If this is your first baby, you’ve never used your breasts like this before and they can become a little tender; tender is not necessarily the same as sore. So, what’s a mom to do?

My personal preference is never to use lanolin on nipples. Lanolin is made out of sheep-sebum. They take a sheep, shear the wool, boil it and the sebum (lanolin) floats to the surface. I neither like the stickiness nor the potential for mom’s to be allergic. I also think it clogs up the Montgomery glands (the small pimple like protrusions on the areola. Hospitals hand it out like ice water but I’d prefer you use an olive oil or coconut oil-based product, such as Tiny Human's Nipple Crack, as I believe they’re much better. There’s also a prescription product called APNO (Dr. Jack Newman’s recipe, that can be amazingly helpful).

For baby’s anatomy, keep in mind, when I first started practicing, we didn’t even know about tongue ties and yet, the majority of women were able to nurse. Ties are important but rarely a deal breaker. Also, there’s nothing wrong if, at some point, you decide to pump and bottlefeed. This is not a defeatist attitude but I’ve heard that not everything in this world is black and white; I’ve been told there are 50 shades of gray and this is about what’s best for you.

Although I have a lot more to say, I’m going to stop here, as three years ago even my own daughter who had just delivered her first baby said “Mom, please stop talking.”


Kathleen is the owner and clinical director of Metropolitan Breastfeeding, serving families globally through virtual lactation support services and in person in the VA, MD and DC metro areas with @ home or in office visits.

She and her team understand, each mother and baby is an individual with unique needs and circumstances. Kathleen personally, with the knowledge of many years as a nurse practitioner and having assisted well over 5,000 dyads achieve a positive and nurturing breastfeeding experience, is able to respond to a broad range of medical circumstances that arise in the course of breastfeeding. She leads her team with the paramount belief that there first must be an understanding of the objectives for each dyads nursing experience. By listening, she and any of her practitioners, can help create an environment of peace and understanding where the breastfeeding dyad can thrive and grow. After understanding the objectives and lifestyle needs, her philosophy is to then approach the teaching of breastfeeding from the perspective of the baby. After explaining the needs and reflexes of infants, she and her team then match the breastfeeding goals of the family to help the dyad create a unique, synergistic nursing relationship.