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How to Deal With Sore Nipples From Breastfeeding

Focusing on your latch.

It’s mechanical, not magical.

It’s all about getting your nipple far back into your baby’s throat.

A lactation consultant can help you in your first breastfeeding moments to avoid this common problem.

Sore nipples might occur if...

Your nipple is being compressed between your baby’s tongue and palate.  A shallow latch will cause increasing pain over the course of several feedings. You may feel that the first few feedings were pain free and now a mild stinging feeling starts up when your baby begins to suck.

In the first few days after the birth of your baby you will be putting her to breast frequently, perhaps as often as once an hour. With proper positioning, you will soon be observing longer and longer periods of rhythmic, continuous sucking and swallowing...without pain.                        

If you are experiencing pain, trauma is occurring.  It won’t go away on it’s own, your nipples don’t need to toughen up...you need to get your nipple farther back in your baby’s throat, free floating back there near her soft palate, away from the tongue (feels a bit like a cat’s tongue, eh?) and her hard, upper palate.  She should be compressing the breast tissue way beyond your nipple, not the nipple itself.  It’s mechanical, not magical.  

It’s all about aligning your baby for optimal stimulation to get her to open her mouth wide, with a desire to feed...using the pressure of your body and breast against her belly, chest and upturned chin.  Lift your whole breast from underneath, like the underwire of a bra, and use your nipple to stroke downward on her lower lip to get her to open wide.  This is your opportunity to introduce your breast into her mouth.  Using the heel of your hand that has been positioned between her shoulder blades guide her head, chin first, onto your breast.  Don’t be afraid to pop her on quickly when she opens wide.  Lower lip away from the areola, top lip can be a little closer.  This asymmetric latch; more breast tissue in her mouth against her tongue, helps her get your nipple farther back and get more milk per suck, triggering those continuous swallows.

Leaning back, once your baby is deeply latched, hugging her close to you as you settle back on pillows, is the best way to keep your nipple from pulling into the front of her mouth. Use this position as often as possible and your baby will be able to pull more tissue into her mouth all on her own, as well as open her mouth slightly to let excess milk dribble out.  Once your milk begins filling your baby’s mouth the (intraoral) pressure eases on your nipple and the pain lessens.  You can stimulate a letdown response manually or with a pump before you offer your breast to your baby to avoid the first minute of stinging and subsequent tenseness.  

If your latch is still too shallow your pain won’t go away altogether. You may see a wedge shaped nipple after a feeding or a white compression line across the face of your nipple...sadly, this will turn into a crack if you don’t re-position your nipple in her mouth.

You should be able to breastfeed with minimal pain even when your nipple has a crack or abraded tip if the nipple is in the right place.  A lactation consultant would be able to assess whether a properly fitted nipple shield might be the right answer for you.  Please seek the support and guidance of a board certified lactation consultant prenatally and immediately following the birth of your breastfed baby so that you may fully enjoy your breastfeeding journey.

Breastfeeding can be magical and pain free if you get the mechanics right.

Paula Zindler
RN IBCLC

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