Nipples sting breastfeeding

Nipple Vasospasm and Breastfeeding - Breastfeeding Support

A vasospasm is a sudden constriction (or narrowing) of the blood vessels. A nipple vasospasm may be triggered by a breastfeeding baby in a shallow latch and it can also be connected with Raynaud’s phenomenon (a condition affecting blood supply). Nipple vasospasm can also be associated with deep breast and muscle pain—a condition referred to as Mammary Constriction Syndrome. This article looks at the symptoms, causes and possible treatments for easing nipple vasospasm.

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What are the symptoms of nipple vasospasm?

Symptoms of nipple vasospasm include:

Painful nipples—the pain is often described as burning, stabbing or itching and may be felt a short time after breastfeeding or in between feeds.
Sore nipples—nipple vasospasm is associated with misshapen nipples and sore nipples.
White nipples—nipple tips may look white (blanched) after a feed or mothers may notice other colour changes in their nipples e.g. blue or dark red (associated with Raynaud’s Phenomenon—see below)
Deep breast pain—some mothers may also feel shooting pains deep in the breast.
Cold temperatures may worsen the pain or trigger it.

Lactation consultant and author Nancy Mohrbacher explains:

Excerpt from

Breastfeeding Answers Made Simple, Mohrbacher, 2010 p. 639

Vasospasm is a constriction of the blood vessels in the nipple that causes the nipple to blanch, or turn white. Compression of the nipple is a common cause, either due to shallow breastfeeding or the baby compressing the nipple to slow fast milk flow. When the nipple is compressed, it may look misshapen after feedings—pointed or creased, like the tip of a new tube of lipstick. The blood flowing back to the nipple may cause a burning sensation, intense throbbing, or shooting pain.

Bacterial or fungal infection may have similar symptoms

Vasospasm symptoms such as burning pain and soreness can be very similar to those of a fungal infection (e.g. thrush) or a bacterial infection (e.g. a Staph infection). A misdiagnosis of thrush and resulting unnecessary prescription medication, may make vasospasm symptoms worse ¹.

What causes nipple vasospasm?

For breastfeeding mothers, the main cause of nipple vasospasm is likely to be a poor latch (the way a baby attaches to the breast). A range of risk factors for nipple vasospasm are set out in a useful patient handout from the Goldfarb Breastfeeding Clinic:

Excerpt from

Nipple Vasospasm Patient Handout, Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic, 2019

Exposure to cold temperatures.

Periods of severe emotional stress.

Cigarette smoking or second-hand smoke.

Certain medical conditions such as Lupus, rheumatoid arthritis, and hypothyroidism.

Certain medications such as Fluconazole/Diflucan (thrush treatment) or the birth control pill.

Nipple cracks or trauma.

Poor latch or biting.

Migraines.

How can I avoid vasospasm symptoms?

Minimising the risk factors can work very well to help prevent symptoms of nipple vasospasm, namely:

Get help with positioning from an International Board Certified Lactation Consultant so that your baby’s latch is not triggering vasospasm. A poorly latched baby, an ineffective suck or the baby clamping on the nipple can all cause nipple blanching. Babies with high muscle tone or those with tummy ache (e.g. from a food allergy) may seem to “bite” at the breast and can cause a nipple vasospasm. A baby needs to attach to the breast deeply with a big mouthful of breast as well as the nipple. See Breastfeeding Positioning for Newborns, Latching Tips and Why Does Breastfeeding Hurt? for more information and see your breastfeeding specialist for one to one help.
Rule out thrush or a bacterial infection—check with your health professional that you don’t have any other causes of burning pain and sore nipples.
Keep warm; breastfeed in a warm room and cover the nipple as soon as a breastfeed ends. Don’t leave nipples to air dry as they will get colder that way. Keep breastpads dry, some mothers use woollen or fleecy breastpads for warmth. Try to avoid sudden temperature changes.
Gentle massage. Try massaging the nipples with warm oil after a breastfeed to stop a nipple vasospasm ².
Avoid the following triggers: cigarette smoke and smoking, nicotine, caffeine, or any medications that promote vasoconstriction e. g. some decongestants³ and avoid stress where possible.
Keep active with aerobic exercise.

Raynaud’s phenomenon

Raynaud’s is a disorder of the tiny blood vessels of the extremities which reduces blood flow. In cold temperatures, the blood vessels go into spasms, which may cause pain, numbness, throbbing and tingling. Some women who have Raynaud’s in the fingers and toes may find they get Raynaud’s of the nipple when they start to breastfeed. This might be because breastfeeding affords lots of opportunities for nipples to get cold e.g. just before and after latching. Raynaud’s is often misdiagnosed as thrush or a poor latch ⁴.

Diagnosis of Raynaud’s

Raynaud’s can usually be distinguished from nipple vasospasm due to a poor latch by:

Symptoms can be triggered by cold and tend to occur in both nipples and can happen separately from breastfeeding.
Colour changes of the nipples e.g. from white to blue to red/purple may be seen with lighter skin tones.
Raynaud’s may be linked with a history of migraines or a history of poor circulation ⁵.
May be associated with previous breast surgery ⁶.

Breastfeeding tips for Raynaud’s sufferers

Help for Pregnant & Breastfeeding Moms from the Raynaud’s Association, has specific tips for Raynaud’s sufferers such as:

Never latch a baby while the nipple is having a vasospasm, try warming the breast and repeatedly squeezing the nipple to help blood flow back into this area before latching.
Pumping may be less painful than direct breastfeeding for some mothers.
Keep warm, never leave nipples to air dry after a breastfeed (as above). Try warm compresses after a breastfeed. Use woollen breast pads and warm layers of clothing to keep warm.

Treatments for nipple vasospasm

In addition to using the above ideas to avoid getting vasospasm symptoms, there are a number of treatment options for vasospasm that persists after a poor latch has been corrected and other infections ruled out. Treatments include pain relief, dietary supplements (calcium, magnesium and vitamin B6), omega fatty acids and prescription medication. The Goldfarb Clinic discusses these in more detail:

Excerpt from

Nipple Vasospasm Patient Handout, Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic, 2019

The use of Advil™ or Motrin™ (ibuprofen) and/or Tylenol™ (acetaminophen) may be very useful to treat the pain of nipple vasospasm. These medications are safe during breastfeeding.

Your health professional may suggest high doses of calcium and magnesium, and vitamin B6. Please consult your health professionals for doses specific to your case.

Omega fatty acids may also help. Evening primrose oil (up to 12 capsules a day) and fish oil capsules are rich sources of omega fatty acids.

Nifedipine (Adalat™) […] normally used for high blood pressure, can also be used for nipple vasospasm, and is safe for breastfeeding mothers and infants.

Nifedipine

Refer to the full Goldfarb article online for precautions regarding nifedipine and share this with your health care professional. The Breastfeeding Network discusses doses and side effects of nifedipine in their fact sheet Raynaud’s Phenomenon in Breastfeeding Mothers and for more places to find information about the safety of nifedipine online see Medications and Breastfeeding. Always discuss medications or medicinal doses of supplements with your health care provider.

Treatment tips from Dr Jack Newman

Jack Newman, a Canadian paediatrician and breastfeeding expert, has a protocol for treating vasospasm which can be found in Vasospasm and Raynaud’s Phenomenon or his book Dr. Jack Newman’s Guide to Breastfeeding. In addition to a discussion of certain vitamin and mineral supplements (also referred to in the patient handout quoted above), Dr Newman advocates:

All Purpose Nipple Ointment, a topical cream with antibacterial, antifungal and anti-inflammatory ingredients to help with soreness.
Massaging warm olive oil into the nipples during burning episodes for instant relief.
Treat deep breast pain for Mammary Constriction Syndrome.

Complimentary medicine

Scleroderma and Raynaud’s UK (SRUD) discuss natural and over the counter complimentary medicine for scleroderma and Raynaud’s in Natural Therapies. They discuss doses of vitamin C, vitamin E, gamolenic acid (GLA), ginkgo bilboa and ginger and more. The latest recommendations on the compatibility of many supplements while breastfeeding can be checked online at e-Lactancia and should always be discussed with your health professional.

Excerpt from

Natural Therapies, Scleroderma and Raynaud’s UK (SRUD), 2016

Gingko Biloba Up to 240mg daily in three doses. Some people find that this produces a significant reduction in their Raynaud’s symptoms.

Ginger 2000mg–4000mg daily.

The Breastfeeding Network fact sheet for Raynaud’s adds that it may be helpful to include ginger in the mother’s diet e.g. drink ginger tea, or even add a spoonful of ground ginger to bath water.

Summary

Nipple vasospasm is a narrowing of blood vessels in the nipple. It can be triggered by a baby breastfeeding in a shallow latch and can cause burning, stabbing or itching pain in the nipples after a breastfeed. Nipple vasospasm can also be associated with Raynaud’s phenomenon and can also cause Mammary Constriction Syndrome or deep breast pain. Treatment involves avoiding the triggers of nipple vasospasm and some medications may help.

Footnotes & References

Nipple Vasospasm Patient Handout, Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic, 2019
Raynaud’s Phenomenon in Breastfeeding Mothers, Breastfeeding Network, 2019
Raynaud’s Syndrome, Breastfeeding Network, 2019
Anderson et al, Raynaud’s Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding, Pediatrics, 2004
Raynaud’s Phenomenon in Breastfeeding Mothers, Breastfeeding Network, 2019
Anderson et al, Raynaud’s Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding, Pediatrics, 2004

Breast & nipple thrush | The Royal Women's Hospital

Breast and nipple thrush can cause strong nipple and breast pain. The pain may be severe enough to lead to early weaning if the condition is not treated.

Thrush is a fungal infection caused by the organism Candida albicans, which can occur in the nipples or breast tissue (as well as other places in the body).

If you have nipple pain that doesn’t go away when you adjust your breastfeeding attachment, you may need to talk with a lactation consultant or other health care professional. Early diagnosis and treatment of nipple and breast thrush will help to improve your breastfeeding experience.

Causes

Breast and nipple thrush may be linked to a history of vaginal thrush, recent use of antibiotics or nipple damage. However, sometimes the cause is not known.

Symptoms

The most common symptom is nipple pain or breast pain, or both.

Nipple thrush pain is often described as burning, itching, or stinging and may be mild to severe. The pain is usually ongoing and doesn’t go away with improved positioning and attachment of your baby to the breast. Your nipples may be tender to touch and even light clothing can cause pain.

Breast thrush pain can vary. It has been described as a stabbing or shooting pain, a deep ache or a burning sensation that radiates through the breast. It may be in one or both breasts.

Often this pain is experienced immediately after, as well as in between, feeds.

Signs of nipple and breast thrush

There are usually no obvious signs of thrush on your nipples. However some signs may be present and include:

your nipples may appear bright pink; the areola may be reddened, dry or flaky. Rarely a fine white rash may be seen
nipple damage (e.g. a crack) that is slow to heal
signs of thrush may be present in your baby's mouth or on your baby's bottom, or both. Thrush in the mouth appears as a thick white coating on the tongue or white spots on the inside of the cheeks, or both. Thrush on a baby's bottom appears as a bright red rash with spots around it which does not clear without antifungal cream.

If you or your baby have been diagnosed with thrush you will be both need to be treated.

Management and treatment

Breast or nipple thrush is treated with antifungal tablets and creams. You also need to treat thrush in your baby and any other fungal infection in you or your family members.

Thrush in your baby’s mouth is treated using an oral gel or drops.
Breast and nipple thrush is treated with antifungal medicine and antifungal nipple gel/creams.
Treat any other site of fungal infection in the whole family, i.e. vagina, nappy rash, feet.
Keep your nipples dry by frequently changing breast pads as thrush grows well in a moist and warm environment.
Clean teats and dummies thoroughly after use and boil for five minutes. Replace weekly if possible.
To prevent the spread of thrush, wash your hands thoroughly after nappy changes and before and after applying any creams/lotions.
Wash towels, bras, cloth nursing pads etc. in hot soapy water and air dry outside.

Nursing nipple care | Breast Care

Breastfeeding is good for you and your baby, but it can be a real challenge for the nipples. Check out our tips and tricks to help reduce the pain.

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Sioned Hilton, health visitor, neonatal nurse and lactation consultant:
A mother of three, Sioned Hilton has been supporting families with newborns and young children for over 30 years. She provides advice on breastfeeding and pumping, both in clinics and at home. In addition, Schoned writes articles for parenting magazines, attends conferences, and conducts seminars for attending physicians.

New mothers often hear: "Breastfeeding doesn't have to be painful." However, in the early days, many are faced with the opposite.

In most women during pregnancy, the nipples enlarge and become more sensitive. When a newborn baby begins to suckle, it creates a certain pressure, and this is a completely new and unfamiliar sensation for a woman (at least for a first-time mother).

Feedings can be prolonged for a long time, sometimes up to an hour, and the child may ask to be breastfed up to 13 times a day. ¹ This sucking, pressure and saliva of the baby can cause sore nipples.

Remember how your lips crack in the wind and sun. The more often you lick them, the more they will dry and become inflamed. Therefore, lips require good hydration to soften, protect and speed up the healing of cracks. The same thing happens with nipples.

However, sore nipples usually don't last more than a couple of weeks and go away as your baby and your breasts get used to breastfeeding. It is important to start nipple care as early as possible to prevent the situation from worsening. Therefore, if your nipples become very inflamed, crack or bleed, contact your doctor as soon as possible. ²

Prevention is better than cure, so check out our tips.

Check your baby's latch-on

Correct latch is the key to pain-free breastfeeding. When putting the baby to the breast, point the nipple towards his palate. This will allow him to grab the nipple and the part of the areola (the darker skin around the nipple) underneath. When the nipple and part of the breast is in the baby's mouth, feeding is taking place correctly. ³

For the first few days, see a lactation consultant or specialist to check for proper latch. He will be able to give you advice on how to solve problems and recommend other feeding positions that will make it less painful for you to feed your baby.

Check tongue tie

Tongue tie (ankyloglossia) occurs in 4-11% of
newborns. ⁴ At the same time, the strip of skin that attaches the tongue to the bottom of the mouth - the so-called frenulum - is too short. A child with a shortened frenulum will not be able to open his mouth wide enough to latch onto the breast well, and his tongue will not cover the lower gum when sucking. As a result, the baby will be nervous, and your nipples may become inflamed.

The doctor or lactation consultant must examine the baby to make this diagnosis. The problem of a shortened bridle is solved by a simple undercutting procedure. It is performed by a doctor, and is usually done without blood and does not require anesthesia. Cutting the bridle allows you to restore the normal feeding mechanism almost instantly. ⁵

Less common in children is a short frenulum of the upper lip. In this case, it is necessary to dissect the skin that connects the upper lip to the gum. A shortened frenum of the tongue or upper lip in a newborn is not always detected during the examination conducted immediately after birth, so if you think that this is what is causing your nipples pain, seek medical advice as soon as possible. ⁴

Breastfeeding Tips

Wash your breasts with water only when you shower or bathe. Small bumps on the areola (Montgomery's glands) secrete oil that moisturizes and protects your nipples. Soaps and shower gels can strip away this natural defense, causing dryness and irritation. ⁶
Pat the nipples gently with a soft towel or simply let them air dry. In the past, women were often advised to rub their nipples to make them stiffer, but thankfully, such advice is a thing of the past!
Do not wash breasts or nipples before feeding. The bacteria found on the surface of the breast actually help the baby's intestinal microflora to develop. ⁷
Fresh breast milk helps to heal cracked nipples, ⁸ so rub a few drops of milk into them before and after feeding.
Change your bra pads often if they get wet. This will reduce the risk of bacterial and fungal infections, including thrush. ⁶
It is not necessary to increase the intervals between feedings to give the nipples a "rest". For a baby to be healthy and grow well, it needs to be fed on demand. Remember, frequent feeding stimulates and maintains milk production, so keep feeding despite the pain. ⁹

Healthy teat care products

Pure lanolin teat cleaner, a natural product derived from sheep's wool. It moisturizes and promotes healing of the nipples. This cream is safe for the baby, so it does not need to be washed off before feeding.
Hydrogel Pads* can be applied to sore nipples to relieve pain while feeding and help promote healing. They can even be stored in the refrigerator to enhance the soothing cooling effect.
Breast pads* fit into the bra. They help prevent nipple irritation from clothing and have air holes to help nipples heal.
Nursing Bras** are made from breathable material such as cotton or a special fabric that dries quickly and wicks moisture away from sore nipples.
Nursing pads* are special silicone pads that fit over the nipples. They have small holes through which milk flows when you are breastfeeding. The pads help to protect the skin underneath and help the baby to better latch on to the nipple by making the nipple stiffer. Do not use nursing pads for a long time. If you have problems or pain, contact your healthcare professional or lactation consultant.

When to Seek Medical Care

The soreness should go away as your nipples and baby get used to breastfeeding. It is worth repeating that the main cause of sore nipples is improper grip. If your lactation consultant has not been able to resolve your pain while feeding, see another specialist and a third if necessary.

If nipple pain persists or if you notice unusual symptoms, talk to your doctor. The appearance of white spots or flakes on the nipples may be a sign of thrush, whitish or bluish nipples may indicate a circulation disorder such as Raynaud's disease (vasospasm), and pus and redness indicate an infection. ²

Literature

1 Kent JC et al. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006;117(3): e 387-395. - Kent J.S. et al., "Amount and frequency of breastfeeding and fat content of breast milk during the day." Pediatrix (Pediatrics). 2006;117(3):e387-95.

2 Berens P et al. Academy of Breastfeeding Medicine. ABM Clinical Protocol#26: Persistent pain with breastfeeding. Breastfeeding Medicine. 2016;11(2):46-53. - Behrens, P. et al., Academy of Breastfeeding Medicine, AVM Clinical Protocol #26: Persistence of Breastfeeding Pain. Brestfeed Med (Breastfeeding Medicine). 2016;11(2):46-53.

3 Cadwell K. Latching - On and Suckling of the Healthy Term Neonate: Breastfeeding Assessment. J Midwifery & Women's Health. 2007;52(6):638-42. — Cadwell, K., "Latching and sucking in healthy newborns: evaluation of breastfeeding." F Midwifery Women Health. 2007;52(6):638-642.

4 Segal LM et al. Prevalence, diagnosis, and treatment of ankyloglossia: methodological review. Canadian Family Physician. 2007;53(6):1027-1033. - Segal L.M. et al., Incidence, Diagnosis, and Treatment of Ankyloglossia: A Methodological Review. Canadian Family Physic. 2007;53(6):1027-1033.

5 O'Shea JE et al. Frenotomy for tongue - tie in newborn infants. The Cochrane Library. 2017. - O'Shea J.I. et al., "Dissection of the frenulum in the newborn", The Cochrane Labrery (Cochrane Library), 2017.

6 Jacobs A et al. S3-guidelines for the treatment of inflammatory breast disease during the lactation period. Geburtshilfe und Frauenheilkunde. 2013;73(12):1202-1208. - Jacobs A. et al., "Recommendations S -3 for the treatment of inflammatory diseases of the breast during breastfeeding. Geburtskhilfe und Frauenheilkünde. milk bacterial communities and establishment and development of the infant gut microbiome JAMA pediatrics 2017;171(7):647-654 - P. S. Pannaraj et al. development of the neonatal gut microbiome." JAMA pediatric. 2017;171(7):647-654.

8 Mohammadzadeh A et al. The effect of breast milk and lanolin on sore nipples. Saudi medical journal. 2005;26(8):1231-1234. — Mohammedzade A. et al., "Effects of breast milk and lanolin on sore nipples." Saudi Medical Journal. 2005;26(8):1231-1234.

9 Kent JC et al. Principles for maintaining or increasing breast milk production. J Obstet , Gynecol , & Neonatal Nurs . 2012;41(1):114-121. - Kent J.S. et al., "Principles for Maintaining and Increasing Milk Production". J Obstet Ginecol Neoneutal Nurs. 2012;41(1):114-121.

Read instructions before use. Consult a specialist about possible contraindications.

* RC № № ФСЗ 2010/07352 dated 19.07.2010

** RU No. ФСЗ 2009/05592 dated 11.25.2009

Breastfeeding with pierced, flat or inverted nipples

The shape and size of nipples in different women can vary greatly. Our practical tips will help you make breastfeeding easier, no matter what your nipples are.

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Most women's nipples protrude, enlarge and swell when touched, but some have flat or even inward nipples. In addition, some women pierce one or both nipples. Usually flat, inverted or pierced nipples do not cause problems when breastfeeding, but in some cases additional help may be needed.

“Don't panic if you have flat or inverted nipples. As a rule, this does not interfere with breastfeeding in any way,” says Shawnad Hilton, a lactation consultant, health visitor and newborn care specialist who has worked with Medela in the UK for more than a decade. “Remember that your baby takes into his mouth not only the nipple, but also part of the breast. ”

However, in the early days, when the baby's mouth is still very small and suckling skills have not developed, inverted or flat nipples can make feeding difficult, especially if the baby is unwell or born prematurely.

“Flat or inverted nipples may not reach the baby's palate and therefore not trigger the sucking reflex,” Schoned explains. “That is, the baby may have trouble grasping and holding the breast in the mouth, and the baby will not get enough milk.”

How to tell if you have flat or inverted nipples

Flat nipples ¹ do not protrude much from the areola (the darker
area surrounding the nipple) even when stimulated.

Inverted nipples seem to be recessed in the center. They may look like this all the time or only if they are stimulated. Sometimes inverted nipples are on the same level with the areola, and sometimes even sink deep into the breast tissue.

This feature may occur on one or both nipples. It is estimated that approximately 10% of nulliparous women have at least one retracted nipple. ² If you're not sure what type of nipples you have, try a simple pinch test: Gently squeeze your breast with your thumb and forefinger on both sides of the areola. The nipple should come forward. If your nipple hides inside, creating a depression, then it is retracted.

Preparing inverted and flat nipples during pregnancy

You may have noticed that your breasts have changed during pregnancy and your nipples have become more protruding. If this does not happen and you are worried that the shape of your nipples will make breastfeeding difficult, try using nipple formers* in consultation with your doctor. These are soft and flexible silicone discs that are discreetly placed in the bra and slightly squeeze the nipples, helping to pull them out.

“In a normal pregnancy, nipple formers can be worn from 32 weeks,” advises Schoned. - Start wearing them for an hour a day, gradually increasing the time to eight hours. If you have an incompetent (weakened) cervix or are at risk of preterm labor, check with your healthcare provider about when you can start using shapers, as nipple stimulation can trigger contractions. ”

“Nipple formers can continue to be worn after childbirth,” adds Schoned. “Try to put them in a bra 30 to 60 minutes before feeding.”

“I have inverted nipples, and after two or three weeks of constantly trying to latch on, I almost switched to formula,” recalls Nina, a mother from Germany. “I turned to La Leche Liga for help, and one nice woman came to me and supported me to continue to feed. She suggested trying nipple shapers and they really helped me. Somehow my baby began to understand what to do! Breastfeeding went well and I nursed him until he was 21 months old.”

How to help your baby latch on to flat or inverted nipples

If your baby enjoys sucking on your thumb but isn't as interested in your breasts, chances are your nipple isn't reaching the palate. The baby may become nervous, push off the breast and cry or even fall asleep on your chest. If this happens, ask a lactation consultant or healthcare professional to check the grip.

There are several tricks you can use before every feed to make your nipples more comfortable to latch on to. Schoned recommends the following:

twist the nipple between thumb and forefinger so that it protrudes better;
Place fingers in a "V" or "C" shape and squeeze the breast just behind the areola to push out the nipple;
apply a cold compress or ice cube to the nipple to push it forward;
Express milk manually or with a breast pump for a couple of minutes before feeding so that the nipple comes out more.

“I had a flat nipple, but I only found out when I noticed Austin was having a hard time sucking on that side,” says Jennifer, mother of two in the UK. “From an anatomical point of view, there is nothing abnormal in this, it’s just that my nipple does not protrude so much, and this requires some skill when feeding. Before giving this breast, I always pinched and squeezed the nipple a little and tried to put it into the baby's mouth. It was a little difficult at first, but over time I learned.”

Using nursing pads

If none of the above work and your baby still has difficulty latch-on, your lactation consultant or healthcare professional may recommend that you breastfeed with a nursing pad*. They are thin and flexible nipple-shaped silicone funnels with holes at the tip through which milk will flow.

It is easier for the baby to put the feeding pad in his mouth, as it is larger and more rigid. In addition, such an overlay will reach him to the sky, causing a sucking reflex. Do not use nursing pads for a long time. If you experience pain or other problems, contact your lactation consultant or healthcare professional to check that your baby is latching on properly with a breastfeeding pad. You will also need to monitor your baby's weight gain to ensure that milk production is meeting his needs. ³

Over time, as your baby learns to suckle properly and your nipples get used to breastfeeding, you will be able to breastfeed without breast pads.

“My nipples are rather flat. The doctor advised me nursing pads, and I was successfully able to feed my two babies,” says Ann-Sophie, mother of two from Sweden. “My secret is to make them adhere better to the skin, I lightly wet the edges before use. ”

Breastfeeding with pierced nipples

Many women with pierced nipples find it does not affect their ability to breastfeed. However, jewelry must be removed before feeding, as the child may choke on them or injure their tongue, gums or palate.

“I had a nipple piercing, but I got it off a year later when I got pregnant because my breasts were very sensitive,” says Kelly, mother of three from the UK. “I breastfed my daughter exclusively, and then her two younger brothers, and never had any problems. And the pierced nipple was my favorite!”

Some women report that milk can leak from piercings, while others believe that piercing scars reduce milk production ⁴ - but this has not been well researched.

“You can't predict how a piercing will affect breastfeeding until milk production begins,” Schoned explains. - If you are concerned, talk to a lactation consultant or healthcare professional. And remember that one breast may be enough for babies to get the nutrition they need if there are problems with the second. ”

What to do if you can't breastfeed with flat or inverted nipples

If you've tried all the options and still can't breastfeed, you still shouldn't deprive your baby of breast milk.

“Mom and baby's health is the most important thing,” says Schoned. “Maybe you should switch to full pumping and feed your baby only expressed milk. You can also try the supplementary feeding system** where the baby continues to feed at the breast while receiving additional expressed milk through a tube. That is, the baby will still suck on the breast and stimulate the production of milk, which, in turn, will help you pump even more.

“I have inverted nipples. After the disastrous experience of breastfeeding my first son with my second, I decided to get my way after all,” says Babettli, mother-of-two from Italy. - On the advice of experts, I tried nipple formers and nursing pads, but everything was unsuccessful. In the end, pumping with the Medela Symphony*** Double Electronic Clinical Breast Pump proved to be the best solution for us. I fed exclusively on expressed milk for up to four months.”

Care for different types of nipples

Flat or inverted nipples may require extra care as the baby may squeeze them harder and they may become inflamed at first. Tips on how to care for sore nipples can be found in Nursing Nipple Care.

If your nipples become inverted after a feed, any moisture can lead to inflammation and increase the risk of infections, including thrush. Blot your nipples dry after each feed before they have time to hide inside.

With swelling of the mammary glands, when even protruding nipples can become flat, flat or inverted nipples can be difficult. Read the helpful tips in the article on breast swelling.

The good news is that continuous breastfeeding or pumping can change the shape of your nipples and breastfeeding will become easier over time. With the arrival of the next child, you may not have to face this problem at all, as happened with Leanne, a mother of two from the UK.

“The second feeding was like a fairy tale,” she says. “After almost four months of pumping for my first son, my flat nipples were so extended that with my second son I no longer had to use breast pads - he was able to suck directly from the breast. The youngest is now nine months old and I still breastfeed him.”

Literature

1 Pluchinotta AM. The Outpatient Breast Clinic. Springer International Publishing ; 2015. - Pluchinotta A.M., "Treatment of breast diseases on an outpatient basis". Springer International Publishing. 2015.

2 Alexander JM, Campbell MJ. Prevalence of inverted and non-protractile nipples in antenatal women who intend to breast-feed. The Breast . 1997;6(2):72-78. — Alexander JM, Campbell MJ, "Prevalence of inverted and intractable nipples in pregnant women who intend to breastfeed." Ze Brest (Chest). 1997;6(2):72-78.

3 McKechnie AC, Eglash A.

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