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Tender nipples breastfeeding pregnancy


Nipple Pain Remedies - American Pregnancy Association

Breastfeeding is a natural process for you and your baby. A healthy full-term baby instinctively knows what to do when presented with your breast. You may experience nipple pain in the early days of breastfeeding. As many as 90% of new moms have some nipple soreness. It is a very common condition that is temporary, usually going away after a few days. Most mothers find nipple soreness peaks on the fifth day of breastfeeding and then resolves.

Luckily, there are some strategies to ease the hurt and help your nipples heal quickly! Below we will discuss some reasons for nipple pain and some strategies to overcome it.

Should I Continue Breastfeeding?

It is very important to continue to breastfeed if you are experiencing nipple pain. Try to nurse your baby on the least painful nipple first; she will not suck as hard on the second, more painful nipple. If putting your baby to breast hurts too much, use a breast pump or hand-express to keep your milk supply flowing.

Your breast milk can also help your nipples heal with antibacterial protection. If you have a crack in your nipple or broken skin, squeeze out a few drops and gently rub over your nipple. Let your nipples air dry before covering with your bra or nursing pad.

What Causes Sore Nipples During Breastfeeding?

There may be quite a few causes of sore nipples, including:

    • Improper or incomplete latch
      • Slippage during feeding
      • Baby is tongue-tied (restricted or shortened frenulum)
      • Having inverted or flat nipples
      • Feeding too late (early vs. late feeding cues)
    • Body positioning during breastfeeding
    • Stopping a breastfeeding session without first breaking the suction
    • Wearing bras that are too tight on the nipples

Nipple Pain Remedies & Preventative Measures

If your nipple pain persists for more than 7 days, goes away and then returns, or your nipples are actively bleeding, see your lactation consultant or healthcare provider for evaluation.

Research shows warm, moist heat is soothing for sore nipples and can help your skin heal faster. To use moist heat, run a clean washcloth or cloth diaper under warm (not hot) water, squeeze out the extra water and place it directly over your nipple. When it cools to room temperature, repeat the process. Many mothers find this method is also helpful in relieving the discomfort of engorgement, which can occur along with nipple soreness.

Another natural avenue to help nipple pain and healing is to hand express a small amount of milk and gently rub or pat it into your nipple. Be sure to let this air dry before putting your nursing bra back on.

Reverse pressure softening can be a helpful remedy or preventative measure if there is a great deal of swelling in the breast (there could be excessive swelling from IV fluids during birth or breast engorgement that makes it hard for the baby to reach or latch onto the nipple). Using gentle pressure from one or two fingers around the nipple base can move some of this swelling away from the nipple.

Proper Latching (Preventative)

Nipple pain may come if your baby does not hold a tight or proper latch. If you bring your baby to the breast when he/she is crying and is “desperate” for milk, the baby may not have/take the time to create a proper latch and this can cause problems for mom’s nipples and baby’s drinking.

To prevent this, look for early hunger cues (vs. late cues like crying) such as the baby opening his mouth, sucking on his fingers or hands, and/or moving his head in a side-to-side motion.

A proper latch starts with the baby’s mouth open wide (like a yawn), with his tongue cupped and forward. If you think your baby has latched incorrectly, don’t be afraid to break the suction gently (placing a finger in the side of baby’s mouth) and reposition.

Body Positioning

Here are the most common breastfeeding positions. If you are experiencing pain, consider trying another position to see if this allows you & your baby to create a better latching environment.

  1. Laid Back/Lying Down:  (bed, couch, chair) Lie down. Position your baby’s front against your front so that your body lengths are parallel, with his cheek resting on one breast. Support the baby’s bottom and/or feet while feeding.
  2. Cradle:  (chair) Lean slightly back, don’t hunch over. Whichever breast you choose to feed on, that forearm will support your baby. Position your baby’s front toward your front and have him rest on your arm, perpendicular to your body length.
  3. Cross Cradle:  (chair) This is very similar to the cradle position, but uses a pillow on your lap to support the baby instead of your arm/forearm, with your hand supporting baby’s head.
  4. Football/Clutch:  (chair) Also very similar to the cradle position, but for this one, the baby should be under your arm (the same side as the breast you feed on). Pillows should support the baby’s weight.

La Leche League provides more complete information on breastfeeding positions.

Creams and Products

While most creams and ointments don’t make your nipples heal faster, they do create a soothing barrier for your tender nipples. Avoid ointments containing lanolin as they can cause allergic reactions and have a strong smell and flavor which can cause your baby to refuse to breastfeed. Newer ointments are olive oil-based and have little smell or taste to interfere with your baby’s senses.

You may also want to find a nipple cream which includes Self Heal and/or Calendula to help heal in addition to soothe sore nipples.

Hydrogel pads are another product that creates a soothing barrier for sore nipples. These thin sheets of silicone-like material are about the size of your areola and can provide relief from material (nursing pads, bra cup) rubbing against your nipple.

If nipple pain worsens after the early days of breastfeeding your nipple pain may be due to other causes like thrush, bacterial infection, or tongue-tie. Consult your healthcare professional for help.

 

Compiled using information from the following sources:

1. La Leche League International. Breastfeeding with Sore Nipples.

https://www.llli.org/breastfeeding-info/breastfeeding-sore-nipples/

2. McClennan, HL, et al. (2012).Nipple Pain during Breastfeeding with or without Visible Trauma
Journal of Human Lactation, November 2012; vol. 28, 4: pp. 511-521., first published on June 11, 2012.

3. Cable, B., Stewart, M., Davis, J., (1997) Nipple Wound Care: A New Approach to an Old Problem.

Sore or cracked nipples when breastfeeding

If you get sore nipples when breastfeeding, it's usually because your baby is not positioned and attached properly at the breast.

It's important not to stop breastfeeding. With help, feeding should quickly become more comfortable again.

Get help early for sore nipples

If you find 1 or both nipples hurt at every feed, or your nipples start to crack or bleed, it's important to get help from your midwife, health visitor or breastfeeding supporter as soon as you can.

They can watch as you feed your baby and help you get them correctly positioned and attached to the breast.

When your baby is effectively attached, your nipple rests comfortably against the soft palate at the back of their mouth.

If your baby is poorly attached to the breast, the nipple is nearer the front of their mouth and can be pinched against the hard palate, causing pain.

Flattened, wedged or white nipples at the end of a feed are a sign your baby may not be properly attached. Your baby may also seem unsettled after feeds.

Having sore nipples when you're trying to breastfeed a new baby can be stressful and upsetting.

Try to carry on breastfeeding or express milk by hand if you can, and ask for help early.

Learn more about expressing milk by hand

Self-help tips for sore nipples

Bear in mind that self-help tips will not be effective if your baby is poorly attached during breastfeeds.

But you may find it helps to:

  • change breast pads at each feed (if you're using them) – if possible, use pads without a plastic backing
  • wear a cotton bra so air can circulate
  • keep feeding your baby for as long as they want – keeping breastfeeds short to "rest" your nipples will not ease nipple pain and could affect your milk supply
  • avoid using nipple shields (a thin, protective cover worn over your nipple as you breastfeed) or breast shells (a hard, protective cover worn inside your bra) – these will not improve your baby's attachment to the breast

If your nipples start to crack, try dabbing a little expressed breast milk onto them after feeds.

Important: Important

Get help early if your nipples are cracked or bleeding, as this increases your risk of getting an infection in your nipple.

If nipple pain does not improve

If your baby is properly positioned and attached at the breast during feeds and your nipples are still sore, ask your midwife, health visitor or breastfeeding supporter for help.

There may be an underlying problem, such as an infection like thrush.

Find out more about breastfeeding and thrush

Video: How do I know if my baby is properly latched?

In this video, a midwife talks about how to check if your baby is latched on properly when breast feeding.

Media last reviewed: 4 October 2022
Media review due: 4 October 2025

Page last reviewed: 8 November 2022
Next review due: 8 November 2025

Breast changes from the beginning of pregnancy to the end of breastfeeding

Medela's experts explain the changes that occur in the breast from the beginning of pregnancy to the end of breastfeeding, as well as tips for taking care of your breasts throughout this period.

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From the moment of conception, your body begins to prepare for the birth of your baby. This applies not only to the uterus - the anatomy of the breast also changes radically. This article will tell you what to expect in each trimester, during and after breastfeeding.

First trimester breast changes

Early in pregnancy, many women notice changes in their breasts. Moreover, often they become the first signs of pregnancy. Fluctuations in hormone levels and changes in the structure of the mammary glands can cause increased sensitivity and soreness of the nipples and breasts as early as the third or fourth week. For some pregnant women, breast tenderness persists until childbirth, but for most it goes away after the first trimester.

“Sometimes during pregnancy, breasts grow very quickly in the first weeks, and sometimes their size increases gradually,” says Dr. Jacqueline Kent, a leading lactation specialist at the University of Western Australia. “All women are different. For some, breast size may not change much until childbirth or even after them. In general, we can say that by the time the milk arrives, the breast will most likely become one and a half times larger than before pregnancy! 1

As soon as your regular bras start to feel tight (usually around 12 weeks), it's time to buy a maternity bra. The most comfortable, according to many women, are seamless models with wide straps made of soft, breathable fabric. It is best to avoid underwired bras as they can put pressure on the developing milk ducts.

It is important to take your measurements correctly in order to find the right bra with a good fit. Take measurements every couple of months, as you may need a different size bra as your baby grows and your breasts get bigger.

Breast changes in the second trimester

From about the 15th week of pregnancy, newly formed cells that produce milk are activated in the breast, and by about the 22nd week, production begins. 1 But don't worry - most of this milk will be absorbed by the body without going out, as pregnancy hormones prevent it from being overproduced or excreted.

“During the second trimester, you may notice that the nipples and areolas (the areas of skin around the nipples) become darker and larger,” says Dr. Daniel Prime, Medical Research Associate at Medela. tubercles - the so-called glands of Montgomery. They secrete oil that moisturizes the nipples and will protect them from inflammation and infection when you start to feed. Scientists believe that the smell of this fat is similar to the smell of amniotic fluid and helps the newborn baby find the nipple.” 2

Do not use harsh soap for breast hygiene and do not rub hard with a towel as this can damage this natural lubricant. Just wash your breasts with warm water and pat dry. And if someone tells you to pinch or rub your nipples to prepare them for breastfeeding, don't listen to them!

If you have flat or inverted nipples, your pregnancy is over 32 weeks, and your pregnancy is normal, you can try inserting special nipple formers* into your bra in consultation with your doctor. They help to gently pull out the nipples so that it is easier for the newborn to grasp them. Consult your healthcare professional or read our article on flat and inverted nipples to learn more.

If breast size increases dramatically during pregnancy, breast skin may itch and stretch marks may appear on it. A good moisturizer can help soothe itching. The appearance of stretch marks usually depends on genetics and skin type. If you have a predisposition to stretch marks, it is unlikely that you will be able to prevent them, but, fortunately, over time they will become lighter and less noticeable.

Breast changes in the third trimester

In the last trimester, you may again have soreness and heaviness in your chest. A sleep bra will keep you comfortable at night, while a supportive sports bra will help you avoid soreness and ligament damage during exercise.

Don't forget to buy a pair of nursing bras one month before your baby is born. If possible, consult a specialist in the store or study the online guide to select the appropriate model and size. Every woman is different, but usually cups of a nursing bra are chosen one or two sizes larger than before pregnancy. The underbust girth may also increase as the ribcage expands to provide enough room for the baby. The sales assistant should choose the size of your bra, taking into account the appearance of milk after childbirth. Models with fasteners that can be unfastened with one hand make it easier to attach the baby to the breast.

Surprising but true: milk appears in the breast even before the baby is born. This is why your nipples may start to produce some colostrum (the first breast milk), which will be quite thick and sticky. Sometimes this happens as early as 14 weeks, but more often it still happens in late pregnancy. To avoid the appearance of stains and smudges on clothes, you can use special bra pads.

“If you have diabetes or have been diagnosed with gestational diabetes, your doctor may tell you to express some colostrum by hand and freeze it. A recent study showed that after the 36th week it is quite safe if the pregnancy does not have other complications, 3 , says Dr. Prime, “Storing colostrum can come in handy because babies with diabetic mothers are at higher risk of hypoglycemia (low blood sugar), and frequent colostrum feeding is the best remedy. . However, be prepared for the fact that there will be very little colostrum. You may only be able to express a few drops at first, and that’s perfectly fine.”

What happens to the breast after childbirth

Approximately two to four days after the baby is born (sometimes later if there was a caesarean section or a traumatic delivery), you will feel your breasts becoming heavier and firmer - this means that the milk has come. 4

“This breast fullness is not only due to excessive milk production – there is also an increase in the amount of blood circulating around the breast and the volume of lymphatic fluid,” explains Dr. Prime, “All this is the result of a gradual decrease in pregnancy hormone levels that began after the birth of a child and which allows the hormones responsible for the production of milk to enter into work.

During this period, you may experience soreness and discomfort in your breasts, a condition called breast swelling. This is quite common and usually resolves after a few days, during which time breastfeeding must continue. Read on for our tips on how to relieve swelling and discomfort, and if the problem persists, see a lactation consultant or healthcare provider.

What happens to the breast during lactation

For about the first three months of breastfeeding, your breasts are likely to fill up a lot before feeding. Over time, you may notice that your breasts become less full, but this does not mean at all that your milk production has decreased. If you are breastfeeding your baby exclusively and on demand, and at the same time he is growing well, then everything is in order with the amount of milk.

“Be prepared for the fact that after six months of breastfeeding, your breast size will begin to decrease,” Dr. Kent explains, “This is not a sign that your body is producing less milk. Most likely, the amount of adipose tissue in the breast simply decreased. By the time your baby is 15 months old, your breasts may be back to their pre-pregnancy size, but not smaller. However, whether you continue breastfeeding or not, you may still produce 100 to 300 ml of milk per day.”

This may be due to the start of more efficient milk production after six months of breastfeeding, which, according to Dr. Kent's research, may be the result of redistribution of breast tissue. 5

How your breasts change after you stop breastfeeding

When you finally stop breastfeeding—be it after three weeks, three months, or three years—the breast changes associated with lactation disappear. “After the complete cessation of breastfeeding, the breasts, as a rule, return to the size that they were before pregnancy. This usually happens in about three months, and for someone else while breastfeeding,” Dr. Kent explains, “If you get pregnant again, the whole process starts all over again. ”

Literature

1 Cox DB et al. Breast growth and the urinary excretion of lactose during human pregnancy and early lactation: endocrine relationship. Exp Physiol . 1999;84(2):421-434. - Cox D.B. et al., "Breast growth and urinary lactose excretion during pregnancy and lactation: an endocrine relationship." Exp Physiol. 1999;84(2):421-434.

2 Doucet S et al. The secretion of areolar (Montgomery’s) glands from lactating women elicits selective, unconditional responses in neonates.PLoS One . 2009;4(10): e 7579. - Doucet S. et al., "Papillary gland secretion (Montgomery's glands) in lactating women induces a selective unconditioned response in the newborn." PLOS One. 2009;4(10):e7579.

3 Forster DA et al. Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomized controlled trial. Lancet. 2017;389(10085):2204-2213. - Forster D.A. et al., "Women with Gestational Diabetes are Recommended to Express Milk Late in Pregnancy (Diabetes and Antenatal Pumping [ DAME ]): A Multicenter, Open, Randomized, Controlled Trial. Lancet (Lancet). 2017;389(10085):2204- 2213.

4 Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals, Geneva : World Health Organization ; 2009. AVAILABLE FROM : https://www.ncbi.nlm.nih.gov/NBKS/NBK148965/ - "POSTICION" POSTICION "POSTRISS" POSTRIMENT "POST textbook for students of medical and related professions. Geneva: World Health Organization, 2009. Article cited: https://www.ncbi.nlm.nih.gov/books/NBK148965/

5 Kent JC et al. Breast volume and milk production during extended lactation in women. Exp Physiol. 1999;84(2):435-447. - Kent J.S. et al., "Amount and production of breast milk during long-term lactation in women". Ex Physiol. 1999;84(2):435-447.

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

* RU № ФСЗ 2010/07352 of 07/19/2010

Care for nipples for nursing mothers | 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:
Schoned, a mother of three, 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 become larger and more sensitive. When a newborn baby begins to suck on the breast, it creates a certain pressure, and this is a completely new and unfamiliar sensation for a woman (at least for a first-time mother).

Breastfeeding can be prolonged for a long time, sometimes up to an hour, and the child may ask to breastfeed 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 baby latch on

The key to pain-free breastfeeding is the correct grip. 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 with which the tongue is attached at 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 for nipples

  • 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 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 Nipple Care Products

  • Nipple Care made from pure lanolin, 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 inside a bra. They help prevent nipple irritation from clothing and have air holes to help nipples heal.
  • Nursing Bras** are made from a 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.

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