Why do nipples bleed when breastfeeding

Cracked or bleeding nipples - BabyCentre UK

In this article

• What causes cracked nipples when breastfeeding?
• Bleeding nipples or blood in breastmilk
• What else can cause cracked and bleeding nipples?
• What can I do to heal my cracked nipples?
• Can I still breastfeed my baby with cracked nipples?

If your nipples are so sore when you're breastfeeding that they're cracked and bleeding, it probably means that your baby is not latching on well. Breastfeeding shouldn’t hurt, although your nipples and the area around them (areola) may feel tender while you’re getting used to it. Breastfeeding is a lovely way to bond with your baby but the last thing you want is to be wincing with pain each time you settle down for a feed. Ask for help from your midwife or health visitor if you have cracked nipples while you’re breastfeeding.

What causes cracked nipples when breastfeeding?

If your baby can’t take a big mouthful of your breast when they latch on, your nipple may become squashed in your baby’s mouth. It can get squashed between your baby’s tongue and the roof of their mouth (hard palate).

This will make your nipples sore, and before long, cause them to crack and bleed.

Helping your baby to get a good latch should sort this out. Ask your midwife or health visitor for support, or visit a breastfeeding drop-in centre, such as a Baby Cafe, to pick up tips on breastfeeding. You may only need to make a slight change in the way you breastfeed to see an improvement.

Bleeding nipples or blood in breastmilk

Sometimes mums who express their breastmilk notice that it's tinged with blood in the first few days of feeding, making their breastmilk pink. If your nipples aren't sore or cracked, this is usually nothing to worry about.

It’s caused by increased blood flow to your breasts, and the growth of milk-producing tissue. If you still notice a pinkish tinge to your breastmilk after your first week of breastfeeding, talk to your midwife.

What else can cause cracked and bleeding nipples?

Having very dry skin or eczema can cause cracked, sore and bleeding nipples. If you have an eczema-like condition on your nipples or breasts, it may be caused by:

• irritants in a cream, lotion, soap or perfume
• washing detergent left on your clothes

Using a breast pump incorrectly can damage your nipples in the same way as a poor latch. Be careful if you express milk with a pump. Try adjusting the suction to see if it helps, and take it slowly. Check that the funnel is big enough so that your nipple is not catching on either side of it. This can happen if the funnel is too small. Most breast pumps come with one funnel, so you may need to buy a larger funnel separately.

If your nipples are sore, burning or itchy in between feeds, or if they have a red, flaky rash, you may have a thrush infection on your breasts. Thrush can occur if you or your baby have recently had a course of antibiotics. Read more about breastfeeding and thrush.

If your breasts become engorged and swollen, it can affect the nipples too, pulling them into a flatter position than normal and making it harder for your baby to latch on. This may also cause your nipples to crack and bleed.

What can I do to heal my cracked nipples?

Ask your midwife or health visitor for advice, or ask them to put you in touch with a breastfeeding specialist. Improving the way your baby latches on to your breast is the first thing to try to help cracked and sore nipples.

Your midwife, health visitor or breastfeeding specialist can watch you feed your baby, and help you get your baby latched on correctly.

How to get a comfy attachment

Getting your baby to latch onto your breast comfortably can take practice. Look out for these tell-tale signs that your baby is feeding well. More baby expert videos

See pictures in our how to breastfeed article to help you set up a good latch.

Express a few drops of breastmilk to dab on your nipples. Breastmilk contains substances that aid healing and fight infection.

You could also try smoothing a thin layer of soft white paraffin jelly, or nipple cream, on your nipples. A small amount may help to ease your pain and speed up healing, without forming a scab. Always wash your hands before you dab anything on your nipples, to guard against infection. Use the cream after each feed even if you don’t feel pain straight away, as this will help prevent soreness.

You won’t need to wash the ointment off your nipples before feeds, but using too much may mean your baby can't latch on properly because your breast is slippery. This may result in your nipple slipping forward in your baby's mouth and pressing on their hard palate, making your soreness worse.

Some mums try highly purified anhydrous (HPA) lanolin to ease their cracked nipples, which may help to reduce nipple pain. If you're prone to eczema though, there's a chance that lanolin could irritate your skin, making you more sore.

Washing, or having a bath with plain water, is all it takes to keep your breasts and nipples clean. There's no need to wash with soap or use scented lotions and they could irritate your nipples further.

If your nipple pain is severe, it's fine to take paracetamol or ibuprofen according to the dosage on the packet.

Wear a cotton bra so air can circulate around your nipples. If you’re using breast pads, avoid using pads with a plastic backing and change to fresh, clean breast pads at every feed.

If a crack or wound shows no sign of healing despite your efforts, see your doctor, midwife or health visitor.

Can I still breastfeed my baby with cracked nipples?

Your baby won’t be too bothered about your cracked nipples. A little blood won’t put them off your milk, and as long as you can bear it, you can carry on breastfeeding. The important thing is to get your baby feeding efficiently, so your nipples have a chance to heal.

Some mums find nipple shields useful while their nipples are healing.

If you are using nipple shields, ask your midwife, health visitor or lactation consultant to check your latch so that you can get back to feeding without the shields as quickly as possible.

Nipple shields can encourage your baby to nipple feed as opposed to breastfeed, making the problem worse. So they're only ever a temporary fix and should only be a last resort.

Making sure that your baby is latched on well will benefit them as much as it will help you. If your nipples are cracked because your baby isn’t latched on well, they probably aren’t getting a full feed. Feeds may drag on without your baby sucking efficiently.

If you’re finding it impossible to feed, try gently expressing your milk and giving it to your baby by bottle or open cup, in the meantime. Find out how to store expressed breastmilk safely.

Most nipple pain should improve in seven days to 10 days, even without treatment. As long as you address the underlying cause, you and your baby will soon be able to enjoy breastfeeding again.

Read more:

• Find out the benefits of breastfeeding.
• Try out these different breastfeeding positions to see if they help your baby get a better latch.
• How to cope with breast pain while you breastfeed.

References

Bonyata K. 2018. Healing tips for nipple cracks or abrasions. Kellymom.com. [Accessed January 2021]

Coentro VS, Perrella SL, Lai C et al. 2020. Effect of nipple shield use on milk removal: a mechanistic study. BMC pregnancy and childbirth, 20(1), 516. https://doi.org/10.1186/s12884-020-03191-5 [Accessed January 2021]

Dennis CL, Jackson K, Watson J. 2014. Interventions for treating painful nipples among breastfeeding women. Cochrane Database Syst Rev. Dec 15;(12):CD007366. doi: 10. 1002/14651858.CD007366.pub2. [Accessed January 2021]

Jackson KT & Dennis CL. 2017. Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial. Maternal & child nutrition, 13(3), e12357. https://doi.org/10.1111/mcn.12357 [Accessed January 2021]

LLLGB. 2016. Comfortable breastfeeding. La Leche League GB. www.laleche.org.uk. [Accessed January 2021]

LLLI. nd. Color of milk. La Leche League International. www.llli.org. [Accessed January 2021]

Mariani Neto C, de Albuquerque RS, de Souza SC et al. 2018. Comparative Study of the Use of HPA Lanolin and Breast Milk for Treating Pain Associated with Nipple Trauma. Rev Bras Ginecol Obstet. 2018 Nov;40(11):664-672. doi: 10.1055/s-0038-1675180. [Accessed January 2021]

NHS. 2019. Sore or cracked nipples when breastfeeding. NHS Choices, Health A to Z. www.nhs.uk. [Accessed January 2021]

NHS. 2018. Breastfeeding and thrush. NHS Choices, Health A to Z. www.nhs.uk. [Accessed January 2021]

NICE. 2017. Breastfeeding problems. National Institute for Health and Care Excellence Clinical Knowledge Summaries.cks.nice.org.uk. [Accessed January 2021]

Santos, KJ, Santana, GS., Vieira, T et al. 2016. Prevalence and factors associated with cracked nipples in the first month postpartum. BMC pregnancy and childbirth, 16(1), 209. [Accessed January 2021]

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Sore, cracked or bleeding nipples

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Sore, cracked or bleeding nipples are common. Some mothers have such trouble with them that they stop breastfeeding early.

As a new mother, you may find it could take a few days or weeks to adapt to the strong suck of a healthy baby on your breasts.

It is normal for your breasts to become more sensitive in the first weeks after you have given birth. They may sting, burn, ache or feel tender. Over time, the discomfort and sensitivity should resolve.

If you have sore nipples, it may be that your baby isn’t attaching properly to your breast. This pain usually lasts about half a minute while baby first draws your nipple into their mouth.

Try to make sure your baby’s mouth is attached correctly for suckling from the very first breastfeed.

If you do not correct your baby’s latch, your nipples could be damaged, which causes problems like mastitis (infections).

How to get baby to attach to your breast correctly

• Make sure you are sitting or lying comfortably. Position your baby’s chest against your chest, with their mouth and nose facing your nipple.
• If you are lying down, let your baby’s cheek rest against your breast. If you are sitting up, lift your breast slightly so it does not press on your baby’s chin.
• Position your baby so the first contact point is their chin on your areola — the coloured area around your nipple.
• Bring your baby’s head to your breast, not the breast to baby’s head. Support your baby to move to where they are trying to go — towards your nipple.
• Ensure the nipple and much (or all) of the areola and some surrounding breast are in your baby’s mouth.

After a few rapid gulps, your baby should start to suck and swallow in a regular rhythm. Once you have got the hang of it, breastfeeding can be enjoyable and should not be painful.

How to manage sore nipples

Before putting baby to the breast

Wash your hands and sit in a comfortable position and try to relax. Apply a warm washer to the breast and gently massage or express to help milk flow. Express some milk to soften the areola to lubricate the nipple.

At the breast

Poor attachment is a key cause of sore nipples. Make sure the way your baby latches to your breast is correct. If you are not sure, ask for help from a health professional.

If the attachment feels uncomfortable after 30 seconds, break your baby’s suction by putting your finger in the corner of their mouth. Take your baby off and let them re-latch to your breast. Try different feeding positions. If your nipples are tender, limit your baby’s comfort sucking.

After the breastfeed

Check your nipples for redness and misshapen appearance. Wipe your breasts with clean water and let them dry. It can help to leave your bra off for a while and allow your nipples to air. Make sure your bra fits.

When expressing milk, make sure that the suction on your breast pump is not too strong. If the pain in your nipples increases after the first week, talk to a health professional.

Finding the cause of cracked or bleeding nipples

You will need to work out the source of your nipple problems. The first thing to do is to check if your baby is latching on correctly. You may need to ask a health professional for assistance. They can also check your baby for problems with their lips and tongue and whether you have medical problems like dermatitis or nipple infection. If you use a nipple shield, make sure it is the correct size and if you’re using a breast pump, make sure you’re doing it properly.

How to treat cracked or bleeding nipples

There are a number of things you can do to treat cracked or bleeding nipples.

• Look after your nipples: wash your nipples with water after every feed and clean and sterilise your nipple shield after each feed.
• If you can, continue breastfeeding (it is quite safe for baby to feed on a bleeding nipple). But if it’s too painful, you may need to take your baby off the breast for 24 to 48 hours, rest the nipple and feed your baby expressed breast milk. Gradually reintroduce the breast after resting for a short time and take special care with positioning and attachment.
• If you’re going to take pain-relieving medication, talk to your doctor or pharmacist. Many household remedies are ineffective or harmful.

The Australian Breastfeeding Association has more tips on treating sore or cracked nipples.

If you need further help or are experiencing prolonged abnormal breast pain, contact your doctor, lactation consultant, breast feeding counsellor, child health nurse or Pregnancy Birth and Baby on 1800 882 436.

Sources:

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Last reviewed: December 2020

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Related pages

• Expressing and storing breast milk
• Breastfeeding your baby

Need more information?

Nipple infections | Australian Breastfeeding Association

About 10% of breastfeeding mothers experience nipple/breast pain (not associated with breast redness or fever) that is often described as one or more of the following: ‘burning’, ‘stabbing’, ‘knife-like’, ‘shooting’, ’sharp’. It is possible that such pain is caused by a nipple infection, especially when baby is attaching well to the breast, it is beyond the first week and other causes of nipple pain/trauma have been ruled out (e.g. tongue tie). This article provides information about the causes and symptoms of nipple infection.

Read more on Australian Breastfeeding Association website