Breastfeeding should NOT hurt. Sore nipples are NOT a normal part of breastfeeding!

Although transient, initial sensitivity is common during the first seconds of breastfeeding in the first week or two, pain that persists or worsens and nipple damage are red flags for underlying problems. Although each woman perceives “sensitivity” and “pain” at varying thresholds, there is a difference between these words.

Poor or incorrect latch is the most common cause of sore or damaged nipples. Nipple pain and damage are in NO WAY related to your skin type, colour or prior nipple preparation. Your nipples are designed for breastfeeding and need no preparation whatsoever. As a matter of fact, so-called nipple preparation can cause serious damage to nipple tissue, and in some cases, premature labour (see "Preparing for Breastfeeding").

If your nipples are tender beyond a few seconds when your baby latches on, or so painful that you cannot, or do not want to breastfeed, the suggestions below may help. Too many new mothers are wrongly told that their baby's latch is fine in spite of persisting pain. Whomever tells you this is unfortunately misinformed or lacks the skills and experience to identify the problem. However, pain does not lie and should be taken seriously. Do not wait to contact a skilled lactation professional, such as your local IBCLC. Together, you and she will seek out the cause of your pain, whether it be poor latch, infection or other. There is always a solution before giving up!

SUGGESTIONS

1. Identify and correct the cause of your sore nipples. Have a skilled professional observe you while you nurse your baby.

2. Position yourself so that you are sitting upright with a pillow behind you and your knees higher than your hips.

3. Position your baby at the breast so that he is able to get a large amount of the areola into his mouth, and not latch on just to the nipple. Latch should be asymmetrical, meaning your baby should take in a larger portion of the breast with the lower jaw.

4. Treat any engorgement you may have. Engorged breasts may make it difficult for your baby to latch on properly. Engorgement, if left untreated, can seriously jeopardise your milk supply, as well as be extremely painful.

5. Reposition your baby's lips if they are not flanged out.

6. Air-dry your nipples well after each feeding and/or pumping. Leave your breasts exposed to air as much as possible.

7. Opt for relatively short, frequent feedings, rather than longer, spaced out feedings. Use breast compression to make feedings more efficient. If possible, vary positioning to minimise pressure on the affected area.

8. Offer the least sore side first. However, do not neglect the sore side.

9. Massage the breasts before nursing, to stimulate the letdown reflex. By doing this, you reduce the time that the baby spends suckling more rapidly and vigorously to stimulate letdown, which can often be most uncomfortable for sore, damaged nipples.

10. When using a breast pump, apply olive oil to the nipple and areola before pumping to prevent the discomfort of friction on sore areas. Begin with the pressure setting on low. Increase the pressure as your pain tolerance allows.

If the pain persists or worsens, seek help from a skilled professional (IBCLC or nurse/physician with experience in breastfeeding management).

See also Dr. Jack Newman's article "Sore nipples"

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