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    Sore Nipples From Nursing

    Ouch is never something a breastfeeding parent should say when nursing their baby. You read that right, breastfeeding should not cause pain. 

    Parents are often given different information by each provider they see about breast and nipple soreness. Sometimes they are even told that some amount of pain is normal. Looking at your complete health history, your baby’s health history and your nursing experience so far can help uncover the root cause of your discomfort. There are many causes of sore nipples and there are always solutions. 

    What are some of the reasons for sore nipples from nursing?

    Positioning 

    Babies rely on their reflexes to find their food source after birth and attach to the nipple. Being skin to skin helps your baby initiate this crawl up to your nipple to latch on and begin breastfeeding. Holding your baby close to you, belly to belly in a  slightly reclined position, allows your baby to be more connected to your body by gravity offering postural stability. 

    When nursing in other positions, consider how gravity can be helpful. For a deep latch, try pointing your nipple upwards towards the baby’s nose, bringing your baby in close when they open their mouth wide. Planting their chin on your chest gives support and stabilization for the baby to have their mouth open wide as the tongue comes out over the bottom gum line to cup more of the areolar tissue.

    While nursing, you should be comfortable and so should your baby. Placing your baby on a pillow at chest can position your baby too high or in an awkward position for feeding. Use pillows to support you and you support your baby.

    Breasts come in many shapes and sizes. If you have larger breasts, you may find rolling a towel to fit under your breast gives a little lift so you can more easily position your baby. It can be hard to see where your baby is latching if you have a lot of breast tissue. If you sit in front of a mirror, this will allow you to see a different view than from the top of your chest. The mirror allows you to see where your baby is in relation to your breast and nipple. You will quickly form muscle memory and be able to latch your baby on without being in front of a mirror.

    Engorgement 

    Milk increases in volume between days 2 -5 after birth. Sometimes this transition of more volume in milk can cause engorgement. Your breasts become overly full of milk, making the skin taught and the nipple more flattened and harder for your baby to latch on well. Try using reverse pressure softening to push the milk back up the ducts just far enough for your baby to be able to latch on easier and remove your milk. 

    If you are having a hard time getting milk out, try taking a warm shower. Lean forward using gravity to help release milk. Using very gentle massage and hand expression can encourage milk to flow. After you have nursed your baby or pumped your milk out, you may find relief using a cold pack on your breast.

    Latch 

    Your nipple should look the same after a feeding as when you began a feeding. If your baby unlatches and your nipple is misshapen, adjust your positioning. If it is still happening, you should contact your IBCLC to do a complete oral assessment. There is a lot happening inside your baby’s mouth that we can not see from the outside of your baby’s latch. How a latch looks is only one indicator of how nursing is going. When the parent shares their whole experience of feeding their baby, we get a better understanding of how feeding is going. Your provider should ask about your health history, evaluate your breastfeeding experience including the baby’s oral anatomy, muscles, reflexes and body structure. A shallow latch can cause the nipple to be damaged and cause pain. Nip Dip can soothe the soreness. It contains Manuka Honey which is an amazing ingredient for repairing skin.(2) Recurrent milk blebs, plugged ducts, candida or mastitis can be indicators of latching issues and oral restrictions. 

    Pumping

    Using the right flange size will be comfortable as well as maximize milk removal. Using Legendairy Milk’s Nipple Ruler can give you a good idea of your flange size. Many IBCLCs specifically offer flange fittings to help you get the best fit. Adding lubrication to the flange/shield can reduce friction and make pumping more comfortable. The oils in Legendairy Milk’s Pumping Spray are nourishing to your skin during and after pumping.

    Your pump uses suction to express milk, but your baby nurses using suction and compression. Adding compressions with your hand while you pump  will remove more milk. Using a heat pack before and during pumping to relax the smooth muscles and increase blood flow helps with milk flow and letdowns.(1)

    Teething

    Babies who are getting teeth often want to chew on everything to soothe their sore gums. Giving your baby a teether between nursing can help massage sore gums. A deep latch means your baby can still latch on even when teeth are poking through their gums and you will be comfortable. If you have teeth marks on your breast after your baby nurses or pain while nursing when your baby’s teeth come in, a visit with your IBCLC for a functional oral assessment is in order. It is sometimes not until teeth erupt that latch compensations are recognized.

    Your period returns or pregnancy

    Changes in hormones can cause nipple soreness and sometimes affect milk supply. Before you get your period, blood calcium levels drop and can slightly decrease your milk supply. 

    Taking a calcium magnesium supplement can help replenish calcium and decrease soreness. If your period has not returned and you are experiencing nipple soreness, it may be time to take a pregnancy test.

    The key takeaway here is that nursing and pumping should be comfortable and not cause soreness or pain. Take note of anything that has changed to help determine the cause and the best solution to eliminate your discomfort and avoid future sore nipples.

    Footnotes:

    1. https://pubmed.ncbi.nlm.nih.gov/22424466/
    2. https://pubmed.ncbi.nlm.nih.gov/28901255/

    Resources:

    https://bfmedneo.com/our-services/breast-massage/

    http://www.breastfeedingonline.com/rps.shtml#sthash.nGkO6mST.dpbs

    https://www.uofmhealth.org/health-library/hw133953#:~:text=Breast%20engorgement%20means%20your%20breasts,can%20be%20treated%20at%20home.

    https://kellymom.com/ages/older-infant/sorenipples-older/

    https://kellymom.com/bf/can-i-breastfeed/herbs/natural-treatments/#pluggedduct

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4626966/


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