Types of breastfeeding pain:

If you develop a fever or flu like symptoms, please contact your health care provider RIGHT AWAY!

The most common types of nipple are breast pain are due to a poor latch, a physical issue with the baby, engorgement, a bacterial infection (plugged ducts or mastitis), a fungal infection (yeast), or vasospasms. We will go through each type.

Poor latch:

Poor latching and positioning are the cause of most nipple pain!  Many families have been been told they have a “great latch” but they are still in pain. Here are what I consider the elements of a good latch- No pain and good breastmilk transfer. If you are in pain and/or the baby’s not getting enough breastmilk, I am dubious that you have a good latch! What can you do? Get comfortable yourself. Make sure your body is well supported. We suggest laid back breastfeeding or making sure they baby is well supported, whole body against mom’s body, getting the baby’s chin off of the baby’s chest, and having both cheeks touching equally. Here are two videos that might help:

1. From Our Youtube Channel: https://www.youtube.com/watch?v=0iZohdhAA1M
2. From Breastfeeding Made Simple: http://breastfeedingmadesimple.com/challenges/latch-videos/

Physical issue with the baby:

Babies are born to breastfeed but they can also have some physical issues that can make breastfeeding painful. Here are some physical things that could be going on:

1. The birth- Too long, too short, c-cection, head being tilted funny, vacuum extraction, on and on. Being born is hard on mother and baby, but boy is it hard on that baby head! This can cause pain for the baby when they try to latch so they often don’t.
2. The baby could be tongue tied. Google it.
3. Baby was born preterm, lacks fat in their cheeks, or another physical issue.
4. Baby has had too many fast flow bottles and is impatient.

Almost all of the above can be resolved with some expert help!

Engorgement:

There are two types of engorgement, when it happens immediate post-partum or when the baby is older. When a baby is a week or less old, much of engorgement or “when your milk comes in” is actually not breastmilk that is making your breast hard, heavy, burning or painful. Much of the swelling is increased blood flow and edema (extra water retained in the body. This can be exacerbated by having IV Fluids during labor and delivery. Some things that can help with early engorgement:

1. Eat watermelon, cucumber, and/or celery in the next few days to help flush out extra fluids, edema, from your body
2. Consider Ibuprofen for swelling. Ask your doctor about this!
3. Consider cold, green, cabbage leaves for hot, swollen breasts unless you are allergic to Sulfa drugs. We encourage you to peel off several outer leaves and rinse them with water before using them.
4. Consider breast and lymph node drainage and massage. Lay on your back. Start at areola and gently stroke down through the armpit, up toward the elbow. Use gentle rake like motion with your finger tips from your areola down to your chest wall. Gently stroke outward from your breast bone to your shoulders.
5. Consider Reverse Pressure Softening if breasts are too hard for baby to latch http://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/

If the baby is older than one week, engorgement is usually due to poor breastmilk removal. The solution?  Breastfeed, hand express, or pump more often!

Remember: This is a temporary condition! However, the pressure in the breast has got to be relieved or else the body will interpret the pressure as needing to shut down milk production.

Plugged ducts:

Plugged ducts can come from breastmilk that cannot drain or outside bacteria. Here are some ideas that mothers have found helpful if you feel you have a plugged duct:

1. Please contact your health care provider right away if you feel as if your flu like symptoms, fever, body aches, extreme fatigue returns and/or bright redness on the sore area appears.
2. Consider the homeopathic remedy Phytolacca, 30 C taking it every few hours.
3. Consider resting, eating, and drinking
4. Try warmth and vibration before nursing.
5. Consider cold and Ibuprofen after nursing
6. Remove your milk as often as you can on your infected side. If you are nursing, nurse on that side first. Try nursing over the baby on hands and knees to help the plug release. Try pumping and/or hand expressing on the affected side after nursing.
7. Try different nursing positions.
8. Try some lymphatic drainage. Lay flattish on your back and stroke from your nipple to the outer edges of your breasts. Think about stroking from the nipple down through your arm pit to your elbow. This can help remove extra fluid from your breasts.
9. Example of massage- Scroll down to bottom for video http://pmr.med.umich.edu/bfsp
10. Consider an ultrasonic treatment.

Mastitis:

This is a breast infection. It is almost always bacterial and needs medical attention right away. Please contact your health care provider right away if you feel as if your flu like symptoms, fever, body aches, extreme fatigue returns and/or bright redness on the sore area appears.

Yeast infections:

I may get a lot of hate mail for this but in all the years I have been practicing I feel I have seen only a few cases of mothers have a yeast overgrowth. Remember, we all have yeast all the time. It is a matter of whether the yeast is growing at a healthy level or not. The other thing that drives me crazy about yeast is that IF you do have a yeast overgrowth it should be easy to get under control. If you have a vaginal yeast infection, what do you do? Use some topical or by mouth medication and it goes away. Do you need to boil your underwear? Do you usually pass it back and forth to your partner? I have been thinking about this a lot and it seems to me that if your yeast levels are in balance how can someone else make your yeast levels get out of balance? When they do research on mothers with confirmed cases of yeast overgrowth (Yes, they use science!) they all clear up with one course of Diflucan. Science! If you are being treated over and over again for a yeast infection and it is not clearing up I will ask you to consider, could it be something besides yeast? Food for thought!

If you are a person who suffers from a diagnosed, chronic, yeast over growth problem, here are some ideas that may help:

1. Consider taking a probiotic. Ask which ones have live cultures that need to be refrigerated.
2. Consider taking Grapefruit seed extract. 250 mg three times per 24 hours is a suggested amount.
3. Consider reducing sugar and dairy product intake
4. Consider adding Garlic, Zinc, and B vitamins to your diet
5. Consider being tested for diabetes and anemia- These conditions can make you more susceptible to yeast overgrowth. 

Vasospasms:

Many mothers can have vasospasms and they are often incorrectly diagnosed as a yeast infection. Most mothers and health care providers are not familiar with this condition. A good rule of thumb is if you are having nipples that turn white after feeds, burning nipples and/or shooting pains in your breasts between feeds, if you are sensitive to cold in your hands and feet, and warmth makes your nipples and breasts feel better, you may be suffering from vasospasms.  Here is some more information and ideas for resolution for this problem:

1. http://kellymom.com/bf/concerns/mother/nipple-blanching/

Consider:

1. Avoiding cold, caffeine, alcohol, and nicotine
2. Consider Ibuprofen
3. Wool nursing pads
4. Covering your nipples and breasts immediately after taking the baby off
5. Dry warmth on breasts right after feeding and between feeds.
6. B-6 and magnesium
7. L-arginine 500mg 3 x per day usually resolves pain within 24 -48 hours.
8. Nifedipine- Suggested dosage: 30-60 mg/day of sustained-release formulation (Hale, 2008)