Written by Robin Kaplan, M.Ed., IBCLC, Owner of the San Diego Breastfeeding Center
I’m terrified of my nipples and breasts hurting while breastfeeding. How can I prevent this from happening? I would say this is the most common question brought up in all of my prenatal breastfeeding classes. No one wants nipple and breast pain! That sounds terrible, right? So, let’s talk about how to prevent and treat any soreness in your nipples and breasts!
Sore Nipples - Latching discomfort
So, it is not uncommon to have a bit of nipple tenderness in those first few postpartum days. I mean, that is a lot of stimulation for one part of your body day after day. But that tenderness should subside within the first week or two after your baby is born. To prevent sore nipples, it all goes back to a nice wide latch. The wider the latch, the more comfortable you will feel. And if your kiddo is trying to slurp your nipple in like a strand of spaghetti, try the ‘flipple technique’ (easily found on YouTube!) to get a ton of breast tissue into his/her mouth. And if your nipple is damaged from breastfeeding, have a lactation consultant assess your baby for a tongue tie or lip tie.
If you are dealing with some sore (possibly cracked) nipples, express some milk onto the tips and let them hang out for a few minutes. Or try a ‘nipple chapstick’ like coconut oil or an organic nipple balm. Also, comfort gels can feel amazing and really help with wound management.
Sore Nipples - Thrush
Oh, yeast infections…. The scorned enemy of every female! An overgrowth of yeast can attack any mucous membrane, one being your nipples. Thrush symptoms include red/irritated nipples, a burning sensation in your nipples while feeding/pumping (and all times in between), and sometimes shooting pains into your breast. Yeah, thrush massively sucks! Typically thrush occurs when a breastfeeding parent or baby has antibiotics, so do everything you can to stay away from those unless absolutely necessary. And if you need to take antibiotics, you can prevent thrush by taking a high-quality probiotic at the same time. Thrush can also occur when cracks in the nipple are not healed quickly, so heal those wounds as soon as possible (see above). Babies can also get thrush, which looks like white patches on the inside of the mouth and a really bad diaper rash.
If you are dealing with thrush, definitely start some high-quality probiotics to help recolonize your gut with good bacteria. Also, consider removing sugar from your diet, as yeast LOVES to grow on sugar. Garlic pills and Silverette cups are also some great natural remedies. You can also speak with your doctors about medications, such as Diflucan (for the parent) or nystatin (for the baby) as a treatment.
Sore Boobs - Engorgement
Around 3-5 days postpartum, you should hopefully notice that your breasts are fuller, heavier, full of veins, and full of milk! This fullness is normal and expected. Engorgement is when your breasts become so full that your baby has a difficult time latching, which is something we want to prevent from happening. Engorgement might also happen later on in your breastfeeding journey if you go for a bit too long in between feeding/pumping sessions. To prevent uncomfortable engorgement, we need a nice wide latch (I know… common theme!) and frequent emptying of your breasts. For those first few months, that means feeding/pumping every 2-4 hours. Once your baby is a bit older, you might find your breasts still do ok with a longer stretch of sleep at night.
If you are dealing with engorged breasts, try to bring down the inflammation with some cold compresses (like frozen peas) and ibuprofen or omega 3 vitamins. You can also try reverse pressure softening before latching or pumping for a few minutes after breastfeeding to try to relieve some built-up pressure. And feed/pump every 2-3 hours until the engorgement subsides.
Sore Boobs - Mastitis
Unresolved plugged ducts and severe engorgement can turn into mastitis, which is an infection in your milk ducts. Symptoms include red streaks on your breast, knots/tight areas on your breast, flu-like symptoms, and a fever of 102F+. You essentially feel terrible all over. It is a total bummer. To prevent mastitis, you want to make sure that your breasts are not getting too full of milk without frequent emptying. You also want to make sure that you are supporting your immune system, especially during those first few months when you are also dealing interrupted sleep in the middle of the night. Daily Vitamin C and D3 are fantastic immune boosters, as well as continued prenatal vitamins, probiotics, and Omega 3s.
If you are dealing with mastitis, you may not need to get antibiotics right away. Your body might clear the infection with diligent milk removal. Consider taking a fever-reducer or anti-inflammatory reducer to help you feel more comfortable. Try to pump after breastfeeding, or in place of breastfeeding if you are in too much pain, every 3-ish hours, to release those tight pockets of backed-up milk. Get in bed and rest! Drink lots of fluids (water, coconut water, broth). Castor oil compresses can really break up those blockages below the skin. If your fever goes away within 24 hours, even if you have other mastitis symptoms, you can probably hold off on antibiotics. But always discuss your situation and symptoms with a lactation consultant if you are concerned or have more questions.
Breastfeeding should be a great experience for both you and your baby. So, if you have sore nipples that last beyond the first week or two or are dealing with a lot of nipple and breast discomfort, reach out to your local (or virtual) lactation consultant. This is why we exist…. To help relieve nipple and breast pain so that you can enjoy breastfeeding to the fullest!
Robin Kaplan is an International Board Certified Lactation Consultant (IBCLC) and founder/owner of the San Diego Breastfeeding Center. Over the past 10 years, she has helped thousands of families overcome breastfeeding challenges through her virtual/live prenatal breastfeeding classes and in-person and virtual consultations. Robin is the author of Latch: A handbook for breastfeeding with confidence at every stage.