Sore nipples are one of the more common concerns new mamas face when beginning their breastfeeding journey.
Breastfeeding is a wonderful, natural way for a mother to bond with her baby, and breast milk is recommended as the only source of food for a baby’s first six months of life.
Whilst the production of breast milk occurs naturally, the art of breastfeeding doesn’t always go smoothly.
For many mothers the experience is simple and straightforward, but for some it can become a painful ordeal.
Breastfeeding is a learned skill for both mother and baby, and there are bound to be some hiccups at the beginning. Sore nipples are often dismissed as part of the process but pain definitely isn’t something new mamas should ‘put up with’. Sore nipples can be so painful that a mother gives up breastfeeding altogether.
Find out what you need to know about sore nipples and breastfeeding, and what we recommend for prevention and support.
Pre-pregnancy breast soreness
Breasts, areolas and nipples come in all shapes and sizes and will change throughout a woman’s life cycle, from adolescence through to menopause. We need to have an awareness of what is normal for our breasts by doing regular breast checks so we can spot any unusual changes quickly.
Breast soreness is very common. It affects most women at some time in their lives, usually in the form of swelling, lumps, bumps, general aches and soreness. Commonly felt at varying times of the menstrual cycle, breast soreness is usually regarded as normal. The soreness will vary from woman to woman, so it is important to be aware of what is normal for you.
If there is any unusual pain, extreme pain, or changes in the breast tissues (with or without pain) it needs to be explored further. This could be due to other factors such as cysts, tumours or mastitis. Seek advice from a medical professional for further investigation into the source of pain and treatment.
Pregnancy breast soreness
During pregnancy, your breasts undergo many changes, influenced by hormonal fluctuations.
During the first trimester your breasts may feel generally sore and tender. The breasts often increase in size and as the pregnancy moves forward the areola and nipples will usually darken and become larger.
It is important to make sure to be fitted with the right style and size of bra during pregnancy, to prevent not just soreness but long-term damage to the breast tissue.
During the third trimester the breasts will begin to make colostrum in preparation for milk supply for the soon to be born baby. This can be seen as a shiny, clear discharge from the nipples.
Some women may hand express this colostrum after consultation with their midwife, obstetrician or doctor. In certain situations babies need supplementation after birth and a supply of colostrum in the freezer can be used instead of formula.
Breastfeeding is biologically the normal way to feed mammal babies and the production of milk (lactation) occurs naturally after giving birth. Breast milk contains everything your baby needs for nutrition for the first six months of life.
Breastfeeding begins soon after birth, often with mum bringing the baby to her breast within minutes after birth. Babies left on their mothers bellies after birth have an innate instinct to seek out the breast, and will crawl up to the nipple.
In the first few days, your breasts will produce colostrum and this provides everything your baby needs. Within a few days, your milk ‘comes in’ and changes in volume and composition. This can cause some discomfort as breasts become full and engorged, and your baby is increasingly hungry and more demanding.
Breastfeeding shouldn’t be painful. But in the initial few weeks, at the beginning of a feed, there may be some discomfort when the baby first attaches to the breast. The sensation should subside within a short time and as the feed continues it should not be painful.
There can also be other issues such as engorgement, mastitis, nipple vasospasm, thrush and other infections. Nipples may appear bright pink or red in colour, bleeding, dry, flaky, or have a white rash (thrush).
Causes of sore nipples when breastfeeding
Sore nipples most often occur if the baby doesn’t have the proper attachment or ‘latch’ to the breast.This can cause cracking, splitting and bleeding of the nipple. Sometimes these sores are obvious, but small cracks can be hard to see, even if very painful.
There can be other issues such as a baby with tongue tie, incorrect use of breast pumps, or medical conditions such as dermatitis or an infection. In these cases it is important to seek help from a qualified professional to properly diagnose the problem and offer the right course of treatment.
Even if breastfeeding is going well problems can still arise. Nipple soreness can occur if mum or baby become complacent about latch, the baby has a growth spurt causing a sudden increase in feeds, or baby begins teething.
What can be done to help breastfeeding and sore nipples?
Even if you have breastfed before, breastfeeding each baby is new and can take some adjusting to. Being prepared for breastfeeding before you have your baby is a good foundation to understanding what can go wrong and what to do about it.
Nurtured Birth recommends Born To Breastfeed, a comprehensive and accessible breastfeeding guide for mothers, answering all your questions and providing support for challenges. You can purchase this through Nurtured Birth’s shop here.
- Seek advice straight away! The best person to help is a lactation consultant. They will have specialist training and knowledge on breastfeeding issues. Your midwife, maternal & child health nurse, postnatal doula or paediatrician can also provide some support.
- Consider attending breastfeeding classes during pregnancy to prepare yourself and your partner. You can also make contact with a lactation consultant so they will already be on hand to assist once the baby is born.
- Try to feed on the baby’s first cues of being hungry, not waiting until they are crying. You can try putting the baby to the breast more often, expressing some milk prior to feed and offering the less sore side first.
- Finding the proper positioning while feeding. Getting the right set up of chair, pillows, baby’s position to allow for correct attachment to the breast.
- Keep nipples dry between feeds. Make sure to change nursing pads frequently and use 100% cotton for best airflow, not plastic lined ones.
- After a feed leave some fresh breast milk on your sore nipples and keep them open to air for a few minutes. Pat dry gently.
- Products like the BodyICE Breast Pads provide relief for sore nipples. You can purchase these cleverly designed pads that fit into your bra through Nurtured Birth’s website here.
- Soothing products to assist with the pain and healing: after a feed apply a saltwater rinse to the nipple or try a warm cloth compress. A lanolin ointment that is 100% medical-grade is also safe to use on your nipples after a feed.
- Check your expressing technique – some electric pumps can be too harsh and may need to be adjusted. Sometimes a manual pump or hand expressing can be gentler on sore nipples.
- Nipple shields can be used for short periods of time to ease sore nipples. They often lead to future issues with poor attachment so need to be used with advice and careful consideration.
- Some causes of sore nipples need medical intervention. Thrush can be treated with an ointment that is safe for baby, mastitis may need antibiotics so it does not become serious and lead to hospitalisation. Always seek out advice from a medical professional.
Where do I find help?
You can contact the following organisations for more information:
Australian Breastfeeding Association runs the National Breastfeeding Helpline 1800 686 268
Maternal and Child Health Line (24 hours) – 13 22 29
Nurtured Birth postnatal doula available for home visits in Melbourne, even during Covid-19 times.
Written by Sharon Clarke, Remedial Therapist at Nurtured Birth