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Below you will find feedback (responses to questions) from several moms on nipple soreness. I wanted to include this because "real life" experiences and feedback can be more helpful and encouraging to moms sometimes, than "text book" answers.


When asked, "In your experience what is the most common cause of pain in the early weeks of breastfeeding?"


"A too-shallow latch. Baby isn't opening wide enough and taking enough breast tissue into the mouth. Instead, baby is sucking in the nipple like a noodle."
"Poor latch is the most common cause. But there is some discomfort due to the fact that most of us aren't used to getting this much nipple stimulation. Those little babies can have a suck with hoover strength! And personally, having flat nipples to begin, I had some discomfort as the attachments stretched and broke. I now no longer have flat nipples!"

"My pain was minimal and was caused by improper latch-on -- he kept pulling his bottom lip in, and I would check right away and relatched him till we had it right."

"With my first, the only problem with pain I had was engorgement...he was 5 weeks early and had jaundice so he was not all that hungry in the first week. After I got a pump it went right away. With my second I had undiagnosed thrush from the birth which I thought was a poor latch since he was 6 weeks early. Once it cleared up (after 2 months!) the pain went completely away."

"Most common cause of pain early on was a little bruising and tenderness caused by latch-on and from the frequency of nursing. I also had the itchy feeling in the first couple of weeks, which was not due to thrush. It was more like the itchy of a little scab healing. I guess my nipples were just getting accustomed to the work-out."

"Bad latch and position."

"I feel the common cause of pain is a poor latch or nipple confusion in those first few weeks (2-3).... Giving even a pacie can cause confusion in a baby just learning to do things.."


When asked, "What is "normal" pain?"

""Normal" pain is tenderness or an "ooh!" feeling at latch on that subsides within the first 30 seconds and fades after the first week or so."

"There is some normal pain or discomfort as baby is latching on for the first week or so, especially if nipples were flat or inverted before. But this should ease as the nursing session goes on. The pain should NOT be unbearable. I think that some bruising is within the realm of normal because this is a sensitive part of the body in most women and doesn't get that much constant stimulation. Plus, the constant wet conditions can create some chapping. However, these issues should be addressed and fixed right away. They shouldn't linger for days or weeks on end. Also, some minor engorgement can be within the realm of normal as well. But, again, it should be recognized as something to be addressed and alleviated. It's not a required part of breastfeeding."

"Normal pain -- I couldn't say there is any that was normal. I was told I would have pain because I am fair-skinned, but I did not find that to be true."

"Some women feel pain (I considered it mere discomfort) with letdown. However I must say I was dealing with thrush so that could have been part of it. Since we got rid of the thrush I experienced no pain when DS was latched correctly. I think pain signals something isn't right, either incorrect latch, thrush, possible plugged duct or mastitis or even something I haven't heard of. Always get it checked out by an IBCLC."

"Normal pain: I really don't have any everyday pains from breastfeeding. I feel the let-down, sometimes more than other times, but it is comforting, not painful."

"I've never had "normal" pain. I've had pain from bad latch and pain from thrush and one totally painfree experience."

"There is no normal *pain* a mild discomfort maybe, but you should not have pain and no discomfort past 5-10 sec. after latch.... With my first we had nipple confusion, sore and cracked nipples (warm washcloth before feeding and some hand expression to soften the breast and we were better within 1 week) and supply issues due to stress and not getting the breastfeeding relationship off to a good start (nothing a little alone time and lots of H2O could not fix)."



When these moms were asked "What conditions are "abnormal"?"

"Any excruciating pain, any pain that causes you to dread feeding times, any pain at all that lasts throughout the nursing session, or any time there is cracked or bleeding nipples."

"As I said in question 2, the pain should not be unbearable, nor should it last throughout the session. No one should suffer through cracked, bruised, bleeding nipples for days (or weeks!) on end. If it hurts so much that you don't want to do it, there's something wrong."

"Abnormal would be anything that is painful."

"Cracks, bleeding, sores, blisters....burning, stabbing pains or general achy nipples, hot, red and/or hard parts of the breast, especially with fever (plugged ducts, mastitis)."

""Abnormal": My only experience out of the ordinary was a pluged duct. But having read all the remedies in the "Nursing Companion" book, I tried them all out and the pain went away in just a couple of days."

"Cracked bleeding nipples."

"It is not normal to crack or hurt for an extended amount of time....If there is a problem contact a person trained to deal with this and get an evaluation."



When asked, "How would you respond if an expectant mom asked you if it hurts to breastfeed?"


" I would explain what is normal and abnormal, and explain that if she is feeling any of the "abnormal" pain, she should seek the help of an experienced LC as soon as possible."



"How I *have* responded: There may be some discomfort involved, especially early on. You can't imagine how strong that little baby can suck! It will take the two of you some time to get it right. You need to work on a good latch if the baby doesn't get it right away or you will be in major pain! Your breasts/nipples need to adjust to being pulled out and suckled. If you are getting bruised or cracked, there's something wrong with the latch and you need to be more vigilant about getting a good one. If you can't figure it out on your own, you should see an LC or at least someone with more experience to help. The discomfort should go away as you work on your latch, as your breasts get used to all this attention, and as baby learns to suckle. If you have unbearable pain, there's something wrong.

Another thing is that everyone has a different pain threshold. What is painful to some might be only discomfort to others. Add to the fact that everyone's reaction is different. If you have overly sensitive breasts to begin, the sensations may border unbearable. If you are on the other end of the spectrum, you may experience mild discomfort or nothing.

I think the big thing to recognize is the semantics here. Breastfeeding does not have to hurt; pain is not a requirement. It may hurt in the beginning as both parties learn the art of breastfeeding. In this case, making a mistake causes pain. Getting it right doesn't. Just like learning every other skill we have, mistakes can be expected. However, we should learn from our mistakes and improve our skill level. If we can't fix the mistake by ourselves, we need help. Think about it this way, walking should not cause pain; yet, when we were learning to walk we fell down and bumped into things and experienced pain because of it. Can we safely say "Walking should not hurt; if it does, there's something wrong"? Yes, I think we can safely say that. But the warning "Learning to walk may involve some mistakes that can cause pain or discomfort" is also true. We wouldn't tell a toddler with a scraped knee and bumped head that walking doesn't hurt. We comfort them and help them work on the skill, removing obstacles if possible. And we encourage them that someday, walking will be so easy they don't have to think about it! Does this make sense? "



"If an expectant mom asked if it hurt, I would tell her to have some Lansinoh on hand, because while she and baby are in training, there may be some pain, but if she has people around to help her get on track at the start, there's no reason for her to suffer. The most important thing I can advise anyone who is going to breastfeed is to have someone experienced on hand from the start."



"I would tell her that it can be uncomfortable at first until she and her baby learn how to nurse effectively. I would suggest giving it a week (of proper techniques...I'd make sure she had good info and/or an LC consult) and if there was still pain to get it checked out. Persistant pain *usually* indicates a problem of some sort. I guess it would depend on her pain threshhold, I imagine if someone had no tolerance for pain, the normal process of latching and breastfeeding might be considered uncomfortable. I would tell her that *many* women breastfeed pain free and that pain isn't necessarily normal in my opinion."



"I would say yes, you will feel some pain, at least initially. And it varies from person to person how bad and how long it lasts. But, my advice would be to buy a breastfeeding manual and stay in touch with lactation consultants. It should not be painful at all after you have gotten over the hump in the learning curve."
"I would say that it *may* be uncomfortable (but not downright painful) for the first couple weeks. I would also HIGHLY reccomend they work with a GOOD LC in the beginning."



"I would tell a new Mom that if you nurse often and have a good latch then there should be no pain that after we corrected the problem with the first there was no pain and with the second I just felt as if my nipples were sun burnt from all the nursing."



"I think I would warn future bf'ers that it "could" hurt or be sore, but that it DOES get better...I am living proof of that after dd. But at the same time I offer that it doesn't always hurt...it depends on the baby, the mom, and the support offered to the mom. I am not part of any group, but have offered much support to all ladies that I know that want to BF... Keeping in contact with LC is most important I think...they know things and have products available that most people would never think of. "



And more on breastfeeding and pain:

" My 1st baby was a BF pro no pain. My 2nd caused toe curling pain and come to find out there was a problem something caused me to have a very low supply she was not gaining. I worked with a LC to get her back to all BFing and gaining well pain free by 6 weeks. Some things that helped, was after each feed expressing some milk letting it dry then using pure lan 100. Every now and then this baby toddler will do something that brings back a touch of pain I think it has to do with slipping down on the nipple. I noticed the other day I was sore and the condition of my nipples were very dry. So each time is different not much to do with the breast itself and I think mom in the guilt mode tend to blame our bodies."

" I was in a lot of pain during the first week or so when I was really engorged. I would usually have to pump just to keep from crying. After the baby got on a regular schedule the engorgement went away (unless of course if they slept longer during the night, then I would wake with some discomfort, not really pain, just discomfort). I also noticed with both my kids that my breasts were a little itchy the first month or so. Not thrush, just itchey. I also feel pain during let down for the first few monthes. They burn pretty bad when the milk lets down. That ended with my son at about 3 or 4 mths. Other than that, I did not feel any other pain. I think some pain can be normal especially during the first couple of weeks, but outside of that, there might be a problem. I do think my let down might be a little more painful than what is normal, but I don't think that is due to doing anything wrong. At first with my older son it really took me by surprise how painful it was during let down. To help ease that pain, I would put pressure on the other breast (cause it would hurt too) and that would help some. I hope I answered all the questions, if not I will be happy to give more feedback on my experiances."



" For me, the most common sources of "pain", of varying degrees, during my first weeks were:

1) A 'zing' at the beginning of latch. my LLL leader says that for some women, early on the milk doesn't collect in the lower ducts, so it hurts until it starts to flow. The pain disappears when supply is better established. Sharp pain, but brief - only seconds. Had it for maybe 2 weeks. This does not happen to everyone but can be panicking if you don't have support and know that it can happen and will go away because it's very intense. If you are good at expressing [I'm lousy at it] you may be able to by-pass it by massaging and expressing a little bit before starting to nurse.

2) the "burn/heat" I felt with let down. I thought it wasn't unpleasant but may surprise someone who isn't expecting it. My neighbor hated it because she didn't know that it was normal and would go away. Again, with established supply, it let up.

3) poor latch/poor sucking pattern/learning curve - I was fortunate that I went to LLL BEFORE birth and learned that both Mom and Babe have to LEARN good nursing technique. Early on, good positioning and careful latching helps the baby get it right - and it's VERY important that if it's painful for more than that brief 'zing' to REPOSITION and RELATCH your baby until it's more comfortable. Do NOT grin and bear the pain if it continues. That only prolongs the learning curve for the baby and you and may result in some nipple tissue irritation.

My little barracuda actually raised a blood blister on one nipple during those first days, which I healed with Lansinoh and very careful attention to technique. Nipple tissue heals surprisingly quickly once the irritation to it is stopped. To this day, I will still relatch my toddler if he gets sloppy with his technique [often because his attention has drifted].

Not everyone has pain problems, but many do. I know at least 2 people who had no pain with initiating BF'ing and one of those had a little bit of pain with her second baby - so it's not just the mom, the baby has a role too.

My DS is 2 and we still nurse frequently. There are good things and hard things about it - but I'll nurse the next one too and am very glad I put the time into getting started right. I found LLL, lactation consultants, and other mothers to be the best sources for ideas and information. Hope this helps."

"With dd I was full blown crack/bleeding mastitis 3x by 6 weeks and terrible latch. That was 4.5 y/o ago and there was no LC on staff at our hospital to offer support, and support was very hard to find in my comm. With better support I think it would have been much better.

With ds (now 2 months) it was a totally different experience. There was LC on staff at hospital making regular rounds and very helpful...I am very big busted and that made it hard for his little mouth to latch, therefore leading to a little sorness this time and started to cracked. When that happened my LC offered me Smoothies which were to be worn for up to one week all the time except to nurse or shower...this took away the pain and allowed healing to happen faster. Pain went away within a couple weeks, and I think it took that long because I really had a hard time with large breast and small mouth of ds. We worked at it and problem solved.

I think I would warn future bf'ers that I "could" hurt or be sore, but that it DOES get better...I am living proof of that after dd. But at the same time I offer that it doesn't always hurt...it depends on the baby, the mom, and the support offered to the mom. I am not part of any group, but have offered much support to all ladies that I know that want to BF... Keeping in contact with LC is most important I think...they know things and have products available that most people would never think of.

I personally can't praise the my LC and the Smoothies she offered me with ds enough..that is what saved me...we did have an improper latch that caused me to start to crack and the LC corrected our position and the smoothies aided in a speedy healing."


"Had someone prepared me for the fact that some pain just simply must be lived through I might have had more stamina to endure past the undiagnosed tongue tie that stripped all skin from my nipples so that it took six months for the scabs and calluses to go away. I might have know how to deal with and bear the pain from compressed nipples that caused nerve damage; and I might have known that we had thrush sooner and sought treatment before the pain was so unbearable that I almost threw my son to the floor as he tried to latch during one nursing session. (my dh was right next to me and I was able to muster enough breath to say take him as I thrust ds into dh's arms before falling to the floor in a near faint). 

Had someone told me that some types of pain are just from mom's breasts and nervous system learning how to work I might have been able to endure. But no one told me about any type of pain. I was unprepared, in tears and without medical guidance. The ob/gyn said she only deals with breasts as relates to mamograms and testing for cancer. She said she could get me pregnant but that she didn't handle what happens to breasts after baby was born. The pediatrician referred me to my ob/gyn and his LC who never returned a call once she sold me a pump. LLL by phone was no good because I couldn't understand the directions I was been given for suck training without a diagram. And the person who evaluated my son's mouth missed the tongue-tie because it was so slight as to not cause any speech problems but it was just enough to destroy a nipple. Eventually, he grew big enough by six months that it ceased to cause damage of any kind.

And yet through it all we breastfed, even if only one or two times a day. Eventually, he fed more but not well -- but that was his temperment and even if we had not had physical problems he still would have been an indifferent nurser who was easily distracted at an early age and who always needed to be switched nursed.

And yet I pumped for 1 year out of the first 1.5 years never getting more than 2 ounces in a day. And we breastfed until my dh was 2 and he self-weaned when I was 3 months pregnant.

All that said with my second baby I thought I would be prepared. I had good recommendations for an LC lined up. I had my doula lined up and all the child care professionals in her company including post-partum doulas and LCs. I had the pump in the room following birth and an SNS just in case they tried to insist on supplementing. I was armed with all the ways to feed without a bottle and I insisted on them to the hatred of the nursery nurses. And, once my dd woke up she nused without a hitch. I had mastitis twice due to engorgement but I don't consider that a problem with baby but with mom putting baby to the breast not often enough. It is now 11.5 months and we have nursed in a way that is like a fairy tale to the envy of many breastfeeding moms. Oh, I don't mean to brag, I can hardly believe my own good luck. What did I do differently to get this? I don't know. I don't know how to pass this on. I have much to pass on from my first child but not my second.

So, I agree nursing often gets sugar coated to a degree and it shouldn't be, but if presented properly pain should not be considered a failure of the type to cause a mom to give up.

Sure my story is enough to make any mom not want to breastfeed at all, but I am not a good teacher. A good teacher would take this information and teach well with it so it won't be of an insurmountable scariness or seem like impossible work. And there is more work one could have to do like weighing before and after and keeping records of how often and how long baby nurses, especially with preemies or special needs children.

So, lets make sure we know how to spread what we know in real space not just cyberspace.

And Feedback from an LC:

I generally try to impress on moms that if they are having anything more than "tenderness" (I use a pain scale with 0 being no pain and 10 being the worst I tell the moms it should not go past about a 3) for more than day 3-10 they should seek help. I can't tell you how often a mom seeks me out at about 2-3 weeks post partum crying b/c she "knows it's normal to have pain but I just can't take it any more". Often (not always of course), it is a simple position and latch situation that can be easily remedied with some instruction and I go away steamed b/c someone told her to expect pain so she didn't seek any help thinking that her cracks and severe pain were normal. I hate to think these moms have suffered b/c of receiving the false impresssion that they just need to bear with it for a while and it will get better. Also, if the baby is shallowly latched there is often not an adequate milk transfer and the baby loses weight. I am sure there are many moms in that situation that totally abandon bf b/c it hurts like heck and isn't even working for the baby. These moms and many moms don't even bother to call for help.

I too want to present a realistic view of bf but am so afraid of moms being told to expect pain b/c I have seen the damage that can do. I want moms to be horrified if they are in severe pain and seek help until someone listens and makes it better.

I have worked with a few moms that continued with unresolved pain but I can also say even if I can't find a cause I let the mom know it is not normal and I continue to search for solutions until it is resolved one way or another.

Copyright 2000 - 2003  Jim Yount

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