By Meri Levy, MFT, CLE

You’ve decided to breastfeed, and you should feel great about it! You are doing a wonderful thing for your baby and yourself. However, there’s nothing quite like nursing a newborn to make even the most confident new mom feel like a complete amateur. New babies can be sleepy, squirmy, and fussy during feeding times, and having sore nipples only makes it harder to feel confident and patient with the learning process.

During the first two weeks breastfeeding, it is normal to have some mild soreness or tenderness in the breasts and/or nipples. The usual reasons for this are three:

1. your breasts are not used to being used as a food producer, feeding method, and pacifier up to 12 times or more each day.
2. early feeding sessions are more likely to create soreness, since the baby suckles harder to try to bring down the colostrum. Once there is real milk to reward the baby for his efforts, the suckling becomes more manageable.
3. mom is more likely to tolerate a less successful latch-on in the early days, while she is learning how to feed, which can cause soreness.

However, if your nipples are extremely sore and cracked, bleeding, bruised or blistered, or if any more than mild soreness lasts for more than about two weeks, it is usually a sign that a deeper latch is needed.

PROPER LATCH-ON TECHNIQUE

The most important single factor in preventing and resolving sore nipples is to get a deep latch-on with the baby. If you feel the roof of your mouth, and then move back to the soft palace farther back, you can imagine how much more comfortable it is to have your nipple rubbing against the latter and not the former. In order to get a good latch, there are three factors that I think are most important.

1. POSITIONING. Hold your baby securely for feedings, with the baby’s body aligned (the head is not turned to the side), the baby’s hips flexed, and the head free (in whatever position you choose, make sure that the baby is free to tilt his head back to open his mouth wide). Proper positioning is crucial for newborns to stimulate their reflex to open their mouth wide and draw the nipple far back into their mouth.
2. ASSYMMETRICAL LATCH. The baby should be held somewhat below the breast level, so that the baby tilts his head back to open wide, and latches onto the underside of the areola first. One trick is to point your nipple at the baby’s nose, and when the baby opens wide and tries to latch on the underside of the areola, flip the nipple into the baby’s mouth. This technique often gets a deeper latch than pointing the nipple straight into the baby’s mouth.

When your latch is good, even if your nipples are sore, you should notice less pain during feedings. Traumatized nipples should heal quickly. If your baby’s suckling hurts like heck for more than just the first minute of feeding, you probably don’t have a deep enough latch. Use your pinky in the corner of the baby’s mouth to take the baby off the breast and try again.

COMFORT MEASURES FOR SORE NIPPLES

For ordinary soreness, or for increasing the comfort of traumatized nipples while they are healing, the following products are recommended:

1. Glycerin gel pads can be chilled in the refrigerator, and cut into four pieces each to get the most out of each pad. They feel soothing, promote healing, and protect your nipples from friction while they are sore.
2. Modified Lanolin nipple ointments. Long the stand-by for treating sore nipples, these ointments are derived from sheep’s wool and purified to remove allergens and contaminants.
3. Natural nipple salves. For moms who want to avoid animal products and mineral oil, or who don’t like the goopiness of lanolin (or the fact that it can stain your bras), there are natural nipple salves from Earth Mama Angel Baby or MotherLove. These organic salves contain ingredients such as shea butter and calendula to help heal sore nipples, and they are safe in the quantities involved for your baby to ingest.

PREVENTING SORE NIPPLES

If you haven’t yet begun breastfeeding, there are some things you can do to minimize the risk of sore nipples.

Don’t bother using nipple creams before your baby is born or before you feel any soreness. Using such products once you do feel tenderness is just as effective as using them from the start, so have them on hand, but save the nipple cream for when (or if!) you need it.

Despite the common misconception that nursing less often is beneficial for preventing soreness, the opposite is truer. Nursing frequently or for long periods, with a proper latch, will not harm your nipples. But less frequent nursing can cause a couple of problems:

1. Engorgement, leading to latching difficulties. When your breast is engorged with milk and tissues are inflamed, it can be very hard to get the baby latched on correctly.
2. A very hungry baby who is difficult to latch on correctly without a lot of trauma to the baby, the mother, and the mother’s nipples

So, one way to help prevent sore nipples is to nurse often (at least 8-12 times/day), for as long as the baby wants. And, learn to recognize and respond to your baby’s early feeding cues, so you can feed before your baby is frantic.

WHEN TO GET PROFESSIONAL HELP

If you do not get relief within 48 hours from an improved latch, or if you are unable to obtain a better latch, there may be something more going on, and it would be appropriate to see a Lactation Consultant. There can be many reasons why you and your baby can’t get a good latch, from something simple to the more complex, and a Lactation Consultant can help you get it sorted out.