Breastfeeding is normal and natural and is not supposed to hurt. If breastfeeding hurts at any time check through our suggestions and links below and seek help from your IBCLC lactation consultant or breastfeeding helper. Without quick help, pain during feeding can quickly cause sore or cracked nipples. And if breastfeeding hurts, because your baby isn’t attached to the breast (latched) correctly, this can reduce your milk supply leading to a baby who seems to be constantly feeding, fussing or pulling off the breast or one who isn’t gaining much weight.
Why does breastfeeding hurt?
The most likely reason for breastfeeding to hurt is if your baby is not latched to the breast properly. If your baby latches just to your nipple without a deep mouthful of the surrounding breast tissue, the nipple will be pinched against the roof of your baby’s mouth and it will be very painful. Your nipple may come out of your baby’s mouth slanted like the top of a new lipstick instead of rounded like a cherry on a cake. Or your nipple may look white for a few moments as if the blood has been squeezed out of the nipple (see Vasospasm Symptoms).
Shallow latch (painful)
Latching mostly on the nipple rather than the breast is known as a shallow latch and means your baby’s tongue won’t be able to reach the milk ducts properly. He will find it difficult to get enough milk.
Deep latch (comfortable)
When the breast fills the mouth in a deeper latch your baby’s tongue can work properly during suckling and reach more milk. In a deep latch the nipple is protected from the painful pinch because it is deep in your baby’s mouth at the junction of the hard and soft palate. See our article Latching Tips for further help to get a deep latch.
Babies Need a Big Mouthful
While there might be some milk in your nipple, the milk is mostly in the ducts in your breast. The baby who just chews on a nipple won’t get much, and it’ll hurt! When your baby has a big mouthful of breast beyond your nipple, that’s when it’s comfortable. And that’s where the milk is. So when it feels good, it is good. As Toronto paediatrician Jack Newman often says: “It’s called breastfeeding, not nipple-feeding.”
How to get a deep latch (positioning)
The way your baby is held can make a big difference to how well he can latch on and breastfeed. In the right position your baby may automatically improve his latch and know what to do. See our articles Breastfeeding Positions for Newborns, Breastfeeding Videos and Why Skin to Skin? for ways to hold your baby so he can get a big mouthful of breast easily and get a deeper latch. The best way to check yours and your baby’s position is to see an IBCLC lactation consultant who will take a full history, make suggestions to improve baby’s latch and check how your baby is using his tongue during a breastfeed.
My health visitor say the latch is fine, but I still have pain
If breastfeeding hurts there is still something wrong, find a lactation consultant or look for a second opinion. It can be difficult to find the cause of the pain sometimes but painful feeding is not normal.
Other causes of pain
Sometimes a baby who has had bottles will try to apply the way they get milk from the bottle (sucking like a straw) to the breast. This can cause a shallow latch with pain. You could try to avoid bottles and dummies completely while your baby learns the right technique, if supplements are needed you could try cup-feeding or a supplemental nursing system instead. Or try using these Tips to Bottle Feed a Breastfed Baby to make bottle feeding more like a breastfeed.
Tension or compression from the birth
Any tension or compression from your baby’s birth may affect the nerves and muscles involved in sucking and swallowing. This could cause high muscle tone, a tight jaw, poor tongue movement or a preference for one breast over another. Forceps, ventouse or cesarean deliveries tend to be the most common causes, but sometimes even in an intervention free birth there can be physical issues due to the way your baby was positioned in the uterus. Some mothers find body work such as cranial osteopathy from a skilled therapist can improve things, particularly if your baby has had a difficult birth.
If the membrane under a baby’s tongue (the frenulum) is very short or tight it can prevent his tongue from moving properly, even with very careful positioning. This can cause a painful latch for his mother. For an assessment contact an IBCLC lactation consultant who can assess the range of movement in the tongue and may suggest trying some simple tongue exercises to improve tongue function and strength to make breastfeeding more comfortable. Sometimes body work may be helpful and supervised tummy time 1 is said to help strengthen muscles involved in feeding. Your lactation consultant will advise you if they feel a procedure is needed to release the tongue and refer you to a tongue-tie practitioner as needed. See Is My Baby Tongue Tied? for further information.
Vasospasm of the nipple is the name given for when the nipple is squeezed so tightly in a shallow latch that it squeezes the tiny blood vessels in the nipple, leading to decreased blood flow and oxygen in that area. When baby lets go of the nipple it may look white where the blood has been squeezed out of the nipple. As the blood returns it can be very painful causing a deep throbbing, burning type pain. For more information on causes and prevention see Nipple Vasospasm and Breastfeeding and Breastfeeding Latching Tips.
Mammary constriction syndrome
Mammary constriction syndrome is a recently described syndrome related to vasospasm and vasoconstriction (see above). It is described fully by Edith Kernerman, IBCLC in Dr Jack Newman’s Guide to Breastfeeding (see excerpt below) and there’s more information in Mammary Constriction Syndrome (on this website).
Because of difficulties the mother may have had during pregnancy, labour, or after birth, she may have tightness in her shoulders and chest that causes her pectoral (chest) muscles to press on the blood vessels that lead to her breasts and nipples, causing a lack of blood flow and oxygen, leading to pain. This pain may be throbbing or constant, deep or superficial, itchy, tingling, aching or knife-like, burning or freezing, shooting, sharp or dull, or a combination of any of the above. Also, if a latch feels painful, the mother may tighten her shoulders, clench her teeth, etc., causing the cycle triggering pain to begin again.
Nipple infection, bacterial or fungal
Sometimes the same painful symptoms described for vasospasm or mammary constriction syndrome are due to an infection or skin condition, particularly where there is broken skin and nipple damage. Mothers may describe a shooting or burning pain in the nipple or breast. An infection might be bacterial, or fungal (thrush/candida/yeast) or even both at the same time. An infection may be painful and continue to be painful even with a corrected latch.
Eczema, dermatitis, psoriasis
The article Causes of Sore Nipples discusses eczema, dermatitis and psoriasis on the nipple as well as infections. Your doctor will confirm whether any of these could be a possibility for you and suggest treatments.
Engorgement, mastitis or a blocked duct
There are several potential causes for your breasts becoming full and tender and uncomfortably engorged (over full of milk). If this happens at any stage it’s important to feed your baby often or pump to drain the breasts to resolve the engorgement and avoid possible mastitis. Mastitis is a very painful inflammation of the breast. Check the suggestions in our articles and ask your IBCLC lactation consultant for help with breastfeeding to understand what caused the engorgement and prevent it happening again.
Protect your milk supply while you work on making breastfeeding pain free
Whenever there is pain and a poor latch there is a chance that your breast milk supply may drop and that your baby won’t be getting enough milk. Expressing after feeds by hand expressing or pumping will keep your breasts well drained and so stimulate your breast milk supply. The expressed breast milk can be fed back to your baby after a breastfeed as needed (by spoon, cup, syringe, bottle or supplementary nursing system). Continuing to get regular weights (weekly, or more often if needed until breastfeeding is pain free) will help to gauge how much milk your baby is getting and see Is My Baby Getting Enough Milk? Other helpful articles to maximise your baby’s breast milk intake include Making More Milk, One Breast or Two Per Feed? and Breast Compression.
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There are several reasons why breastfeeding might hurt. The most common reason for breastfeeding to hurt is if a baby isn’t latched correctly leading to sore or damaged nipples, deep breast pain or both. Once cracked or grazed, nipples are more susceptible to infections, another possible cause of ongoing pain. Your breastfeeding specialist can help to find the most likely reason for pain alongside your health professional who will check for medical causes.