When Breastfeeding Hurts

Breastfeeding can hurt. (There. I said it.)

No, it doesn’t hurt everyone. No, it doesn’t hurt all the time. But for a good portion of us, at least some part of the breastfeeding relationship will be painful or very uncomfortable.  Now, I know that saying so isn’t popular among the pro-breastfeeding contingent. But as one of those (annoyingly) pro-breastfeeding folks, I think it’s all the more important to tell the truth.

I was chatting with my doula right after the birth of my second child, and we were talking about the early days of breastfeeding. She birthed and successfully breastfed four kids, and she feels that telling women that breastfeeding “shouldn’t be” or is “never” painful is misleading. I agree wholeheartedly.

Not only is it misleading, but it might be discouraging to a mother who feels like she’s doing everything by the book, but is still struggling with pain and discomfort weeks into the nursing relationship. If she’s in pain, but doesn’t see that pain acknowledged as normal, or discussed anywhere, she may feel that she’s doing something wrong. She may even end the breastfeeding relationship prematurely because she feels her experience isn’t normal. Most info out there suggests that if you’re in pain while breastfeeding, “you’re doing it wrong.”

One of my favorite reminders...

One of my favorite reminders...

So I’m going to level with you, and tell you what I told my best friend about breastfeeding: it hurts. Sometimes it hurts a lot. There will be really, really tough times. Sometimes, you can be doing everything right and it still hurts.

Here are some issues that might come up in the breastfeeding relationship- in all of these circumstances, pain or discomfort can be normal. And it’s time to state the obvious: you need to discuss anything you perceive as abnormal with a doctor or midwife, along with a lactation consultant. For any and all of these concerns, my favorite online resource for evidence-based information is Kelly Mom. Bookmark it, mamas!

Before your milk comes in.

Your body is hard at work healing from labor and birth. You’re getting approximately, well, no sleep. And on top of that, baby is working hard to pull down colostrum (that pre-milk “liquid gold” that sustains the baby until the real stuff comes in). Within minutes of her birth, my first child was latched and nursing like a champ. The hospital’s lactation consultant was thrilled.

But nobody can prepare you for the intensity of having a suckling baby at a (nearly) dry breast. She’s going to work around the clock with an intensity you won’t believe to pull the colostrum down and get your milk production in gear. Your nipples will chafe. They may even crack and bleed. My friend likened it to walking barefoot for the first time. It would take a good bit of walking to desensitize the soles of your feet to the friction.

There will be little you can do to improve this, other than keep working on the baby’s latch and take some deep breaths. You can use nipple butter, you can put what little milk you have in the cracks for healing. If possible, exposing the nipples to a bit of sunshine during the day may aid in the healing process. As long as baby’s latch is good, it will heal! But make no mistake: it can hurt.

Hooray! The Milk Arrives!  (But engorgement is here.)

For some women, the milk doesn’t trickle in. The milk arrives in a deluge that requires nursing pads, blankets, burp cloths, and pretty much anything else soft and within your reach to manage it. Engorgement does subside, but it can cause inelasticity in the breasts and nipple, making it harder for the baby to latch and successfully pull down milk. Engorgement that remains unresolved can lead to infection, so this is not a symptom to ignore.

Engorgement is also usually part of the weaning process at some point or other, although not for everyone. In my opinion, very gradual “baby-led weaning” helps avoid engorgement. Other remedies include cabbage leaves over the breasts.

Baby Latch Issues

Anytime you have an issue with the baby’s latch, you’ll know it. How will you know it? You might know it by the sound of baby swallowing air, or sputtering a bit at the breast. But the first indication is often- yep, you guessed it- the pain.

If you happen to be an utterly exhausted mother of a newborn, and you happen to be awake for the night’s millionth feeding at, say, 4 a.m., you might somehow momentarily forget that you still need to take a moment to adjust the baby’s mouth or body for optimal feeding. If you forget that once or twice, you may have irritation or even swelling around the nipple. If it gets really bad, you may need to even apply ice prior to the next feeding to numb things up. Excluding tongue-tie and other concerns, the baby’s latch should continue to improve if you’re watchful of a few things, like making sure baby’s lips are turned out, and encouraging the baby to take more of the breast tissue in her mouth.

But the learning curve on this can be steep for both mama and baby. So even if you know what you’re doing, it’s reasonable to have some pain in the early stages as you work through the changes.

Get help before your nipples get too raw to move forward.

Painful Letdown

Although this problem sounds more like the feeling of being passed over for a promotion at work, it actually has to do with the speed and power of your MER, or Milk Ejection Reflex. For most women, painful letdown isn’t an issue. In fact, some women struggle with a slow letdown, which can make babies fussy and impatient for more food. But a MER that is sufficiently swift and powerful that it causes pain may mean that you’re dealing with Over-Active Letdown (OALD). This might register as anywhere from uncomfortable to excruciating, depending on how far into the breastfeeding relationship you are, and what your supply is like. OALD is typically related to oversupply issues, however, some women may develop a completely normal and stable milk supply, and still have painful letdown months into nursing. With my first child, all the other problems of breastfeeding (painful latching, sore nipples, etc.) had all resolved by about 8 weeks, but the OALD continued for months despite my normal supply. In fact, letdown was painful for me up until about eight months.

Now, with baby number two, I have the same painful letdown. I’m hoping they’ll subside a little sooner this time, when my supply normalizes. Which brings me to the next painful thing…

Oversupply

“But that’s a great problem to have!” Even most lactation consultants don’t understand why this would suck to much. I’d prefer oversupply issues to having to work to maintain my milk supply. But it can really hurt.

One of the main ways of dealing with oversupply is “block feeding,” which basically means that you nurse for longer periods on only one breast. What this means is that the other breast will become engorged. And for most women with oversupply issues, painfully engorged. Sometimes during a single block feeding of 4 hours or so on one side, I’ll have so many letdowns during feedings that I have to pump a couple ounces off of the other side, just to maintain some level of comfort. Of course, this is a balancing act, because pumping too much will only increase your supply. Chronic over-engorgement can lead to mastitis and other issues.

Pumping

For many women, pumping is uncomfortable, or even painful. Make certain that the flange (the cone shaped thingie you’re placing to the breast) is the right size. And not to sound like one of those people on the internet who thinks coconut oil is the solution to all the world’s problems, but it’s true: putting a little bit of coconut oil on the inside of a properly fitting flange prior to pumping can really ease discomfort.

Plugged Ducts and Mastitis

An obvious, but significant one. Mastitis is an inflammation of the breast, caused by any number of things, including an obstruction, an infection, or an allergy. All of the issues above can contribute to or cause mastitis at any point in the breastfeeding relationship, although mastitis is most common in the first two to three weeks. Mastitis usually brings with it a fever and flu-like aching and chills, among other symptoms. Infrequent or skipped feedings, engorgement, inadequate milk removal, oversupply, and an impact to the breast can all lead to mastitis. I managed to make it through breastfeeding baby #1 without getting mastitis. I wasn't so lucky this time around. The last thing you need when you've had two good hours of sleep in three days (and you're still healing from birth) is to add flu-like symptoms to your day. So stay on top of the first symptoms of mastitis: if the breast feels especially warm to the touch, or even itchy- or if you feel flu-like symptoms and suspect mastitis, read La Leche League's guidance  on mastitis and get in touch with your healthcare professional immediately.

Eeeeeek! TEETH.

Yep, that gummy little smile is going to be replaced by some razor sharp, freshly cut baby teeth. (BTW, don’t let anybody tell you that once she has teeth, it’s time to stop breastfeeding. Some babies are born with teeth. Does that mean they should never eat? NOPE.)

At some point, chances are, baby is going to test out her new chompers. Beware: babies can become fond of the big reaction biting provides, so my best advice (from my daughter’s first pediatrician, a truly stellar Integrative Doc) is to provide a reaction that will startle and also disappoint them. The first big bite might be met with an “OW!” from mama. But if baby tries it again, or appears to be experimenting with getting a reaction from you, our doc advised that you say “OW,” and quickly take baby off the breast and place her down on the floor and walk a few paces away. (It might sound harsh, but creating separation is a natural consequence of one person hurting another, whether intentional or not.) I only had to do this once (so far!) with each baby, because it works.

 

This list could be a lot longer. With thrush infections and several other common issues left unaddressed, I’m barely scratching the surface. 

But an important thing to realize if you’re finding the breastfeeding relationship painful in any way, is that you’re not alone! Discomfort can be normal. Even pain can be normal. So if you’re in one of these tough stages right now, get professional help where you can, get emotional support where you can, and remember: you’re doing something amazing for your child.

As Art Williams once said, "I'm not telling you it's going to be easy- I'm telling you it's going to be worth it." Keep on keepin’ on, mama. 

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