Breastfeeding is a learned experience that can be confusing or frustrating at first. Boca OB/GYN offers these guidelines for breastfeeding and postpartum breast care.
Do not use soap on your breasts while breastfeeding as this can dry out your nipples. Rinsing with clear water is sufficient. If your nipples are very dry, you may use a small amount of pure lanolin on them. Lotions are generally not necessary as your nipples are already producing all they need for their protection.
Always wash hands thoroughly before breast feeding or touching your breasts. Make sure nipples are dry after nursing. Leaving your bra flaps down for a few minutes to let them “air dry” is often helpful.
Some mild tenderness is to be expected as you and your baby acclimate to breastfeeding, but should improve within 3-5 days. Breastfeeding should not be painful. If it is, you need to determine the problem and correct it. Very sore nipples are usually caused by poor positioning or a baby that is latching onto the nipple improperly.
Make sure you’re positioned comfortably, with pillows supporting your arms and in your lap (to bring baby up to the position of your breast). Your baby should be face-to-nipple and tummy-to-tummy with you so that he/she doesn’t have to turn to latch on to your nipple. Baby’s chin should be just below the nipple so it presses into your breast while nursing. If you don’t feel comfortable, detach and reposition baby.
Don’t get frustrated. Some babies take to breastfeeding more naturally and easier than others; it’s a learning process. As you and baby become more experienced, you’ll find there are a number of other comfortable positions for breastfeeding. Experiment and see what works — as long as you’re comfortable and baby is nursing well.
When latching onto the nipple, the baby needs to open wide to take in a good mouthful. (You may need to brush the tip of the nipple along the center of the baby’s lips to stimulate baby to “root” for the nipple.) If baby does not get enough of the nipple into the back of the mouth during sucking, the baby’s tongue may be rubbing against the tip of the nipple or the baby may be gumming the base of the areola (over the milk sinuses).
This kind of nursing is very inefficient (baby will not get enough milk and will want to nurse more frequently, making nipples even more sore) and will lead to painful nipples. If baby is making a smacking sound while sucking, he/she isn’t latched on properly.
If you’re having problems, try the following:
- Make sure baby’s mouth is opened very wide before pulling baby into the breast. Baby should latch on far back on the areola – approximately one inch beyond the nipple.
- Make a “V” with your first and second fingers around the edge or slightly beyond the margins of the areola or by supporting your breast with your fingers underneath and thumb on top, pressing in to flatten the breast while pushing back toward your chest. This makes the areola more taut, longer, and narrower and easier for baby to take into the mouth.
- Use the index finger on the hand supporting the breast to push down on baby’s chin while baby is latching on. This will help keep baby’s mouth open wide. Always break the suction before taking baby off the breast by slipping a clean finger into the corner of baby’s mouth or pressing down gently on the breast near baby’s mouth.
Other causes of sore nipples include:
- Flat or Inverted Nipples. Mothers with flat or inverted nipples can successfully breastfeed their babies without pain, but it may take a little more work and patience. Wearing breast shells during pregnancy may help to draw out your nipples. Once your baby is born, it may be helpful to use a breast pump immediately before nursing to help pull out your nipple before baby latches on.
- Engorgement. When your milk first comes and during the early days of nursing, engorgement is not uncommon. Some babies have a difficult time latching on to an engorged breast. To avoid this, be sure your breasts are emptied frequently. If your newborn is not breastfeeding every two to three hours, hand-expressing or using a breast pump may help avoid engorgement.
The first breast that baby nurses on will be emptied more completely, so alternate breasts with each feeding to avoid having one breast overly engorged. Your milk supply will adjust according to baby’s demands and the engorgement should resolve itself within a few days.
- Removing Baby from Your Breast. Most mothers find that once full, baby will release the breast on their own. If baby must be removed from the breast before this happens, break the suction by inserting a finger into the corner of baby’s mouth, pulling down on baby’s chin or pressing down on your breast near baby’s mouth. “Popping” your baby off the breast can cause sore nipples.
- Thrush or Candida. If your baby is no longer a newborn and you suddenly find yourself with sore nipples that are red, blistery, itching, or burning or with deep breast pain, you may have thrush — especially if your baby has oral thrush (white patches on the tongue or sides of the mouth) or if you’ve just finished a course of antibiotics. Call us if you suspect you have thrush.
- Mastitis. Occasionally you might experience blocked milk ducts. Signs of a blocked duct include areas of the breast that are reddened and/or tender and engorged. It’s important to continue breastfeeding when you notice this so that baby will drain the breast. This will not hurt the baby. Offer the affected breast first and, if possible, position baby so that affected area is aligned with baby’s nose and chin.
The symptoms should subside once the breast is adequately drained. If the breast becomes hot and painful, if you run a fever, or if the skin appears tight and shiny, you should notify us. Do not stop breastfeeding on the affected breast.
- Lactation Suppression. To limit milk production in the first few days, bind the breasts with an Ace™ wrap. Remove the wrap daily to shower. Uncomfortable engorgement usually gets better within three to four days. Do not pump the breasts to relieve discomfort as this will only stimulate more milk production. Cold compresses or ice packs can be applied to the breasts for short periods of time and you may also take ibuprofen to provide relief.