Postpartum Breast Pain

Sore Nipples

Management:
There are a number of things you can do to help alleviate sore nipples. Focus on correcting your baby’s latch. Be patient while you and your baby learn to nurse. Do not allow the baby to nurse with an uncomfortable latch. Take the baby off and try again, even if you have to do this a number of times. Use deep breathing, soft music or other relaxation techniques before and during breastfeeding. Nurse on the least sore side first. Massage you breasts while nursing, from base to nipple. This helps stimulate the milk flow. Use non-plastic lined bras and/or bra pads. Change the pads frequently to keep the nipple dry.

If your nipples become dry, cracked or sore you can express breast milk and gently rub it into your nipples. You may also apply pure lanolin. (Pure lanolin is sold as Lansinoh or Pure-Lan at most pharmacies.) This forms a moisture barrier to help keep your nipples dry. When bathing, avoid using the soap on your breasts or nipples. Water is all that is needed to clean your breasts. Release the suction from the baby’s mouth before you remove your baby from the breast. Do this by placing a clean finger in the side of your baby’s mouth between her/his jaws. Do not take your baby from the breast until you feel the suction break.

If the condition of your nipples is not improved within two days, contact your physician, nurse, midwife or lactation consultant so that they can check for infection.

Prevention:
To prevent nipple tenderness, make sure you are correctly positioning your baby during nursing and that she or he is latching on properly.

Breast Engorgement

During the first week after delivery, as the colostrum is changing to mature milk, your breasts will become full. This normal postpartum fullness usually lessens within three to five days.

If feeding or pumping does not adequately remove all the milk your body produces, engorgement may develop. Breast engorgement can be very uncomfortable. The full areola may cause the nipple to flatten making it difficult for the baby to latch on well.

Managing Engorgement:

• Breastfeed your baby as frequently as 10 to 12 times in 24 hours.
• Avoid giving your baby water or formula for the first three to four weeks unless medically indicated.
• Avoid using a pacifier for the first three to four weeks.
• Express a little milk before you nurse by hand or pump. This will help make the areola softer, and the nipple more erect so latch on is easier. If your baby can’t latch on because your nipples are flattened, gently stimulate your nipples by hand to make them more erect and hand express some milk to soften the areola. You may need to use a hospital-type breast pump to do this.
• Use moist heat for five minutes or less and breast massage before hand expression or pumping. Another option is "reverse pressure softening." Place your index and middle fingers on each hand, opposite one another on each side of the nipple. Push straight back toward the chest wall for 30 seconds. Then move the fingers to a different place on the nipple. If you visualize your areola as a clock and your first position was 3:00 and 9:00, move to 12:00 and 6:00. Repeat pressure for another 30 seconds. This should move some milk away from the nipple, often enough to get the baby to latch on.
• Express your milk if you have to miss a feeding.
• Wean your baby very gradually if you want to stop breastfeeding. For example, if your baby is breastfeeding 10 times per day, drop one feeding every other day.

Treating Engorgement:

• Apply warm, moist towels to your breast for two to five minutes, or take a warm shower before nursing your baby.
• Use gentle breast massage before and during breastfeeding.
• Use deep breathing, soft music, or other relaxation techniques to lessen discomfort and encourage letdown before and during nursing.
• Apply cool compresses or ice to your breasts after nursing to relieve discomfort and decrease swelling. A bag of frozen peas makes a nice ice pack.
• If your baby takes only one breast, use a breast pump or hand express the milk from the other breast during the engorgement period.