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Common questions about breastfeeding and pain

Mother breastfeeding baby

Breastfeeding is a great way for moms to nurture and bond with their babies. While it should not hurt, the idea of pain can make many moms-to-be afraid to even try breastfeeding. African-American women say fear of pain is the number one reason they do not breastfeed. For first-timers, having a breastfeeding expert to help you make minor adjustments is important. With the right information and support, you can do this. Here are the facts on what you should (and should not) expect when breastfeeding.

Why does breastfeeding seem so challenging?

Being a new parent is an around-the-clock job, regardless of how you feed your baby. Breastfeeding is a learned skill, and just like anything you’re doing for the first time, it takes practice and patience to master. Breastfeeding is also a matter of supply and demand. In those first few weeks, breastfeed on demand (when your baby lets you know he or she is hungry) to establish a good milk supply that will keep your baby growing at a healthy pace.

Why do breastfed babies have to nurse so often?

A newborn’s tummy is tiny — about the size of an almond — so it can’t hold much. And since your breast milk is designed to be digested easily, your baby gets hungry quickly. Look for your baby’s hunger cues — head turning toward the breast, fist gnawing, or lip smacking. Crying due to hunger is a grumpy baby’s last resort when someone missed his or her earlier hunger signs. Try not to wait until your baby cries, and look for his or her hunger signs early. Make sure your family and friends also understand the cues so they can support you in those first few weeks. If you stay focused on learning to breastfeed early on, it will pay off in big ways. By the six-week mark, you and your baby will have established a good breastfeeding routine.

What does breastfeeding feel like?

The nipples are often sensitive during those first days of breastfeeding, but it’s temporary. Any discomfort that a new mom feels during breastfeeding should last only a few days as you learn through trial and error. As you’re learning, it may feel strange at first when your baby latches, but it should only be an initial pinch that goes away. If it’s more painful than that, it’s probably a bad latch. And if the latch hurts the mom, it also keeps the baby from getting enough milk. So don’t think you have to “tough it out” by nursing through pain, because that can actually cause bigger problems. Instead, contact a breastfeeding expert, or talk to your doctor or nurse, as soon as possible to help you make what is usually a simple correction to get a good latch.

Why do my breasts get really full and hard?

Your breasts normally feel extremely full around the third day after your baby is born. Your body starts off making a lot of milk just in case there is more than one baby who needs to be fed. But when you breastfeed on demand, your breasts should never feel like two hard water balloons about to burst. That is called engorgement, and it’s an inflammation that happens when you wait too long between feedings. When you’re engorged, not only is it painful for you, but it’s harder for your baby to latch on (because your nipples flatten). Continued and more frequently timed breastfeeding will help you avoid being engorged. You also don’t have to wait until your breasts feel full to nurse. Some women do not ever feel really “full,” even in the beginning. So even if you’re not sure your breasts feel full, it’s okay to offer the breast.

And, as you continue to breastfeed and your body adjusts to the nursing relationship, your breasts may not feel as full as often. Don’t worry, though; no matter how full or not full your breasts feel, your body will still make as much milk as your baby needs.

How do I treat pain from engorgement?

To treat engorgement, apply a cold compress and ask your health care provider if taking ibuprofen is necessary. Rest and pump when you are not feeling well, but you should continue to breastfeed. If symptoms worsen, especially if you develop a fever, call your doctor, nurse, or lactation consultant.

Can’t I just avoid pain if I don’t breastfeed?

During pregnancy, your body starts preparing to breastfeed, no matter how you plan to feed your baby. In the first few days after you give birth, hormonal changes tell your body to start making milk to feed your baby. So even if you never try breastfeeding at all, your body will start gradually making more and more milk for your baby. This is what people mean by “your milk coming in.” If you choose not to breastfeed, you still may experience full breasts or engorgement, which can be painful.

Should I stop breastfeeding if I have cracked, sore, or bleeding nipples?

For first-time breastfeeding moms, it normally takes a few tries before the latch is right, which can make your nipples tender and sore the first few days. If your nipples are cracked or bleeding, chances are you need to make a latch correction. So if it doesn’t feel right, take your baby off the breast and try again. (Use the Breastfeeding checklist: How to get a good latch.) If the pain still doesn’t go away, seek help. But keep on breastfeeding, as it will actually help your nipples heal. You can also rub a little breast milk on your breasts or use purified lanolin cream or ointment to help the healing process. 

What if I have large or flat nipples?

Large nipples or areolas (the area around the nipple) should not affect your ability to breastfeed. The only difference is that when you look down, the baby should have more of the bottom of the areola in his or her mouth. With flat or inverted nipples, depending on the severity, latching might be challenging at first, which could be a little rough on your nipples. A lactation consultant can help you work through it.

Will my breasts leak?

Your body gets ready to make milk while you’re still pregnant. Some breasts leak milk even before the baby is born, but others never leak at all. Some breasts leak all the time, and some leak only when a mother is thinking about her baby. It’s hard to know whether and how much milk you’re going to leak, so it’s a good idea to have some nursing pads on hand. Whichever pads you use, it’s important to change your nursing pads often. 

Do I need to prepare my breasts/nipples in any special way?

You already know the skin on your nipples and breasts is very sensitive. Your breasts also have special oil glands that help keep the skin moist and flexible, and they even tell your baby where the nipple is based on scent! You don’t need to use any soaps or lotions to keep that skin clean and hydrated; in fact, some moms find that perfumes, scented lotions, soaps, and other chemicals are too irritating and drying. So just use plain water to clean your breasts, and blot or air dry.

How do I know if the pain isn’t normal?

Not only is a poor latch painful and miserable for moms, but it can also lead to blocked milk ducts, mastitis, and other infections. A poor latch also isn’t good for your baby, as it means he or she isn’t getting enough milk. (See Breastfeeding checklist: How to get a good latch to know what to expect.) So if it’s been more than a few days and things haven’t improved, get help. There are resources available to you, many at no or low cost. Call the National Breastfeeding Hotline at 800-994-9662. You can also talk to your doctor, your baby’s pediatrician, or a local breastfeeding peer counselor. There is absolutely no shame in asking for help, because when you do, you are doing what needs to be done to do right by your baby and for yourself. That is what motherhood is all about.

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Content last updated: December 21, 2012.

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