Is breastfeeding pain ever normal? And other common problems

Breastfeeding is often pictured as an intuitive and beautifully intimate experience between mother and child. But for some moms it can be frustrating and difficult — or even impossible. It can also be incredibly time consuming. Because each woman’s experience is unique, it’s also hard to know what’s normal and what’s not, even if you have a circle of experienced moms to talk to. Many women experience pain during breastfeeding, especially when their child is newborn. But is this a sign that something is wrong, or is pain during nursing to be expected? We spoke to veteran lactation consultant (LC) Fara Patterson to find out. Patterson has been a practicing LC for decades, and has helped hundreds of women along their breastfeeding journeys. 

How do you know what’s normal?

Patterson says that sensitive nipples are quite common during the first few days of nursing — especially during the initial horrors of cluster feeding — but your body should acclimatize after a few days. 

When it comes to pain, however, Patterson says that 99% of the time it means something is wrong. “In twenty years I’ve come across a handful of people whose skin is just so sensitive that breastfeeding is permanently uncomfortable for them. But those individuals are incredibly rare. So if nursing hurts, especially if breastfeeding causes cracked nipples, broken skin, or bleeding, you need help.” 

Newborn latching problems

Difficulty getting your baby to latch can cause breastfeeding problems for many new mothers. If you experience pain when nursing, it likely has to do with your baby’s latch, and it signals that you could use some help and soon — before it derails your breastfeeding journey. Patterson explains that, “after your baby is born, you have a hormonal cascade that results in breastmilk getting made. But somewhere between week two and six, your hormones ebb and that goes away. At that point, your breast milk making capacity depends entirely on your body replacing what baby takes from your breast.” So if you don’t improve your baby’s latch before this transition, you risk experiencing a decrease in milk supply. (Not to mention continued pain during breastfeeding.)

Breastfeeding with flat or inverted nipples

Many women are concerned that they have inverted or flat nipples which might contribute to painful nursing sessions or even make breastfeeding impossible. While this can sometimes make it more difficult for baby to latch initially, with support from an LC many women with inverted or flat nipples are able to breastfeed. 

Thrush

Besides improper latch, there are a few conditions that can cause breastfeeding pain, and thrush is one of them. A yeast infection of the breast, thrush can be transmitted back and forth between your nipple and your baby’s mouth. Telltale signs include white patches inside your baby’s mouth and increased fussiness during nursing. Moms are likely to notice sharp, stinging pains in their breast and/or nipple during or between feeds, and your nipples might have a red and shiny appearance.

Mastitis

Mastitis is another common breastfeeding problem that causes nursing pain. It affects about 20 percent of lactating women and is caused by a severely blocked duct or an infection in the breast. Mastitis typically appears first as a warm, red area on your breast and can result in flu-like symptoms. If precipitated by a blocked duct, it often begins as a small lump in one of the breasts, although even if no lump is present, a sore breast while breastfeeding can still mean mastitis.

Blocked ducts

Blocked milk ducts happen when breast milk backs up or isn’t removed from the breast properly. This is often caused by a bad latch or a sudden decrease in your baby’s nursing frequency. A blocked duct can be painful, but if the pain intensifies or you also have flu-like symptoms, it’s likely become mastitis. The best way to treat blocked ducts is with nursing, heat and massage. They should be addressed quickly to prevent them from turning into mastitis. 

Milk blisters

A milk blister, or bleb, looks like a pimple or a whitehead on the nipple. It happens when skin grows over a milk duct opening and can be extremely painful both while nursing and between feeds. While typically caused by an improper latch, engorgement, or friction, a bleb can also be precipitated by thrush. To treat it, try and soften the spot with warm compresses or soak it during a bath. Whatever you do, don’t try and open the blister yourself, as this increases your risk of infection. If it is extremely painful or seems to be getting bigger, see a doctor for additional options such as having it lanced.

Should I see a doctor or a lactation consultant?

Mastitis and thrush are two cases where you’ll likely want to go straight to the doctor. While both may go away in the early stages after treatment at home, if you’ve had symptoms for more than a couple of days, antibiotics or antifungals are likely necessary. But no matter what you do, continue to breastfeed — it helps to speed up healing in both cases, and is entirely safe for your baby. Stopping can actually cause secondary issues like engorgement or blocked ducts, leading to further pain.

If nursing is painful and you’re sure it’s not because of active mastitis or thrush, seeing an LC is usually the way to go. Patterson affirms that many breastfeeding problems — pain, low milk supply, and even blocked ducts — all come down to a bad latch. Pain signals that your baby is fastened to the breast in a way that isn’t serving either them or mom. Lactation consultants are trained to help you solve exactly this issue.

A tongue tie is another common reason for pain. This condition can be hard to diagnose on your own, but essentially means that a portion of your child’s tongue is attached to their mouth, making it difficult for them to latch. Both a lactation consultant and a doctor should be able to diagnose the condition, however you will need a doctor to snip the tongue tie.

Breastfeeding tips for sore nipples

• Begin your nursing sessions on the side that is less sore — unless instructed otherwise.
• Don’t let your baby “hang out” on your breast after they finish nursing (if they have fallen asleep for example).
• Don’t pull your baby off your breast forcefully when ending the feed. Instead, break the seal by inserting your pinky into the side of your baby’s mouth and removing your nipple.
• Try different nursing positions. Habitually nursing one way can cause repeated pressure in a certain part of the breast. Varying your hold on baby and the direction they face can help alleviate this.
• Soaps, shampoos, and laundry detergent can dry out sensitive nipple skin. Make sure you rinse your breasts and anything that comes into contact with them thoroughly with clean water.
• Appropriate nipple cream can be a lifesaver for sore and sensitive nipples. It helps to rehydrate your skin and provides a moisture barrier to keep hydration in. Applying a small amount of breastmilk after nursing and allowing it to dry can also be beneficial.

While breastfeeding can be uncomfortable at times, outright pain is typically a signal that something is wrong. Ignoring the issue will only make it worse in the long run. Speak with a doctor if you have any concerns: with the right support, nursing can be comfortable.