Expert Focus: Breast pain Part 1

When you explore the reasons why women find breastfeeding difficult according to the infant feeding survey 2010, breast and nipple pain are one of the 5 top characteristics.

It poses the question – if this is so high on the agenda what can we do to enable women to have more realistic expectations, what is normal and what is abnormal and how to overcome the challenges.

breastshield fitting

Most new mothers will experience nipple soreness. This is down to several reasons:

  • Baby suckling and creating vacuum to remove colostrum
  • Learning how to latch baby on
  • Sustain the latch so that the nipple tip is deep in baby’s mouth at the soft and hard palate junction, rather than shallow, wedged and compressed against the hard palate.
  • Nipple teat confusion

Occasionally there are physiological reasons why some mothers experience nipple pain such as:

  • When baby creates high vacuum
  • Baby has a high palate
  • Baby has a tongue tie
  • Nipple bleb / blister
  • Mother may have nipple vaso-constriction when baby sucks hard, restricting the blood flow and resulting in pain and numbness
  • Early signs of infection – inflammation, redness and tenderness
  • Itchy, flaky shiny nipple skin and breast pain may indicate thrush

Breast pain can also originate from several causes:

  • Breast pain can occur when milk ejection is triggered
  • Engorgement
  • Mastitis
  • Breast abscess
  • Mammary candidiasis (thrush)

Other reasons:

Engorgement and Mastitis - when milk comes in nipple pain is caused when babies are unable to latch effectively and hand expression aids to relieve the fullness and help baby latch easier. If the breast remains engorged there is milk stasis and this can lead to breast inflammation and trauma with or without a cracked nipple. Effective and frequent feeding is advisable – keep on breastfeeding – get early help to check baby feeding, if baby cannot feed use hand or a mechanical breastpump to effectively remove the milk. Increase the frequency of feeds, you may need antibiotic therapy as well as pain relief for sore and painful breasts, fever and aching limbs associated with mastitis.

Nipple bleb / blister - this is where a milk duct is plugged. Apply wet warm heat by bathing or using a compress which thins the skin a little – put baby to breast to feed. If this doesn’t help gently massage and hand express, or seek advice from a health care professional as rarely assistance may be needed to open the blister and topical antibiotics needed.

Vaso-constriction / Raynaud’s phenomenon - apply warm packs or hand massage the breast to aid circulation before and after feeding. Check and aid latch with different feeding positions. Seek advice from GP as prescription medications are available to enhance blood flow.

Thrush - candida albicans is part of our normal skin flora but when the fine tuning of the skin is out of balance this overgrowth of yeast can occur resulting in discomfort for baby and mum when breastfeeding. The maternal symptoms affect both breasts in isolation or together:- itchy, shiny flaky nipple skin and occasionally deep breast pain that intensifies as the feed progresses and after feeds. Occasionally blanching of the nipple occurs (goes white). Sudden onset of nipple/ breast pain after a period of comfortable nursing may indicate a thrush infection.

In baby white patches are visible in the mouth gums, cheeks, tongue, baby may have nappy rash - red or red and raised dots, and does not feeding well because the mouth is sore.

To confirm diagnosis a swab should be taken from both breasts. and both baby and mum need treatment simultaneously. Breastfeeding should continue.

Seek advice from GP if topical treatment are ineffective as systematic treatment for mum may be necessary.

Breast trauma from expressing - A good technique is necessary for hand expression as the breast glandular tissue is close to the skin surface and can be easily traumatised and bruised – chat to your midwife if you are getting bruising

Using the correct vacuum setting on your breastpump is also important – if it is too high it can cause nipple trauma but also it will impede your milk flow by compressing the milk ducts and interfering with the trigger for milk ejection because it is painful. Make sure you gradually increase the vacuum to high and if it is tender just turn it back a little – this is your personal comfortable threshold.

Use the correct shield size for you – make sure that the nipple moves freely in the funnel with the cycle of the pump, the nipple is positioned centrally and good milk flow is seen. The breast feels comfortable and empty after pumping. If the shield is too big or too small it will result in nipple soreness and pain and predispose engorgement and mastitis.

To bring it together – yes getting breastfeeding started does take time to adjust both mentally and physically. The nipples are used for the first time specifically for feeding and can vary in time from 10-30 mins per feed. The natural moisture is stripped and the skin flora is shifted out of balance a bit so using expressed breastmilk and Purelan aids a good balance and helps to moisturise. It is normal to have some soreness tenderness and some bleeding but it is important that you let someone know so that they can help and reassure you – give you some tips and pointers as well as making sure everything is ok.

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