Reducing Breastfeeding Pain Starts With a Deep Latch

Relieve Breastfeeding Pain: Solutions for the Moms Top Breastfeeding Struggles

Tender and sore nipples are normal during the first week or two of your breastfeeding journey. But pain, cracks, blisters, and bleeding are not. Your comfort depends on where your nipple lands in your baby’s mouth. And this depends on how your baby takes the breast, or latches on.

 

To understand this better, use your tongue to feel the roof of your mouth. Behind your teeth are ridges. Behind the ridges the roof feels hard. When your nipple is pressed against this hard area in your baby’s mouth, it can hurt.

But farther back in your mouth the roof turns from hard to soft. Near this is the area some call the comfort zone. Once your nipple reaches your baby’s comfort zone, breastfeeding feels good. There is no undue friction or pressure that would cause sore nipples during breastfeeding.

To make this happen, let gravity help. Lean back with good neck, shoulder, and back support and your hips forward. Lay your baby tummy down between your exposed breasts. When your calm, hungry baby feels your body against her chin, torso, legs, and feet, this triggers her inborn feeding reflexes. When her chin touches your body, her mouth opens and she begins to search for the breast. In these laid-back positions, gravity helps the nipple reach the comfort zone.

In other positions, you need to work harder to help your baby take the breast deeply.

  • With your baby’s body pressed firmly against you and her nose in line with your nipple, let her head tilt back a bit (avoid pushing on the back of her head).
  • Allow her chin to touch the breast then move away.
  • Repeat until her mouth opens really wide, as wide as a yawn.
  • As she moves onto the breast chin first, gently press between your baby’s shoulders from behind for a deeper latch.

That last gentle push helps the nipple reach the right spot. Breastfeeding tends to feel better when your baby latches on asymmetrically, so that more of the areola (the dark part around your nipple) under the nipple is in her mouth than on top of the nipple.

Signs of a Deep Latch

  • You feel a tugging but no pain throughout the breastfeeding session. (In the first week or so you may feel some pain in the first minute or two of sucking that eases quickly)
  • You hear your baby swallowing.
  • Her lower lip is rolled out.
  • You see more of the dark area around the nipple above your baby’s upper lip than below.
  • Your baby breastfeeds with a wide-open (not a narrow) mouth.

If breastfeeding hurts, seek help right away from a board-certified lactation consultant (IBCLC). The sooner you get help, the better.

Unicef WHO, breastfeeding promotion and support in a  bay friendly hospital, training course

Solutions for Sore Nipples 

If you have painful, sore nipples during breastfeeding (beyond the first minute or two of discomfort that sometimes occurs) you need to take your baby off the breast and try for a better latch. Be sure to break the suction first. Gently slide a clean finger between baby’s lips and gums until you feel the suction release.

Even mothers with broken skin on their nipples can heal while breastfeeding. When their nipples reach the comfort zone, there is no friction and pressure.

If your breasts are very full and taut, it may help to express a little milk first. It is easier for a baby to draw a soft breast back to the comfort zone than a firm, full breast.

If after working to get a deeper latch, you aren’t feeling better within a day or two, seek help from a board-certified lactation consultant. Other solutions may be needed with other causes of nipple pain.

If you have broken skin on your nipples, products that provide a healthy moisture balance will help soothe sore nipples. Mothers were once told to keep their nipples dry, but now moist wound healing is recommended.

See our nipple moisturizing products. Helpful products include: Hydrogels

Breastfeeding and Your Preterm Baby

Nursing premature babies offer unique challenges. When you give birth early, your breast milk may be higher in many of the nutrients that your baby needs, such as protein and iron. In addition, all breast milk may help protect your baby against infection and disease and strengthen your baby’s immune system. It also contains enzymes to help your baby digest your milk, and its growth factors help your baby’s gut mature. No other food gives your baby these benefits as well as breast milk.  It is human milk for human babies!

Research has found that preterm babies who miss out on mother’s milk may get sick more often and more severely. As they age, they also may have more vision problems, bone problems, and delays in development.

Your baby’s ability to breastfeed will depend on how early your baby was born and her health. Your hospital may also have policies that affect when you start breastfeeding. Try to hold your baby skin-to-skin as much as you can. This helps your baby stay warm, calm, and sleep better, and it may help you make more milk.

Can a Preterm Baby Nurse?

Your baby has feeding skills even before you start breastfeeding.

  • At 28 weeks, some babies can root at the breast.
  • At 32 weeks some babies can suck and swallow.
  • By 36 weeks, some preterm babies can breastfeed.
  • Babies with health problems tend to take longer to learn to breastfeed well.

Studies have found that preterm babies may have fewer heart rate and breathing problems when breastfeeding versus bottle feeding. A baby who is not taking full feedings at the breast can be fed breast milk in other ways until she is breastfeeding well.

If your preterm baby cannot nurse directly from the breast, pumping breast milk may be the best alternative until she is older and more capable to feed from the breast.  Ameda breast pumps can help you provide breastmilk for your preemie.

When your preterm baby is ready to start feeding from the breast, she may give you some clues. Signs could be:

  • Putting her hand to her mouth.
  • Licking and sucking motions.  
  • Nuzzling and turning her head toward your breast  with a wide, open mouth.

Think of your first breastfeedings as practice.

  • Your baby may lick or mouth the nipple at first.
  • Many preterm babies suck in short bursts and fall asleep quickly.
  • It may take several days or weeks before your baby feeds well. She is making little steps towards learning.
  • If your baby does not get much milk at first, it’s okay. Keep trying! In the meantime  you can supplement with your pumped breast milk.

To make the move to full breastfeeding, you may seek help from a board-certified lactation consultant (IBCLC). To find one near you, check www.ilca.org.

Pumping for a Preemie

Providing breast milk for a preterm baby has significant immediate and long term health benefits.  And because of these benefits, the first step is establishing a good milk supply.

From Birth to Day 3

Your preterm baby may breastfeed well from birth. If not, start pumping. If you can, start within the first hour after birth but no later than six hours. Use a multi-user breast pump. Plan to double pump at least eight times per day for 10-20 minutes. For more details, see our Q & As, Reaching Full Milk Production with a Breast Pump.

Initially, expect to pump just a little colostrum (the first milk). Even drops are important to your baby. Every time you pump it tells your body to make more milk.

From Day 4 to Day 10

Expect to see a big change by Day 3 or 4. Where there were drops, you’ll likely see ounces. If your baby is not yet breastfeeding or you have chosen not to breastfeed, use your pump to try to reach full milk production by Day 10. Your body is primed and ready to do this right after birth. If you wait until later, this can be much harder. When you reach approximately 25 to 35 oz. (750 to 1050 mL) per day, you are there.

When you start to pump more milk on Day 3 or 4, try these tips to boost your supply faster:

    • Pump longer— two minutes after the last drop of milk or until your breasts are softened/no longer feel full.
    • Hand-express milk into the pump flange afterwards. By draining your breasts more fully, you’ll make more milk.
    • Don’t go longer than five hours between pumpings until you reach full production. (Full breasts make milk more slowly.) 
    • Pump 8-10 times during a 24 hour period. You don’t have to pump on a set schedule but try and pump twice between 1-6 am, when your hormones are producing more milk.  
    • Massage your breasts during pumping. 
    • Check your breast flange fit. Flange fit can change as you pump more. See the photos in Getting a Good Flange Fit under Breast Pumping.

Once you reach full production, most mothers can pump less—6-7 times per day—to maintain their milk. Try to sleep longer. See if you can do this without too much breast fullness or a decrease in milk production. Any milk that your baby doesn’t need right away can be saved for later.

Storing Your Milk

Follow your hospital’s rules for milk collection and storage. Most hospitals suggest that you:

Your hospital may give you bottles and lids to use. Ask your hospital for the storage times it recommends at room temperature, refrigerator, and freezer. Use the Ameda Cool ‘N Carry™ or other insulated tote to keep the milk cool between home and hospital.

Boosting Milk Production

If your production drops to below approximately 25 oz. (750 mL) per day, try these ideas to bring it up.

  • Switch to a hospital/rental pump, if you’re not already using one. 
  • Hold your baby skin to skin before pumping. 
  • Massage your breasts before or during pumping. 
  • Hand-express milk after pumping. 
  • Pump longer. (Drained breasts make milk faster.) 
  • Pump more frequently each day. 
  • Pump in a more relaxed environment.

This is general information and does not replace the advice of your healthcare provider. If you have a problem you cannot solve quickly, seek help right away. Every baby is different. If in doubt, contact your physician or lactation consultant or another healthcare provider.

How Do Breasts Make Milk? The Physiology of Breastfeeding

A woman’s breasts start getting ready to make milk when she becomes pregnant. Breast changes are caused by four main hormones. These hormones cause the ducts and glandular tissue (alveoli) to grow and increase in size (see the anatomy of breastfeeding in the image to the left). Your breasts start to make the first milk, colostrum, in the second trimester. Colostrum is thick and clear to yellow in color. Once your baby and the placenta are delivered, your body starts to make more milk. Over the next few days, the amount of milk your breasts make will increase and the color will change to appear more watery and white.

Hormones of Lactation

The complex physiology of breastfeeding includes a delicate balance of hormones. There are four hormones that help your breasts make milk: estrogen, progesterone, prolactin and oxytocin. Your body naturally knows how to adjust the level of these hormones to help your breasts make milk, as seen in the drawing.

Hormone Levels of Lactation

Estrogen and progesterone prepare your breasts to make milk. These hormones are released by the placenta during pregnancy. They have two major roles. They increase the size and number of milk ducts in your breasts. They also keep your body from making large amounts of breast milk until after your baby is born. Once your baby is born and the placenta is delivered, these hormones decrease. This decrease signals your body that it is time to make milk.

Prolactin helps your breasts make milk. After the birth of your baby, prolactin levels increase. Every time you breastfeed or pump, your body releases prolactin. With each release, your body makes and stores more milk in the breast alveoli. If the level of this hormone gets too low, your milk supply will decrease. This is why it is important to breastfeed or pump right after delivery and then at regular time frames.

Oxytocin releases milk from your breasts. When your baby (or breast pump) begins to suck and draw your nipple into her mouth, this hormone is released. This release causes milk to be squeezed out of the alveoli, into the ducts and out of your nipple, into your baby’s mouth. This process is called letdown or milk ejection reflex (MER).

Milk Ejection Reflex

This is general information and does not replace the advice of your healthcare provider. If you have a problem you cannot solve quickly, seek help right away. Every baby is different. If in doubt, contact your physician or healthcare provider.

What Not to Eat When Breastfeeding

Nutrition tips for breastfeeding moms

When breastfeeding or breast pumping, many mothers are curious whether there are specific foods they should or should not eat. In truth, there are no foods that every breastfeeding mother must have, and there are no foods that all mothers must avoid. For example, in most cases there is no need to steer clear of chocolate, spicy foods, onions, garlic, broccoli, or cabbage. A good rule of thumb to follow is “everything in moderation.” Here are some additional tips to consider when breastfeeding.  These are general information tips and do constitute clinical advice.

Tip #1: Eat to hunger

You do not need to eat more than usual to make enough milk, just “eat to hunger.” Extra calories do not seem to be as important as once thought. Your fat stores at your baby’s birth provide much of the fuel needed to make milk. Research has found that your metabolism may be more efficient while breastfeeding than at other times. This may reduce your need for extra calories. More active mothers will need more calories, but they will likely also feel hungrier, too.

Tip #2: There is no ideal diet or foods to make good quality milk or to make more milk

Although eating well is good for you (it boosts your energy and resistance to illness), an ideal diet is not necessary to produce good quality milk. As pediatrician/neonatologist and breastfeeding expert Ruth Lawrence, MD, writes: “All over the world women produce adequate and even abundant milk on very inadequate diets.”* Studies have found that it takes famine conditions for several weeks before a mother’s milk is affected.

*Lawrence, Ruth A. et al. Breastfeeding: A Guide for the Medical Profession 8th edition, Philadelphia 2016: Chapter 9, page 285.

From what we know, food is not related to increased milk production. Milk production is based on how many times each day your milk is drained well from your breasts. The more times you breastfeed or express your milk and the more drained your breasts are, the more milk you will make. For information on herbal and prescribed medicines that increase milk production, talk to your lactation consultant.

Tip #3: A fussy baby is likely not related to something you’ve eaten

Keep in mind that almost all babies have fussy periods, but your baby’s fussiness is probably unrelated to your diet. Besides fussiness, other signs in a baby are dry skin, congestion, bloody stool, rash, and wheezing. If you suspect a food is affecting your baby, try avoiding it. (Cow’s milk takes about two weeks to clear.), then try eating it again. If your baby reacts, you’ll know to avoid that food for a few months. (Most babies will not react after about six to nine months of age.) The most likely culprits are protein foods such as dairy, soy, egg white, peanuts, and fish. Only changing your diet will tell you for sure.

Tip #4: If you choose to diet during breast feeding, approach weight loss gradually

Dieting during breastfeeding may be the best time, as breastfeeding helps burn fat stores. But it’s best to go slowly and lose weight gradually. Any diet should include at least 1800 calories per day.

As with other food products, artificial sweeteners are okay in moderation, one to two servings per day.

Tip #5: If you are vegetarian or vegan, ensure you are getting enough vitamin B12 

As a vegetarian, you need to either eat foods that have vitamin B12 (such as eggs or dairy), eat foods with vitamin B12 added, or take supplements. If you are on a vegan or macrobiotic diet or any other diet that does not include animal products, be sure to get enough B12.

Tip #6: Drink to thirst

Research has not yet found a link between the fluids a mother drinks and her milk production. The simple guideline is drink to thirst. To make it easy to get a drink when thirsty, keep a container of water where you usually breastfeed. A sign that you may need to drink more fluids is if your urine is dark yellow instead of a light, straw color.

Tip #7: Caffeine in moderation

As with all parts of your diet, think moderation. One or two cups of coffee (or other caffeinated drinks such as teas or colas) are not likely to cause a reaction. Unless a baby is unusually sensitive, there is no need to avoid caffeine completely.

Tip #8: An occasional glass of beer or wine while breastfeeding has not been found to be harmful, but stronger drinks or more alcohol take longer to leave your milk

You can have an occasional glass of beer or wine while breastfeeding; a little alcohol in the milk now and then has not been found to be harmful. However moderate to heavy drinking is risky for your baby.

Mothers who want to avoid any alcohol in their milk can have their drink right after nursing. Research shows that alcohol passes quickly into a mother’s milk, peaking within 30 to 60 minutes (60 to 90 minutes when taken with food). But it also passes out of milk quickly. For a 120-pound woman, it takes 2 to 3 hours for the alcohol in one glass of beer or wine to leave her milk. And there is no need to pump to make your milk alcohol-free. As blood alcohol levels drop, alcohol leaves the milk. If a breastfeeding mother has a stronger drink or more than one glass of beer or wine, it will take much longer for the alcohol to leave her milk.

This is general information and does not replace the advice of your healthcare provider. If you have a problem you cannot solve quickly, seek help right away. Every baby is different. If in doubt, contact your physician or other healthcare provider.

Breastfeeding Resources

In order to have success breastfeeding, it’s import to have access to information, support, and assistance.

Breastfeeding Glossary

Breastfeeding terms cover a wide range of topics and details about the physiology and anatomy of breastfeeding. This breastfeeding glossary will help you navigate common terminology while you research breastfeeding and its effects on both mother and baby.

antibody – A substance that protects against infection.

areola – The circular area of pigmented skin that surrounds the nipple.

colostrum – A concentrated fluid secreted by the breast at the end of pregnancy and shortly after childbirth that provides nutrition as well as protection against disease.

engorgement – Fullness, swelling, and enlargement of the breasts.

foremilk – Low-fat milk that leaves the breast first during breastfeeding or pumping; the longer the time periods between breast drainage, the lower in fat the foremilk becomes.

hindmilk – Higher-fat milk that comes later during a breastfeeding or pumping as the breast becomes more fully drained.

hormone – A chemical messenger produced in one part of the body that affects another part of the body.

lactation – The action of producing and secreting milk.

milk ejection reflex – The reflex that causes milk to flow to the nipples and be ejected from the breast (aka let-down, milk release, and milk ejection).

oxytocin – A hormone produced in the brain, released during labor, nipple stimulation, and at other times (such as during a massage); it causes alveolar contraction, milk release (ejection) and uterine contractions.

progesterone – A hormone produced by the placenta in large amounts during pregnancy that stimulates breast development and inhibits production of large volumes of milk.

prolactin – A hormone produced in the brain that stimulates breast development and affects milk production.

Breastfeeding Support

Breastfeeding support and advice is plentiful, and various professional and mother-to-mother volunteer organizations are available to help.

Healthcare Professionals

International Board Certified Lactation Consultant (IBCLC) – Also called a “lactation consultant,” an IBCLC is a credentialed breastfeeding support professional who has passed a board exam after completing many lactation-specific educational courses and has worked many hours with moms and babies to help with lactation issues. IBCLCs are experienced in helping mothers to breastfeed comfortably and can help address a wide range of breastfeeding concerns. Many IBCLCs are also nurses, doctors, speech therapists, dieticians, or other health professionals. Ask your hospital or birthing center for the name of a lactation consultant who can help you. To find an IBCLC, visit the Find a Lactation Consultant Directory.

Breastfeeding Peer Counselor or Educator (CLC OR CBE) – A Breastfeeding Peer Counselor or Educator teaches others about the health effects of breastfeeding and helps women with basic breastfeeding challenges and questions. As a “peer,” they have first-hand experience breastfeeding their own baby. Some breastfeeding educators have letters after their names like CLC (Certified Lactation Counselor) or CBE (Certified Breastfeeding Educator). CLCs and CBEs may be helpful when addressing basic concerns and problems, and by providing basic breastfeeding support. Find a peer counselor through the Women, Infants and Children (WIC) Program, La Leche League, or Breastfeeding USA, or contact the National Breastfeeding Helpline at 1-800-994-9662 to speak directly with a breastfeeding peer counselor.

Doula – A doula (doo-la) is professionally trained and experienced in providing social support to birthing families during pregnancy, labor, and delivery, and at home during the first few days or weeks after birth. Doulas help women physically and emotionally, and those who are trained in breastfeeding support may be able to help you be more successful with breastfeeding after birth.

Physician – Pediatricians are medical doctors who focus on treating babies, children, and teens. Obstetrician/gynecologists (OB/GYNs) are medical doctors who focus on treating women’s reproductive health issues before, during, and after pregnancy. Many physicians also receive basic lactation training.

Certified Nurse-Midwife – A Certified Nurse-Midwife is a healthcare professional who provides care to women throughout their lifespan with a specific focus on pregnancy, labor, and birth. Many midwives also receive basic lactation training and can provide breastfeeding support.

Mother-to-Mother Support

La Leche League International – La Leche is the world’s leading breastfeeding organization of mothers helping mothers. Call 800-LA-LECHE (800-525-3243) to find a group that meets in your area and a local number to call for advice, or visit them online a www.llli.org

Breastfeeding USA – Breastfeeding USA is an organization of breastfeeding counselors who provides evidence-based breastfeeding information and offer mother-to-mother support. Visit them online at breastfeedingusa.org.

Additional organizations that support and promote breastfeeding are:

National Breastfeeding Programs in the US include:

US Government Resources include:

Additional breastfeeding websites include:

Blogs that focus on breastfeeding:

Breastfeeding Videos

Ameda offers video support for breastfeeding.

Breastfeeding Basics

Breastfeeding basics

Benefits of breastfeeding for moms and babies (View the Spanish version)

Your baby knows how to latch-on (View the Spanish version)

One Mom’s Experience

Why I chose to Breastfeed

How breastfeeding and pumping works for me

Breastfeeding Educational Series

How do my breasts make milk?

How will my breasts know how much milk to make?

What is the secret to getting a good latch while breastfeeding?

Which breastfeeding position is best?

References

  1. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3): e827-841. Available at www.pediatrics.org/cgi/doi/10.1542/peds.2011-3552
  2. Ip S, Chung M, Raman G, Trikalinos TA, Lau J. A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeed Med, 2009;4(SI ):S 17-30

This is general information and does not replace the advice of your healthcare provider. If you have a problem you cannot solve quickly, seek help right away. Every baby is different. If in doubt, contact your physician or healthcare provider.