By Emma Numanoglu, Certified Lactation Consultant
One of the most common reasons that women give up breastfeeding is due to painful and cracked nipples. As a Certified Lactation Consultant, I receive calls every week from desperate mothers asking what they can do to be able to feed without pain. Breastfeeding should never hurt, and cracked nipples are a sign that you need urgent help from a certified lactation specialist – either a South African Certified Lactation Consultant (SACLC) or International Board Certified Lactation Consultant (IBCLC).
How to prevent cracked nipples
All pregnant women should attend antenatal classes in pregnancy that cover breastfeeding and see a lactation consultant before birth to help prepare for breastfeeding. A lactation consultant can show the mother what a good or poor latch looks like to prevent damaged nipples.
Damage occurs when the baby does not get enough breast tissue in its mouth or when the tongue is not positioned correctly. There is a lot that can be done to prevent this such as:
• Making sure that your baby is positioned correctly to be able to compress your breast tissue with your nipple positioned deep in baby’s mouth.
• Wait for the baby to open its mouth very wide, like a yawn, before offering the breast. The baby’s lower lip should be fanned outward on the breast. When you gently pull down the corner of the baby’s mouth while it is nursing, you should see the underside of its tongue, which should extend over its lower gum line, cupping the breast.
• The baby’s nose should be away from the breast and the chin close to the breast.
• Try and feed baby skin-to-skin as much as possible in the early weeks. Holding your baby skin-to-skin helps to increase your milk volume by increasing your levels of oxytocin “the love hormone” and these levels increase when you snuggle your baby close.
Tongue-tie can cause difficulties
Tongue-tie can also cause sore and cracked nipples. If the baby’s tongue appears heart-shaped, it could be a short or restricted frenulum (tongue-tie) that prevents a good latch on to the breast.
A tongue-tied baby may:
• have difficulty attaching to the breast
• feed for a long time
• have a short feed and need to feed again
• be unsettled and seem to be hungry a lot of the time
• not pick up weight well, or
• make a clicking sound as they feed, although this can also be a sign that you need help to get a deeper latch or better positioning
Thrush and nipple eczema can cause cracked nipples
Nipple eczema can also lead to cracked nipples.
Nipple eczema can also lead to cracked nipples. Thrush and eczema of the nipples are both treatable conditions and require a trip to a breastfeeding-friendly doctor, who will give you a script for creams to help heal your nipples quickly. You do not need to stop breastfeeding. Typical signs of thrush on the nipples are:
• burning nipple pain
• flaking skin on the nipple or areola
• shiny skin on the nipple or areola
• painful breasts without tender spots or sore lumps
• stabbing pains in the breasts behind the areola
• itching on or around the nipple and areola
Flat or inverted nipples
Flat or inverted nipples can make it difficult for a baby to grasp the breast in its mouth and properly latch on. With a proper latch-on, the baby’s sucking can effectively draw out flat or inverted nipples.
Gentle pumping or special exercises are sometimes recommended to draw the nipple out. If you received IV fluids for several hours during the birth process, this can be a cause of edema (swelling) in the breast and nipple.
Reverse Pressure Softening can help create a softer nipple and areola that a baby can more easily grasp. It involves using gentle finger pressure around the base of the nipple. This temporarily moves some of the swelling slightly backward and upward into the breast.
This technique is also helpful in preventing sore nipples if your breasts become engorged (swollen and uncomfortable) when your milk supply comes in several days after birth, making it difficult for baby to latch on comfortably
Removal from the breast without breaking the latch
Removing baby from the breast without breaking the suction first can be painful and cause damage to the sensitive breast tissue.
If baby is latched on and sucking well, it will end the feeding itself by letting go of the breast or releasing the nipple as it falls asleep. If you decide to take the baby off the breast before it is finished, you can break the suction by inserting your finger into the corner of baby’s mouth.
Feeding bras, soaps, detergents and perfumes
Avoid bras that are too tight and made of itchy fabrics. Be vigilant about thorough rinsing of nursing bras to be sure any laundry detergent residue is removed, as this may cause nipple irritation.
Avoid perfumes, scented roll-on, hair spray, scented body lotions or talcum powder near your nipples. When bathing, rinsing breasts with clear water is all that is needed to keep your breasts and nipples clean.
Do not scrub your breasts with soaps or apply thick layers of cream, as this can irritate nipples and is not needed. If using breast pads, change them regularly. Your breasts are amazing. You may notice Montgomery glands (also called tubercles) that are small sebaceous glands found around the nipple and areola (the area of pigmented skin around the nipple). The secretion of an oily or waxy substance in the nipple area helps to keep the nipples soft and supple. The substance also contains anti-infective properties that help keep germs away.
How to soothe sore nipples
When your nipples are sore you can gently apply your own milk or an emollient that is safe for the baby to ingest, such as Lanolin. Either of these can be very soothing.
See a professional!
Lastly, if you are struggling with cracked nipples, it is better to ask for help sooner rather than later. For lactation consultants in your area, visit the below websites:
Emma Numanoglu, founder of www.breastfeedingmatters.co.za, is a registered nurse and midwife. She has a BA, BSc Hons (Psych) and is a South African Certified Lactation Consultant (SACLC) and International Board Certified Lactation Consultant (IBCLC).
Emma is also an antenatal teacher and currently sees mothers at Life Vincent Pallotti hospital, provides home visits and runs a private clinic from her home in Newlands.