The first few weeks and months of breastfeeding a new baby — even if you have done it before — are often a marathon rather than a sprint. Setting up a new breastfeeding relationship takes time and patience, and can be replete with obstacles.
For some, this comes in the form of issues with the latch, low milk supply, tongue tie or the extreme exhaustion that comes with being available on demand to feed throughout the day and night. But there is also physical pain that can present itself as a result of some of these challenges.
According to the UK’s leading parent charity, the National Childbirth Trust (NCT), 'breastfeeding shouldn’t be painful.' And yet, as anyone who has ever breastfed knows, there are some instances in which feeding hurts. So what are they? If you’re experiencing pain, what are the likely causes? What can you do to prevent them from happening? And when should you speak to a doctor?
What are the most common causes of breastfeeding pain?
'There are different types of breastfeeding pain, each with different causes, but one of the most common is due to sore nipples,' says Parkington, which, she says, is often caused by a poor latch. 'This can be prevented with the right support at the very beginning of your breastfeeding journey, with your midwife teaching you how to position baby to get the best latch and direction on self-positioning so that when you’re on your own, you are confident and undaunted.'
According to Dr Patel, other common issues that can cause pain, include:
- overproduction of milk
- breast engorgement (where breasts become overly full with milk)
- breast abscesses
- breast infections such as thrush
- mastitis (inflammation of the breast)
- blocked milk ducts
Why do I get sharp pains in my breast after breastfeeding?
'The breast tissue is full of thousands of nerves,' says Parkington, 'and there are hundreds of nerve endings supplying the nipple — sharp pains can often be caused due to sensitivity of these nerves'. She explains that pain can also often be associated with the ‘let-down reflex’ (a hormonal response that allows the milk to be ‘let down’ or released, which for some women can be painful and is thought to be caused by vaso-spasm). According to Dr Patel, this pain should settle as your body becomes more used to the process.
What does a blocked milk duct feel like?
'A blocked milk duct is caused by compression of the veins around the duct and can cause pressure to build behind it, resulting in a build-up of milk,' says Parkington. 'This can feel like a hard lump with mild to moderate pain, possibly increased before feed and reduced after.' She says that a blocked duct can be relieved by regular feeding. Other things such as breast massage in a hot shower or application of hot compresses can help, too, and some swear by using an electric toothbrush to massage the blockage out.
What does mastitis pain feel like?
'Mastitis means inflammation or an infection within the breast and is a result of bacteria found on the skin and in saliva making its way to the breast tissue through a milk duct or crack in the skin,' explains Parkington. She adds that it is sometimes difficult to differentiate between a severely blocked milk duct and mastitis, as one can turn into the other fairly quickly if treatment is not prompt and effective.
'Patients tell me that they feel unwell, with symptoms of a fever, and like they have the flu, with lumps or redness to the skin around the breast that is affected by mastitis,' says Dr Patel.
Parkington says that it’s also important to note that mastitis only affects one breast, where you may develop a wedge-shaped red mark with a pain more severe than a blocked duct. Other symptoms can include body aches, nipple discharge, nausea, fatigue, headaches and chills.
What does thrush feel like in the breast?
'Thrush is a yeast infection in the mother that can be passed on to the baby,' says Parkington, 'often during the birth process'. If it occurs in the breast, she says, it is often caused by cracked nipples and has been passed on from the baby having oral thrush.
When it comes to what it feels like, Dr Patel says: 'women tell me that they get symptoms of pain in the affected nipple and describe it as a 'burning' or 'shooting' pain that goes on well after the feed has finished.' She adds that they may also get symptoms of cracked and sore nipples, or other skin changes. Parkington says that itching can also be indicative of infection.
What can you do to alleviate the symptoms of these issues?
'For most symptoms of a blocked duct or mastitis the best treatment is to feed, feed and feed again,' says Parkington. Research has shown that the baby is the best method to relieve the blockage and women should be encouraged to continue to feed on demand, she says. 'You can also use a very light, gentle massage of the affected area and massage towards the armpit and away from the nipple.' She adds that ice can help the inflammation, and heat can be introduced to provide comfort to the sore area.
'It is also important that women have the support of a health professional that specialises in breastfeeding, such as a midwife or lactation consultant so that preventative measures, like good positioning and a good latch, are used to ensure that any risk is minimised,' she continues.
Thrush will need to be treated with an anti-fungal cream and the baby will also need treatment to prevent further cross-contamination, whereas mastitis will often require a course of antibiotics.
When should you go to a doctor?
'It is not normal for you to experience pain when breastfeeding,” says Dr Patel, “and you should not feel unwell when doing so'. Anything that is not normal for you, she says, or a change to how you normally experience feeding your baby should lead you to make an appointment with your health visitor or GP to talk through your concerns.
Parkington adds that Lansinoh offers a free midwife service where you can talk to fully qualified midwives through live chat, allowing you to check symptoms with a professional before seeking further advice.
Tips to avoid any of these occurring or preventative measures
'It’s helpful to research and educate yourself on breastfeeding before birth,' says Parkington, which will help to 'set your expectations, and ensure you have a strong foundational basis of knowledge to empower and provide self-management techniques should any of these issues occur.' She adds that your midwife or health visitor should help with advice and resources.
Once the baby is here, Parkington says, feeding on demand from both breasts efficiently, frequently or for long periods of time — and without restrictions or supplements in the first few days after birth — is likely to prevent painful engorgement. She adds that 'women need emotional support as well as physical support and building a network of peer-to-peer support is also extremely beneficial — other mums who have been through it before can be helpful in spotting early symptoms and providing real-time advice'.
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What causes pain in breastfeeding mothers?