Breastfeeding and your nipples
Not so long ago, a standard recommendation for all pregnant women was that they needed to prepare their nipples for breastfeeding. Applying wool fat or lanolin was thought to help soften the nipples and make them more suitable for infant feeding. Alarmingly, some recommendations were based around the idea that the nipples needed to be “toughened up” and doing this would help in the prevention of any skin breakdown. Nail brushes, rough washcloths, methylated spirits and vigorous towel drying after showering where all included in the repertoire of suitable breastfeeding preparation.
Now we know better. Nipples are designed to tolerate a baby’s suck, but there are still some key points which will help during the ante natal period.
Preparing your Nipples for Breastfeeding
- Speak with your midwife or doctor about what your maternity hospital’s policy is on breastfeeding. Is it “Baby Friendly” and does it adhere to the guidelines which fit this classification?
- Avoid using any creams or ointments which could be drying on your nipples.
- Have your breasts correctly measured for well fitting, supportive bras. Your breast size may change a few times during your pregnancy and you may need to buy new bras more than once.
- Ask your midwife or doctor to check your breasts and nipples to see if there are any obvious problems which may impact on you being able to breastfeed. Inverted nipples, particularly large breasts, a history of breast surgery or having had breast cancer can all have an influence.
- You may choose to do the simple technique of pulling out your nipples and rolling them gently between your thumb and forefinger. Stretching the nipple this way is similar to the action which occurs when the baby sucks.
- Speak with your partner about their attitude to breastfeeding. Research has proven that partners who view breastfeeding positively and normalise it, help significantly towards breastfeeding success.
- You may need to wear breast pads during your pregnancy if you are leaking colostrum. Replace pads as necessary. There are disposable as well as washable varieties; cost and comfort factor in which ones are preferred.
Aim to breastfeed your baby as soon after birth as possible. This will help to initiate your milk supply and help with the bonding process. Having skin to skin contact with your baby will also help you both to build an emotional connection. Some midwives and obstetricians place the newborn baby on the mother’s tummy immediately after birth. Babies who are alert and wakeful will often start an upwards creep towards their mother’s nipple whilst their “rooting reflex” helps them to locate where to start sucking.
Many women develop nipple sensitivity when they first start breastfeeding. This depends on a lot of factors, most importantly how the baby is attaching to the nipple. Incorrect attachment can traumatise nipples so it is very important, from the start, to learn the techniques involved in getting your baby on the breast and checking to see that they are sucking correctly.
Avoiding blisters, cracks, pain and chaffing is important; not only because they are painful but because they can lead to other breastfeeding problems.
What to do to Prevent Sore Nipples
- Ask your midwife to check and see that your baby is attached and sucking correctly. A wide mouth, baby turned towards you, strong rhythmic sucking and absence of pain are all signs of good attachment.
- Feed your baby as they demand it, when they are awake and hungry. This will be when their mouth is open and they will be searching for the breast.
- Avoid soap, shampoos, hard scrubs and drying agents around your nipples when you shower or bath.
- Let the baby detach themselves from the nipple when they have fed enough. If you need to stop them feeding insert a clean finger into their mouth and gently break their suction.
- Smear a little expressed breast milk onto your nipples at the end of each breastfeed.
- Avoid wearing wet breast pads and replace them frequently.
- Airing your nipples and breasts may be useful.
- Change your bra every day for a clean one.
- Some breast tenderness is normal, especially in the early days of establishing breastfeeds. Pain, however is a sign that something is not right.
What to Do If You Have Sore Nipples
- Limit your baby’s comfort sucking. Restrict their time on the breast to purely for feeding.
- If your nipples are very sore and you can’t tolerate breastfeeding, you may need to cease offering breastfeeds for a few feeds and express your breast milk. Hand expressing is gentler than using a pump on sore nipples. When your baby resumes breastfeeding, then it can be useful to shorten the time they feed until the nipples are comfortable.
- Feed from the less tender breast first. Hungry babies suck vigorously, so aim to take the edge off your baby’s appetite before feeding on the breast which is sore.
- Breasts shields worn between feeds can be useful to enhance air flow. They can also limit the discomfort of having breast pads and a bra creating more friction on a tender nipple.
- Avoid your breasts becoming engorged with milk. This can make attachment difficult.
- Warm showers, warm washers and gentle massage can be very soothing before and in-between breastfeeds.
- Change the way you normally hold your baby during feed times. Position can impact on the point of stress placed on the nipple and cause soreness. Madonna style holds can be changed for a football hold; using a pillow to support the baby so they are in alignment with the breast and ensuring you are comfortable first, before starting each breastfeed can all make a big difference.
- Creams which are specifically manufactured to relieve nipple pain can be useful. Follow the manufacturer’s recommendations for use and be mindful that some require removal of all traces and washing off before offering breastfeeds.
- You may want to hand express your breasts gently before offering your baby a feed. This can promote a letdown response causing the milk to flow more easily from the nipple. This will help to prevent the baby from sucking so hard at the start of the feed.
When to Get Help
- If you feel your nipples are not improving, or getting worse.
- If you are confused or not sure about how to manage feed times. Often a phone call and some reassurance is all that is needed to boost confidence and help women to feel they are on the right track.
- If you can no longer breastfeed your baby because your nipples are too sore.
- If you feel you are developing mastitis you need to see your GP. Breast pain, swelling, redness, temperature or flu like symptoms can all indicate an infection of the breast tissue which requires antibiotic therapy.
- If breastfeeding is no longer enjoyable for you or your baby. If you are dreading feeds, becoming anxious about them, are feeling depressed and/or you are becoming obsessed by breastfeeding to the point of neglecting other aspects of your own or your baby’s care, then a health assessment is crucial.
Where to Get Help
- Your local Plunket nurse will have specialized training in breastfeeding support and education.
- Your General Practitioner.
- Lactation Consultant. Check here for help finding a consultant in your local area.
- New Zealand Breastfeeding Authority. Check www.babyfriendly.org.nz for more information.
- Other mothers, friends and family.
- Your partner.