What is normal nipple pain?
Normal is, not painful on day one, a little soreness on day two, with no cracking or bruising, pain beginning to subside by day three.
Severe pain with latch, cracking or bruising on day 1 maybe a sign of a problem. Quickly identifying what is causing the problem is crucial to reducing pain, preventing bruising and cracking, as well as improving milk transfer. Think about it, if latch is painful on day one, it will only get worse by day two.
(Bleeding not associated with cracking that comes from inside both breast while pumping or breastfeeding in the first few days is considered normal and the milk is safe for the baby to drink).
Painful latch can be caused by the baby not being ready therefore not opening the mouth wide enough. The baby’s tongue maybe up blocking the breast from going deep into the baby’s mouth. Perhaps the shape of the breast or the nipple are making it difficult for the breast to get in deep enough to prevent pain and trigger suck.
Possibly the positioning of the baby may be unstable causing the baby to slide down to the nipple after being latched on or the baby’s mouth maybe latched onto the nipple only and not the areola. Often times a finger maybe in the way of the baby getting passed the nipple or a finger is being used to pull the breast away from the baby’s nose for breathing room causing the baby to again slide down to the nipple. Some babies may have a slight oral cavity issue like a tongue tie or a bubbled palate.
The goal of latch is still the same! Open mouth, tongue down, deep latch. Identifying an issue a can be very helpful to improve technique. However when the oral cavity issue is mild or moderate it maybe be difficult to identify. In the case of a mild tongue tie or a bubbled or high palate for instance, there isn’t a fix available clinically, therefore you need to learn how to accommodate what cannot be fixed at this time. Therefore understanding what is happening and what needs to happen to get a good latch can really be helpful in working through it. Tweaking your hold, yours and your baby’s position, using tools like; pillows and foot stools to find a good effective, comfortable latch. It is extremely important to wait for a baby to root and open his mouth wide with the tongue down, so that the breast goes in above the tongue and deep into the baby’s mouth.
The baby should not be sucking on the nipple itself. The lips should be wrapped around the areola passed the nipple, so that the nipple is actually deep inside to where the hard and soft palate meet. In order for the breast to trigger suck it must get in deep and up near the palate.
Pain is often caused because the baby has not yet opened wide and the tongue is up, pointing to the roof of the mouth, blocking the breast from going in deep enough
In order to get the baby to root and open the mouth, you must tickle the lips to trigger the rooting reflex, but back away a bit until the baby actually says Ahh. If the baby doesn’t open wide tickle and back away again. If after a few attempts the baby doesn’t open wide. Wait a few minutes. The baby may not be ready.
When attempting to latch and the baby is not ready and not rooting, the baby will move around and often pull away from the breast and get fussy. This may seem as if the baby does not want to breastfeed.
Sometimes babies will want to be close to the breast but not actually eat. Trying to feed at this time can cause confusion. Since the baby is not ready, the baby will respond but not open wide enough to get a deep latch. Constantly trying to latch will cause the baby to get fussy and even go to sleep to conserve energy.
So take a moment calm the baby and let the baby regroup.
When an infant is ready to eat, touching around the baby’s mouth will cause the baby to root: turn to the breast and open the mouth. But, it is important to wait for the right open mouth to latch.
I use what I call the tickle back away technique with an anatomical latch. Which is also known as chin to breast, nose to nipple. First, place the baby’s chin to the breast, hold the breast in a C or U shape with fingers away from the nipple, and rub with the nipple downward from the nose to the chin rolling out the bottom lip. Back away slightly so the baby can open for you. Repeat a few times until the baby opens wide and allows the breast to land deep inside the mouth above the tongue. Again if the baby doesn’t open wide or gets fussy, stop to calm before attempting latch again.
Lay the baby’s cheek against the breast and cuddle a moment to see if the baby wants to eat or just cuddle skin to skin. On a side note some baby’s won’t eat when they have a wet diaper so if you feel you are getting the breast deep into the mouth but the baby is still fussy, check the diaper.
There are several kinds of nipples; flat, everted, inverted, retractable, etc., a mother’s breast can be firm, taught, pliable, round, tubular, triangular, there are so many variations no one hold or position will work for everyone. So, don’t focus on the nipple! The milk is behind the nipple. Focus on getting the breast itself deep into the baby’s mouth.
I often find that some mothers really are hard on themselves and when latch is difficult they blame themselves. When often there is something unforeseen or simply unexplained. Remember Rome was not built in a day. Take your time with latching. Mom needs to be in charge of when the baby latches, slow it down look into the mouth if possible to make sure the tongue is down.
Reattaching is painful! So it is better to slow down and get a good deep latch the first time. Then don’t be stiff, but don’t move a lot once the baby is latched. Readjusting your position will cause the baby’s mouth to slide down.