From You and Your New Baby By Christine and Peter Hill

Sore Nipples

This is, in our experience, the commonest reason for giving up breast-feeding. There are rather too many theories about the causes of sore nipples, though poor latching-on is well recognised. We have also been struck by the escalating number of mothers with sore nipples since it has been declared fashionable to encourage the baby to suckle for protracted periods in the first few days.

This is the typical scenario:

Day 1 Your baby suckles for well over 15 minutes on each breast, but you don’t mind because it is such a joyful experience.

Day 2 Baby is still suckling for long periods; the joy is wearing off as your nipples are becoming quite tender.

Day 3 Your nipples are agony and, if you are unlucky, also cracked and bleeding. You let your baby suckle for the shortest possible time and give ‘top-up’ bottles.

Day 4 Milk comes in and you get primary engorgement. Help! Now your breasts are so full that it is hard for your baby to latch on, so the situation becomes even worse. Everyone becomes distraught.

First Aid is as follows:

• Take two paracetamol in water every four hours
• Feed from the less painful nipple first (forget starting on alternating sides for the time being)
• If your breasts are too full for the baby to latch on, try expressing enough milk to make it easier for you both. You can do this by hand or by using a pump
• Try using a nipple shield (you can buy them from a chemist) for about five minutes at the start of a feed. This will be easier for your baby to latch onto and he can take enough milk from your breast to enable your nipple to stand out. At this point, dispense with the shield and put your baby back directly on to the breast (A nipple shield can be a life-saver, but use it for emergencies only as it tends to reduce your milk supply if used for too long.)
• Don’t let your baby suckle for much longer than ten minutes from each breast
• Make sure your baby is latching on at the correct angle.

Cracked nipples

Most sore nipples are just suffering from unaccustomed wear, but may progress to being cracked nipples, which is extraordinarily painful and can bleed so much that you see blood in the baby’s mouth. Some creams can be helpful but don’t go mad. What really helps healing is allowing the nipple to dry gently, which in practice means exposing your breasts to the air. On the occasions that it is not appropriate for you to go topless, a useful trick is to put a tea strainer (handle removed) into your bra to hold the material away from the nipple and allow air to circulate. What you don’t want is your nipple wallowing in soggy breast pads, especially not those with a plastic backing.

If things get too bad, contact your local feeding counsellor or NCT branch and allow an electric breast pump (which is actually not painful) to empty the affected breast while you carry on feeding with the other breast — at least until the other nipple packs up through overuse. You can avoid this by putting the expressed (pumped) breast milk in a bottle for your baby and trying to get him to feed from the bottle. Bottles with stumpy teats, which are most like human nipples, are less likely to be rejected. Even then he might not take from it, just to add to your problems, in which case rejoice in the fact that you at least have (or had) a sense of humour.