As a nurse-midwife, I regularly counsel patients on the benefits of breastfeeding for both mother and baby. I am a huge proponent of breastfeeding. And though I have witnessed the challenges that women sometimes face when breastfeeding, I had always assumed breastfeeding my own child would be easy. After all, I have plenty of knowledge about breastfeeding and a lot of motivation to be successful. Isn’t that all one needs? But about five days after the birth of my own son, an unexpected question entered my mind, “Why does ANYONE breastfeed?”

Breastfeeding is one of the most selfless acts a mother does and many women are unprepared for how burdensome and occasionally tedious it might feel, even when it goes smoothly. When it doesn’t go perfectly, successfully breastfeeding your child can require heroic efforts, limitless determination and, of course, a good lactation consultant.

By far the most common complaint I hear from breastfeeding moms is sore nipples. Nipple pain is usually described as a burning sensation either during or after feedings. It is often caused by trauma to the nipple, an infection in the nipple or a condition involving vasospasms, or sudden constriction of the blood vessels in the nipple skin.

Nipple Trauma Due to Improper Latch

When nipple pain occurs in the early postpartum days it is usually due to trauma caused by an improper latch. One would think that latching a baby to the breast would be second nature for both parties involved, but it’s not. Usually both mother and baby spend the first few days learning. During that time, it is very important to get assistance from a well-trained nurse or lactation consultant. If a poor latch is not corrected quickly, bruises, cracks and blisters can develop, which will worsen the pain. Also, an uncorrected poor latch can eventually lead to a lower milk supply or a breast infection. Applying purified lanolin, olive oil, soothing gel pads or breast shields between feedings can help protect the nipples from further damage while healing occurs.

There are also physical conditions that can lead to latch problems. Some women have inverted or flat nipples and their babies can find it challenging to get the nipple deep enough into their mouths. Lactation consultants have several tricks to “draw out” the nipple and help the baby latch well. Some infants have ankyloglossia, or “tongue-tie,” which occurs when their frenulum (the membrane that attaches the tongue to the bottom of the mouth) is too tight and restricts the baby’s tongue movements. This can interfere with the baby’s latch. If ankyloglossia is suspected, parents should discuss this with their pediatrician or lactation consultant.

Thrush and Other Nipple Infections

Women with persistent nipple pain despite an apparent good latch may have an infection in their nipples. Nipple infections are most commonly caused either by Candida albicans (‘thrush’) or Staphylococcus aureus. Nipple infections do not usually arise in the first few days postpartum, but if a mom is already struggling with nipple pain resulting from trauma, she may not suspect an infection.

A mom with a nipple infection or persistent nipple pain may benefit from a compounded cream often referred to as All Purpose Nipple Ointment. It has an anti-fungal, an antibacterial and a topical steroid mixed together. It is applied to the nipple after each feeding for at least two weeks. At times, an infant will need to be treated for thrush while the mom is treating herself. Otherwise, mom and baby may pass the infection back and forth to one another. If the nipple pain continues, the mom should be evaluated by her obstetric provider or her lactation consultant.

Some providers will prescribe an oral anti-fungal called Fluconazole for suspected yeast infections of the breast that do not resolve with initial therapies. Gentian Violet, a topical antifungal, can also be used. It is applied to the nipple before a feeding once daily. Gentian Violet is messy as it will temporarily dye the nipples and the baby’s mouth purple. But it works well and creates great photo opportunities. Who can resist snapping a picture of their purple-mouthed clown baby?

Vasospasm, A.K.A. ‘Nipple Blanch’

A less common cause of nipple pain is vasospasm, or sudden constriction, of the blood vessels in the nipple skin. This type of nipple pain usually occurs after the baby comes off the breast and the nipples are exposed to a sudden change in temperature. But it can also occur with abnormal compression of the nipple when an infant does not have a good latch. The mother’s nipples may turn white or purple as the blood vessels contract and restrict blood flow to the skin. Within a few minutes, the blood vessels will relax and the nipples will become pink again as blood flow returns. They may also turn bright red before returning to their normal pink color.

Raynaud phenomenon is a condition characterized by blanching of the skin, most commonly in the fingers (or toes), when exposed to sudden cold temperatures. Women who have Raynaud phenomenon or other cold sensitivity are more likely to experience vasospasm of the nipple skin and the corresponding pain. These women may benefit from wearing warm clothes, increasing the ambient temperature in their homes when breastfeeding and avoiding prolonged exposure of their nipples to air. If one suspects she is experiencing vasospasms of the nipple skin, it is always a good idea to visit with a lactation consultant to make sure the baby is latching well. Some women may benefit from a prescription medication called Nifedipine that can help prevent the blood vessels from contracting.

Enjoying Your Baby

Though most women should be able to breastfeed successfully, there are still many women who struggle for one reason or another. When I was struggling myself, I remember watching a video that featured Freda Rosenfeld, a well-known lactation consultant in Brooklyn, NY. Her advice to moms was “Rule 1: enjoy your baby. Rule 2: feed your baby.”

Too often, I see women get stressed about being able to breastfeed. They struggle with guilt and feelings of inadequacy. They often feel like their bodies have betrayed them, especially if they also had a difficult labor and delivery. For many of these women, breastfeeding becomes an onerous task that they dread instead of cherish and it can interfere with their sense of bonding with their infant. The newborn period is brief and there are too many precious moments that may be lost if a mom is not enjoying her time with her baby. When that happens, it is important for mothers to know that it is okay to stop breastfeeding. Bonding with and enjoying one’s baby are far more important to the long-term health and well-being of both the mother and the child.

Jody Lindwall, CNM, MSN, is a Certified Nurse Midwife who sees patients at the Newberg Office of Women’s Healthcare Associates, LLC. The purple-mouthed clown baby pictured in this post belongs to her.

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