Causes of Pain with breastfeeding

“It hurts so much every time we feed, but the nurse at the hospital said he’s getting plenty of milk so I’m trying to just toughen up!”

“My nipples have scabs on them but they did say the latch ‘looks good’ so I probably just need to get used to it more?”

“My nipples look all red and bent after feeding. It hurts! But the doctor said she’s gaining weight so I don’t need to change anything.”

There’s a lot of this going around lately. Women in the trenches of new motherhood, trying desperately to figure it all out, and doing an amazing job asking questions and working towards their breastfeeding goals despite the massive obstacle they’re experiencing—pain while nursing. The frustrating part is that so often women are getting the feedback that they just need to keep on keeping on, to just keep “grinning and baring it.” Their baby “seems fine” so the pain must be their problem or must just be in their head. Or it must just be that they don’t have the physical or mental grit and stamina that it takes to breastfeed. What?!

There are many reasons that a mother might experience nipple pain while breastfeeding and not all of them are related to baby’s latch at the breast (i.e. nipple pain due to things like thrush, ovulation, pregnancy, etc.).

However, the most common cause of nipple pain during breastfeeding is ineffective latching and/or positioning at the breast. Babies are designed to latch “deeply” onto the breast. They are meant to take a big mouthful of breast tissue and areola and to draw the nipple all the way towards the back of the roof of their mouth called their “soft palette.” When a baby is not latching effectively however, they’ll often have a “shallower” latch. In other words, instead of drawing the nipple all the way back to their soft palette, they’re only drawing the nipple to their hard palate—the front of the roof of their mouth, just behind their gums. As the nipple then rubs against the hard palate, it creates friction and pain and maybe even nipple damage—cuts, bruises, scabs, etc. OW!

There are so many different reasons why this ineffective latching and therefore nipple pain, might occur.

The simplest reason for ineffective latching being that mom and baby may not have received helpful in-person breastfeeding support. After all, while breastfeeding is a natural process, it certainly doesn’t always come naturally! There’s a learning curve, and mothers deserve the support needed to learn this new skill. In this case, a few basic tweaks in latching and positioning technique might solve the pain completely. Other times, there’s a more complex underlying issue going on, which is in turn causing the latch to be ineffective. For example, there could be something occurring with baby’s oral anatomy (i.e. tongue/lip tie) that’s making it impossible for her to achieve a deep and pain-free latch. In this case attendance to the underlying issue is necessary in order to support baby in latching effectively.

In many cases it’s very obvious that in addition to the pain being experienced by mom, baby is not receiving adequate milk at the breast. Maybe baby is not gaining well, or not producing enough diapers. Therefore, there are early red flags which need to be immediately addressed forcing attendance to the situation. However, there are unfortunately also many cases like the scenarios described above in which mothers are experiencing pain, but a healthcare provider has expressed the opinion that because their baby seems to be doing well (or “fine”) in the moment, mom’s concerns aren’t warranted or important.

First things first–no one should have to just endure or just “grin and bear” breastfeeding and nipple pain.

A small amount of discomfort in the first couple of days post-birth may be normal, however pain is NOT! Teeth clenching pain and nipple damage are certainly not. Mothers deserve to enjoy breastfeeding and certainly deserve to breastfeed pain-free. Aside from this though, is another factor which nearly no new mother understands. The discomfort itself felt due to incorrect latching is not the only problem, even if baby appears to be doing “fine” in the moment.

Even if your baby seems to be okay despite an ineffective latch, (as in, they’re receiving enough milk at the moment) this does not mean that they will continue to be okay. Instead, over time, it’s very likely that the ineffective latch will not stimulate the breast the way that an effective latch would. So, in a few months’ time, baby’s weight gain could begin to slow and/or mom’s milk supply may have gone down due to the ineffective stimulation that’s now been occurring for weeks or months of painful nursing. Or, it might mean that mom experiences things like recurrent clogged ducts or mastitis, as her baby is consistently unable to drain her breast effectively.

So, this whole concept that baby is fine so mom doesn’t matter is not only completely dismissive of mom’s physical and emotional health, but it’s also not supportive of long-term breastfeeding success. Not to mention, sending the mom the message that everything is fine, when everything may not be fine longer-term, can be downright dangerous for mothers and for babies. Women are so often given a false sense of comfort because for example, maybe one nursed watched them feed one time when their baby was two days old and expressed the belief that the latch “looked fine” despite the pain that mom felt. (It doesn’t matter what it looks like, if it hurts, it’s not a “good” latch!) Or, maybe baby seemed to be gaining well at her first or second weight check at the pediatrician so mom perceives this means her supply will always be adequate despite the pain she’s feeling.

All in all, if you’re experiencing nipple pain, speak up and consult a lactation professional. You don’t need to just “grin and bear it” and you’re not being selfish by voicing your pain. Instead, you’re advocating for both you AND your baby’s short and long-term health and wellbeing.

About Shelley Halloran

Hi! I'm Shelley of Mama Blooms, LLC. As a Lactation Counselor and Postpartum Doula, I serve women and their families; providing both in-person and virtual supports during all phases and stages of a breastfeeding and/or postpartum journey. I'm on a mission to educate, empower, support, and nurture modern mothers, and am honored to witness women bloom into the mamas that they're meant to be! Shelley Halloran, M.Ed., CLC, CPD

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