Breast pain while breastfeeding: What’s normal and when to get help

When you first start breastfeeding your baby, it’s not uncommon to experience some breast discomfort. It can take a little time for you and your baby to learn how to work together, get a good latch, and become more comfortable with breastfeeding. But there’s a difference between normal breast discomfort and the sort of pain that you may want to speak to a lactation consultant about. We’re here to help you understand the difference.

What’s normal and what are signs you should get some help?

NORMAL: Tender nipples when you start breastfeeding

Some nipple tenderness can be normal when you first start breastfeeding. Your nipples may feel slightly tender shortly after your baby latches on to the breast, for about 30 seconds or so. It’s especially common in the first few days because of postpartum hormone shifts and general body swelling. It’s common to need to adjust position or break the latch and start fresh to get comfortable. This should start to get better and more comfortable in the first weeks after birth.  

GET SOME HELP: Cracked, blistered, or bleeding nipples, or nipple pain that lasts well after your baby latches on

If you’re experiencing a lot of discomfort, especially beyond when your little one first latches on, it could be a sign that they’re not latching on well, not sucking correctly, or that their positioning needs to be adjusted. If your nipples are cracked, bruised, blistered, or bleeding, these are signs that some adjustments are needed. Adjusting latch — which means changing the way your baby puts their mouth around your breast and positions their tongue to nurse — or adjusting positioning can help both you and your baby be a lot more comfortable. Sometimes pain can be a sign of tongue-tie, which is when a baby’s tongue movements are restricted (tied), making it hard to get a good latch. Flat or inverted nipples can also make comfortable latching more challenging. 

If you’re a pumping parent, the same information applies! Pumping should never be painful or cause nipple damage. An experienced lactation consultant can help you make adjustments in flange sizing, pump suction and more to get comfortable.

NORMAL: Breast fullness or engorgement

Breast fullness and engorgement are other sources of normal breast discomfort. These situations can make your breasts feel very full, heavy, tight, or swollen. Generally you’ll feel worse before a feeding, and after your baby nurses you’ll feel relief. As your body learns to regulate how much milk your little one needs, this feeling generally improves. It often goes away completely for many people around the 2 month mark (your milk didn’t dry up, your body just got smarter!).  

A few days after your baby is born, breast fullness can feel particularly uncomfortable as your milk first comes in, replacing colostrum. During this phase, your breasts may feel especially full and tender as they become engorged with milk. Sometimes your nipples may become flat temporarily. They may also feel sore due to general postpartum inflammation, which can cause you to feel hot or flushed. This engorgement should improve within 1-2 days as your body starts to adjust to your baby’s needs. After this initial phase, if you happen to go a very long time between nursing or pumping sessions, you might feel engorged again. 

GET SOME HELP: One very sore or hard breast, sometimes with hard lumps; with visible color changes; or with aches, fatigue, chills, and fever 

This sort of breast discomfort, paired with any of these symptoms, could be a sign of an inflamed duct or mastitis.

Hard lumps in your breast that are sore and tender could mean that you have swollen ducts. Feel for a swollen duct right after a feeding, as it is very normal to feel some lumps and bumps when your breasts are very full of milk. If you feel a lump or lumps, start a pattern of ice or cold packs to that area to decrease the inflammation. Use cold for about 5 minutes every hour, and add in Ibuprofen if it’s safe for you to take. Nurse or pump as you usually do, and don’t do any extra milk removals on the sore breast.

If one of your breasts is tender, warm, and hard, with a painful lump (as with inflamed milk ducts), possibly with colored streaks or patches, you might have mastitis. Regular nursing or pumping, rest, ice and Ibuprofen can help, but it is important to contact your healthcare provider as well. They might recommend an antibiotic depending on your symptoms and how long you’ve been unwell. 

Parents who suspect they have mastitis in both breasts should not delay in contacting their healthcare provider or seeking more urgent care. It’s a rare situation to have mastitis in both breasts, and requires prompt evaluation and treatment.

GET SOME HELP: General breast and nipple pain, nipples that are cracked, burning, itchy, shiny, flaky, or have a rash with blisters

These sorts of symptoms could be a sign of thrush, which is a yeast infection localized to your nipples and breasts. (It might show up in your baby as fussiness, with white or yellow patches in their mouth that do not scrape away, or cracked skin at the corners of their mouth.) This type of infection is often passed back and forth from your baby’s mouth to your breasts. It’s most common after a parent and/or baby have been on antibiotics. This is a very normal infection, but it can be uncomfortable and needs treatment. Your healthcare provider will likely prescribe antifungal medications for you and your baby to treat thrush. A lactation consultant can also help you find relief during your medical treatment, and work with you to prevent another yeast infection.

How can you find help and get relief?

These are just some of the most common reasons you might experience discomfort when breastfeeding; there are a number of other reasons that you might experience breast pain that aren’t listed above. So if you’re experiencing any sort of pain and discomfort — including those outlined above — you should reach out to a specialist for health and support right away. A lactation consultant, your OBGYN or midwife, your primary care provider, or your child’s healthcare provider are all good resources depending on the particular situation. When in doubt, reach out to a lactation consultant or the healthcare provider you feel most comfortable with — either of these experts can always refer you elsewhere for more help as needed. Even if you’re experiencing any of the “normal” discomforts listed above, you should also feel comfortable reaching out for help. Breastfeeding may be natural, but it takes time to learn how you and your baby can work together comfortably. 

It can be so hard to really be sure of what’s “normal” when you’re new to breastfeeding, so don’t be afraid to reach out to your Ovia health expert with any questions, concerns, or just for some support. You deserve to reach your breastfeeding goals — and to find comfort as you do so!

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