A good latch is crucial for successful breastfeeding. However, even with a good latch, some discomfort is common in the early days. Nipple pain from breastfeeding, especially in the first week, is often a result of the baby learning how to latch properly. While a good latch is the goal, some soreness is normal at first. By understanding common causes of nipple pain, moms can get the help they need to achieve pain-free breastfeeding.
What is a good latch?
A good latch occurs when the baby takes a large mouthful of breast tissue, with the nipple deep inside the mouth. This allows effective milk transfer and prevents damage to the nipple. Signs of a good latch include:
- The baby’s mouth is wide open.
- The lips are flanged or turned outward.
- More areola is visible above the top lip than below the bottom lip.
- The baby’s tongue extends over the lower gum.
- The baby takes slow, deep sucks with pauses.
- The baby’s cheeks remain full and round while sucking.
- The baby releases the breast by themselves when finished.
With a good latch, the nipple should not look compressed or misshapen after a feeding. It will appear round and erect. There should also be no pain during the feeding latch or while the baby is sucking.
Why can a good latch still hurt?
Even with an excellent latch, some nipple discomfort is common in the early days of breastfeeding. Here are some reasons why:
1. Nipples are adjusting
In the first week after birth, the nipples are not accustomed to a baby’s sucking. The skin needs to toughen up and develop some tolerance. As the skin adjusts, some sensitivity and soreness is expected. This usually resolves within a few days as the nipples thicken.
2. Initial damage is healing
Many moms experience nipple injury from early feedings before the latch is perfected. This can result in skin damage like cracks or blisters. As these heal, they may sting or feel sore during feeding even with improvement in the latch. The discomfort is temporary until the damage has fully mended.
3. Increased blood flow
The hormonal changes of pregnancy and breastfeeding lead to increased blood supply and sensitivity in the nipple tissue. More blood flow to the area can cause nipple discomfort, especially when combined with the stimulation of the baby’s sucking. As hormone levels regulate over the first few weeks, sensitivity and discomfort tend to decrease.
4. Biological response
The nipple has an intricate network of nerves that respond to touch, pressure, and warmth. When a baby first latches, the nipple may be hypersensitive as the nerves send signals to the brain. With repeated stimulation, the sensory response becomes dulled or habituated. This biological process leads to less perceived pain over time.
5. Vasospasm
In some cases, pain results from temporary constriction of the blood vessels in the nipple after feeding. This condition is known as vasospasm or Reynaud’s syndrome. It can cause severe nipple pain, itching, and burning. Vasospasm requires medical treatment but often resolves once an optimal latch is achieved.
6. Thrush infection
Persistent deep breast or nipple pain can be a symptom of thrush, a yeast infection common in breastfeeding mothers and babies. Though not due to the latch itself, thrush requires medical treatment with anti-fungal medication to resolve associated feeding pain.
7. Tongue-tie or lip-tie
Oral restrictions like tongue-tie or lip-tie can interfere with the baby’s ability to achieve a proper latch. These may not be detected at first leading to damage or pain. Once identified, ties can be released through simple in-office procedures to allow for improved latch and comfort.
When to seek help
Though some nipple soreness is expected at first, nursing should never be severely painful with a good latch. Get professional lactation support if:
- Discomfort prevents baby from latching
- Nipples appear compressed or flattened after feeds
- Pain does not start to improve within a few days
- Nipples are cracked, blistered or bleeding
- Mastitis or blocked ducts develop
- Pain continues beyond the first week
An International Board Certified Lactation Consultant (IBCLC) can assess the latch and provide individualized solutions to achieve comfortable, effective breastfeeding. This may involve:
- Observing full feeding sessions and making latch adjustments
- Recommending laid-back/reclined feeding positions to allow baby control
- Trying different holds like cross-cradle or football to optimize alignment
- Assessing oral structure and function for tongue/lip-ties
- Prescribing/fitting nipple shields if needed temporarily
- Advising when to use breast compression and pacing techniques
- Discussing use of hydrogel pads, nipple creams, or warm/cold therapy
- Ruling out other causes like yeast, vasospasm, dermatitis
- Referring to other specialists as needed – lactation docs, dentists, ENTs
With expertise to identify the issue, targeted help is available. Most causes of nipple pain can be corrected by tweaking technique, treating underlying causes, and allowing more time to adjust.
Common Causes of Nipple Pain with Good Latch
While a proper latch is the basis of comfortable breastfeeding, other factors can also contribute to nipple pain and sensitivity even with a good latch.
1. Engorgement
Breast fullness and engorgement in the early weeks can make nursing challenging. The stretched skin and edema around the areola put pressure on nipple tissue. The tight, swollen breast also makes it difficult for baby to grasp and latch deeply onto the breast. Engorgement may lead to nipple soreness and damage until milk supply is regulated.
2. Incorrect Flange Size
Breast pumping with an improperly fitted flange is a common cause of nipple injury. Using too small a flange compresses the nipple, while too large a size fails to provide suction. This friction against the flange tunnel leads to nipple abrasions, increasing discomfort during nursing sessions. Having the flange size professionally evaluated helps prevent this type of nipple trauma.
3. Forceful Let-down
Some mothers experience an overly forceful milk ejection reflex or let-down. The intense pressure of the expelling milk can cause nipple pain as the baby starts to feed. Learning techniques to control the let-down flow can help prevent discomfort. This may include expressing some milk before nursing sessions.
4. Baby Behavior
Certain infant behaviors at the breast may contribute to nipple discomfort even with an otherwise good latch. These include pulling off the breast repeatedly, biting, uneven or shallow sucking, and fussing at the breast. Addressing these habits and calming baby at the breast may be needed to resolve associated nipple stress or damage.
5. Nursing Positions
The choice of nursing positions can impact comfort even with a good latch. Cradle hold may exert torque on the nipple tissue. Lying down allows less control of baby’s latch. Side-lying may press baby’s gums and tongue more forcibly against the nipple. Exploring different positions helps find the one offering the most comfortable fit for mom and baby.
6. Anatomical Variations
Physical differences in nipple shape, size, and elasticity can predispose some women to pain with otherwise normal latch and sucking. For instance, flat or inverted nipples may require more coaxing to achieve an ideal latch. Ultra-sensitive nipples may also not tolerate suction as easily. Addressing anatomical variations helps personalize the approach.
7. Trauma from Prior Breast Surgery
Women who have undergone breast augmentation, reduction, or surgery for cancer may have decreased nipple sensation or residual nerve damage. The breast remodeling can compromise nerve and milk duct function, potentially causing impaired or painful latch even with normal technique. There are still usually ways to successfully breastfeed after surgery.
8. Dermatologic Issues
Skin conditions of the nipple-areola complex can cause pain despite a properly functioning latch. These include infections like yeast or bacterial infections, as well as inflammatory conditions like eczema, psoriasis, or vasospasm. Treating the underlying dermatologic issue is key to resolving associated latch discomfort.
9. Medications
Certain prescription drugs are known to cause nipple sensitivity, including medications given after birth like antibiotics, antihypertensives, diuretics, and birth control pills. Women should inform their healthcare provider about nipple pain that arises while taking any new medication. Switching drugs or making dosage adjustments may be helpful.
10. Normal Hormone Fluctuations
The natural hormones of lactation make nipples more sensitive early on, and normal monthly hormone cycles continue to cause breast changes after birth. Periods of nipple soreness may arise around ovulation, menstruation, or during human growth hormone surges. Understanding these hormonal influences helps moms anticipate and manage cyclic discomfort.
Solutions and Treatments
Breastfeeding should not hurt with a good latch. But when pain persists, there are many solutions to try under lactation guidance:
Latch Adjustments
An IBCLC can assess latch quality and make tweaks by:
- Focusing on optimal lip and tongue position
- Varying nursing holds like football or laid-back
- Trying laid-back and reclined positions
- Alternating sides to allow nipples time to recover
Pumping Modifications
Pumping-related nipple pain often responds to changes like:
- Resizing flanges for better fit
- Using lubricant on flange tunnel
- Double pumping instead of single pumping
- Adjusting suction settings
- Taking more frequent breaks from pumping
Nutritional Support
Dietary measures can assist healing by:
- Increasing hydration and electrolytes
- Boosting vitamins C, D, E, B6, and zinc
- Avoiding known allergens
- Removing possible yeast triggers
Medications and Supplements
Medications that may help in some situations:
- Prescription APNO (all purpose nipple ointment)
- Anti-yeast drugs
- Pain relievers like ibuprofen
- Supplements to manage Raynaud’s (nifedipine, B vitamins)
Alternative Therapies
Natural remedies to reduce nipple sensitivity:
- Acupuncture
- Homeopathics (phytolacca, calendula)
- Chiropractic adjustment
- Herbal remedies
- Warm/cold compresses
Local Breast Care
Soothing aftercare of nipples:
- Hydrogel pads
- Purified lanolin
- Medical grade honey
- Normal saline rinses
- Allowing nipples to air dry
Tools and Devices
Special products that can help:
- High quality breast pump
- Contact nipple protectors
- Finger feeds to allow nipples to heal
- Supplemental nursing system
- Nipple shields
Professional Support
In-person lactation help improve comfort:
- IBCLCPrivate lactation consultant
- Breastfeeding support group
- La Leche League meetings
- Observing feeding session
- Bodywork and craniosacral therapy
Prevention
While some nipple tenderness is expected initially, taking proactive steps can help reduce friction and discomfort even with an optimal latch:
Start breastfeeding early
Beginning nursing in the first hour after birth when the nipple tissue is still soft and pliable allows easier latch establishment. Delaying the first feeding can allow the nipples to toughen up.
Limit bottles and pacifiers
Introducing artificial nipples too soon can interfere with learning proper breastfeeding technique, increasing risk for latch issues and nipple confusion.
Ask for help from nurses
Requesting assistance from nurses and lactation consultants in the hospital ensures the latch is properly established before going home.
Limit nipple rubbing
Excess washing or scrubbing, using alcohol/soap on nipples, and unnecessary pumping can dry out and damage the nipple skin.
Apply breastmilk
Breastmilk has soothing, protective properties for nipples. Applying a few drops after feeds can prevent cracking or irritation.
Avoid nipple creams initially
Early use of ointments/creams can interfere with skin contact needed for latch. Hold off on these until after the latch is well established.
Wear comfortable nursing bras
Choose soft, non-restrictive bras that do not put pressure on breasts or nipple tissue. Avoid underwire.
Use care when positioning
Use care not to bump or allow pressure on nipples and areolas that can lead to bruising or abrasions.
Alternate feeding positions
Switching up positions prevents pressure on the same spot and allows different nipple stimulation and milk drainage with each feeding.
Conclusion
There are many reasons a good latch may still result in nipple pain in the early weeks of breastfeeding. This is usually temporary as the nipples adjust. But persistent discomfort can often be resolved through skilled lactation support. Identifying the underlying cause and using proven solutions tailored to the situation allows moms to continue nursing through the discomfort. While some tenderness may remain at first, targeted help gets breastfeeding back on track for both mom and baby’s benefit.