We should all be clear that breastfeeding should not hurt. However, it is very normalized that the first days of breastfeeding are hard, that cracks are almost inevitable and that pain during feedings is a middle way until “it becomes silent”. Throughout this post we will see why breastfeeding should not hurt and what are the most frequent causes of pain during feedings, since most of them are correctable.
Why should breastfeeding not hurt?
Breastfeeding shouldn’t hurt . Breastfeeding is the natural way for our species to feed our babies during the first months of life; Would we have gotten here if it was painful? It is true that, at first, the nipple may be more sensitive and, as it is a new sensation, it can be somewhat annoying; but it should not go beyond there. These discomforts will disappear during the first days of life. If breastfeeding hurts, as well as if cracks or sores appear on the nipple, it is an indication that something is not working.
Most newborns have the perfect anatomy to breastfeed, and if the relationship between their mouth, tongue, and mother’s nipple is correct, there should be no pain or lesions on the mother’s nipple. As we see in the following video, the baby must make a deep latch, introducing the nipple and a large part of the areola in the mouth. The nipple will be attached to the back of the palate and the baby’s tongue will make undulating movements over the areola, thus pumping the milk.
What are the most common causes of pain when breastfeeding?
Pain when breastfeeding tells us that something is wrong. Without a doubt, the most frequent cause is a bad hitch . It may be because the baby’s position and / or posture is not correct or because there is some anatomical alteration that does not allow a good latch on the baby to the breast, such as a short lingual frenulum or a micrognative and / or retrognathia (lower jaw more small and / or back).
When the baby begins to suckle, a hormone called oxytocin is released (which can also be released by other stimuli) and produces the ejection reflex, which helps the milk come out. This reflex can be painful for some women, but the pain lasts only a few seconds or a few minutes.
Breast engorgement, mastitis, breast abscess, or a blocked duct can also cause pain when breastfeeding.
Alterations in the skin of the nipple (such as dermatitis or eczema) and Raynaud’s phenomenon are other causes, less frequent, in which breastfeeding is painful. Finally, there may be pain from non-organic causes, such as postpartum depression and other psychological difficulties.
The importance of a good down payment
As we have said, an incorrect attachment of the baby to the breast is one of the most frequent causes of pain during feedings , as well as the appearance of cracks and wounds in the nipple. Many mothers ask me how to know if the latching of the baby is correct. an important fact is that it does not hurt. In addition, there are other signs that indicate that the hitch and position are correct :
• The baby’s body must be aligned : ear, shoulder and hips must form a line. Some problems, like a stiff neck in a baby, can make this difficult.
• Although in the past it was said that babies should be navel to navel glued with the mother, this does not seem to be necessary or beneficial. there are higher nipples and others that point lower; the important thing is that the nipple is perpendicular to the baby’s mouth. that is, if our nipple looks a little downward, the baby will have to suckle looking a little up.
• The baby’s lips should be everted (especially the lower one) and wide open , forming a wide angle (greater than 90º). The baby’s chin (and usually his nose as well) will be close to the mother’s breast. Cheeks remain plump (no dimpled during suction). We will see that when breastfeeding, the baby moves the lower jaw even moving the ear. A large part of the areola should be inside the baby’s mouth, an asymmetric latch being preferable (the baby takes more areola in the lower part than in the upper part).
Many babies are able to latch on properly on their own. This is more likely if it happens in the first hour after giving birth doing skin-to-skin with the mother. In other cases, the hitch must be steered; It is important that for this we have the help of a professional trained in breastfeeding.
Anchiology
Ankyloglossia means anchored tongue . This happens in babies who have a short lingual frenulum : a kind of “web” that joins the tongue to the floor of the mouth and hinders its mobility, being a possible cause of a poor attachment of the baby to the breast. In addition to causing pain to the mother while breastfeeding, cracks often appear and babies may not be able to express all the milk well, taking very long feedings and not having adequate weight gain. Babies with a short frenulum nurse better in some positions, such as piggyback. In some cases it may be necessary to cut the frenulum (frenotomy).
Breast problems that can cause pain when breastfeeding
As we have seen before, breast engorgement, mastitis, breast abscess, or duct obstruction can cause pain.
• The “milk surge” usually occurs around the third day postpartum. If there is an excessive accumulation of fluids (edema) we speak of breast engorgement. The breasts are very full, indurated and often painful.
• Mastitis is an inflammation of the breast. An area appears red and hot, fever and general malaise usually appear. They are more frequent in the first weeks after delivery
• Breast abscess is a collection of pus inside the breast. It usually appears as a complication of mastitis. Fortunately, it is rare. We will notice a painful lump in the chest that moves when we touch it, the area will be red or bruised, shiny and “tense.” There is not always a fever.
• A blocked duct is a fairly common problem. We will notice a painful lump in some area of the breast; there is no fever or malaise and the area is not usually red. Obstructions can be due to an incorrect emptying of an area, pressure (sleeping supported on that area, wearing tight clothing) or a rough weaning.
• Raynaud’s phenomenon appears when the smaller vessels that carry blood to some parts of the body narrow, making it difficult for blood to pass. the area turns white and after a few minutes purple and cold. When blood circulates normally again, it turns red. This happens on the fingers and toes and can also appear on the nipple. It is triggered by cold, stress, emotions or by taking some medications.
Non-organic causes of pain when breastfeeding
In some cases, the cause of pain is not organic / physical, but psychological . Among them would be postpartum depression . In addition, mothers with pain and difficulties in breastfeeding are more prone to depression.
