Nipple pain seems to be the most common challenge breastfeeding families face. Their sweet baby is born, roots around and down to the breast and OUCH! latches on in a way that instantly damages nipples. But at least they’re latching, right?!? The baby’s latch appears to be fine, so the mother must ride it out, right? Wrong!
Anyone supporting new families must set higher standards for mothers’ comfort – because a painful latch is not a good latch. Not on day one, not ever. A painful latch is an indication that we can discover something and adjust so the dyad can experience comfortable feeds. It may be the positioning, the angle of the baby’s neck leading to positional tongue restrictions, a tongue, lip or buccal tie, a need for structural adjustments and manual therapy. There are many possibilities, and a skilled lactation consultant should be able to sort out what is causing the damage.
It is NOT enough to say “it will get better” or “it just hurts for a while”. Telling a family that pain is normal and their latch is fine, and expecting that family to endure, is not OK. We must help them achieve a pain free latch! And if we cannot, we have to bypass our own ego and refer out to someone who can.
I encounter many families who were told to take a nipple vacation. A nipple vacation seems to be a solution for the mother, to ‘rest her nipples’ and allow healing time. It bypasses finding a proper solution to the pain. The mother is instructed to interrupt breastfeeding – rather than interrupt the pain with a solution that addresses the root cause – and to express milk and bottle feed while the nipples heal. Three days of bottle feeding, early on in an infant’s life, is a recipe for a baby to not return to breastfeeding! I see many babies who after their nipple vacation have decided to take a permanent vacation and refuse to latch at all.
Instead of asking mothers to take time off of breastfeeding, I urge lactation consultants to approach nipple pain from a different space. To learn more about assessing for the cause of the pain, and make a plan to address that cause.
Below are some assumptions that can be helpful to keep us IBCLC’s on the right track when supporting nipple pain:
Let us assume that nipple pain isn’t normal. Nipple pain is a symptom of a poor latch, which we can almost always address.
Let’s stop telling mothers that it should hurt for a while. It really should not. When there is discomfort in any other normal process (other than birth), we look for a cause and a solution. Medical professionals shouldn’t treat our new mothers any differently.
Let’s start to believe mothers! A woman that I saw recently was “finally believed, at 11 months postnatal, that her nipple pain was real”. After a tongue tie release, her pain was immediately resolved and she cried with relief! Imagine 11 months of professionals essentially telling her the pain wasn’t real. It was real and they resolved it with a simple procedure.
Let’s constantly learn about breastfeeding and other approaches to breastfeeding support. Let’s keep sharing what makes for a good latch and about oral anatomy, unusual anatomy, and when manual therapies are a good complement.
And lastly, let’s allow ourselves to not know everything. Let’s continue confidently trying new and different things until we find the solution. Finally, to have the insight to know when it’s time to ask for help. There is always an answer. Sometimes, the only thing we can say is “I understand that it hurts, and it shouldn’t. I can’t explain why it’s so painful, but I’ll refer you toso we can understand more.” An interdisciplinary approach is always a fabulous choice!
Ashley Pickett, IBCLC
Ashley Pickett is a private practice lactation consultant, doula, and parent educator living and working in Oakville, Ontario. She helps families reach their parenting goals while meeting their babies’ needs. Check out her website at www.ashleypickett.com.