What is normal nipple pain?

Normal is, not painful on day one, a little soreness on day two, with no cracking or bruising, pain beginning to subside by day three.

Severe pain with latch, cracking or bruising on day 1 maybe a sign of a problem. Quickly identifying what is causing the problem is crucial to reducing pain, preventing bruising and cracking, as well as improving milk transfer. Think about it, if latch is painful on day one, it will only get worse by day two.

(Bleeding not associated with cracking that comes from inside both breast while pumping or breastfeeding in the first few days is considered normal and the milk is safe for the baby to drink).

Painful latch can be caused by the baby not being ready therefore not opening the mouth wide enough. The baby’s tongue maybe up blocking the breast from going deep into the baby’s mouth. Perhaps the shape of the breast or the nipple are making it difficult for the breast to get in deep enough to prevent pain and trigger suck.

Possibly the positioning of the baby may be unstable causing the baby to slide down to the nipple after being latched on or the baby’s mouth maybe latched onto the nipple only and not the areola. Often times a finger maybe in the way of the baby getting passed the nipple or a finger is being used to pull the breast away from the baby’s nose for breathing room causing the baby to again slide down to the nipple. Some babies may have a slight oral cavity issue like a tongue tie or a bubbled palate.

The goal of latch is still the same! Open mouth, tongue down, deep latch. Identifying an issue a can be very helpful to improve technique. However when the oral cavity issue is mild or moderate it maybe be difficult to identify. In the case of a mild tongue tie or a bubbled or high palate for instance, there isn’t a fix available clinically, therefore you need to learn how to accommodate what cannot be fixed at this time. Therefore understanding what is happening and what needs to happen to get a good latch can really be helpful in working through it. Tweaking your hold, yours and your baby’s position, using tools like; pillows and foot stools to find a good effective, comfortable latch. It is extremely important to wait for a baby to root and open his mouth wide with the tongue down, so that the breast goes in above the tongue and deep into the baby’s mouth.

The baby should not be sucking on the nipple itself. The lips should be wrapped around the areola passed the nipple, so that the nipple is actually deep inside to where the hard and soft palate meet. In order for the breast to trigger suck it must get in deep and up near the palate.

Pain is often caused because the baby has not yet opened wide and the tongue is up, pointing to the roof of the mouth, blocking the breast from going in deep enough

In order to get the baby to root and open the mouth, you must tickle the lips to trigger the rooting reflex, but back away a bit until the baby actually says Ahh.  If the baby doesn’t open wide tickle and back away again. If after a few attempts the baby doesn’t open wide. Wait a few minutes. The baby may not be ready.

When attempting to latch and the baby is not ready and not rooting, the baby will move around and often pull away from the breast and get fussy. This may seem as if the baby does not want to breastfeed.

Sometimes babies will want to be close to the breast but not actually eat. Trying to feed at this time can cause confusion. Since the baby is not ready, the baby will respond but not open wide enough to get a deep latch. Constantly trying to latch will cause the baby to get fussy and even go to sleep to conserve energy.

So take a moment calm the baby and let the baby regroup.

When an infant is ready to eat, touching around the baby’s mouth will cause the baby to root: turn to the breast and open the mouth. But, it is important to wait for the right open mouth to latch.

I use what I call the tickle back away technique with an anatomical latch. Which is also known as chin to breast, nose to nipple. First, place the baby’s chin to the breast, hold the breast in a C or U shape with fingers away from the nipple, and rub with the nipple downward from the nose to the chin rolling out the bottom lip. Back away slightly so the baby can open for you. Repeat a few times until the baby opens wide and allows the breast to land deep inside the mouth above the tongue. Again if the baby doesn’t open wide or gets fussy, stop to calm before attempting latch again.

Lay the baby’s cheek against the breast and cuddle a moment to see if the baby wants to eat or just cuddle skin to skin. On a side note some baby’s won’t eat when they have a wet diaper so if you feel you are getting the breast deep into the mouth but the baby is still fussy, check the diaper.

There are several kinds of nipples; flat, everted, inverted, retractable, etc., a mother’s breast can be firm, taught, pliable, round, tubular, triangular, there are so many variations no one hold or position will work for everyone. So, don’t focus on the nipple! The milk is behind the nipple. Focus on getting the breast itself deep into the baby’s mouth.

I often find that some mothers really are hard on themselves and when latch is difficult they blame themselves. When often there is something unforeseen or simply unexplained. Remember Rome was not built in a day. Take your time with latching. Mom needs to be in charge of when the baby latches, slow it down look into the mouth if possible to make sure the tongue is down.

Reattaching is painful! So it is better to slow down and get a good deep latch the first time. Then don’t be stiff, but don’t move a lot once the baby is latched. Readjusting your position will cause the baby’s mouth to slide down.

 

 

When you talk about positioning there are actually a lot of things to consider. I always say positions are a guide you have to tweak a position to make it work for yourself rather than trying to perfectly mimic a position that you saw someone else do or that you read in a book or something you saw on the Internet. It's very important that you actually tweak the position to work for you specifically you and your baby. People have often said to me " oh the cradle is my favorite position or the cross cradle or football is my favorite position". But I have found over the years that there are many things to consider when positioning a baby.

1. The position and comfort of the mother. Did mom have a c-section and she is laying on her back. Does she have a 3rd degree tear, an episiotomy or hemorrhoids that prevent her from sitting straight up.

2.The size of the baby. Large , Small, Long?

3.The size and shape of the breast. Round, Tubular, Triangular?

4. The type of nipple and its location.  Does it point downward? Does it retract?

5. What side you are breastfeeding on. Oftentimes you may even have to use a different position on one breast than the other. 

6. There may be an oral cavity issue like a tongue tied or bubble palate.

7.Where you're sitting or laying.  What type of furniture you are using. Does your chair have arms? 

8.You may need to consider the comfort of the baby in a special way, for example if the baby has a fractured shoulder or a twisted neck or clubbed feet or a circumcision.

9. The size of mom's fingers. The distance from her thumb to her index finger determines how well she's able to hold her breast during breastfeeding and how well she's able to position her baby. The amount of space from the wrist to the elbow  makes a big difference, because if she has very large breasts she will not be able to use a cradle position, because she'll lose the stability of the baby's head as it moves further towards the wrist area. 

10. Does Mom have a very long torso or is Mom obese and her breast lean to the side.  Does Mom have a large tummy therefore eliminating the lap space that a pillow would have sat on.  

 My advice is be open-minded. Be comfortable, start with basic positioning and tweak it according to where you are and what works for you. The baby should always be tummy to tummy with Mommy no matter what position. You should start positioning with Mom's comfort. Once mom is comfortable and in a secure position, then you start to secure a position for the baby. But what you don't want to do is put Mom in a position or Mom get yourself into a position and then once you position the baby readjust your own position. You want to stay in the position that you start with during a latch so get comfortable. Get the baby into a good position  right in front of the breast. Don't hold the baby by the neck. Support the baby's head. Don't lay the baby on the pillow, hold the baby and use the pillow for support. Don't hold the baby's arms behind them, no one wants to eat with their hand twisted behind them. Try to get the hands around the breast as if giving the breast a hug if possible. Some people like to swaddle the baby. But swaddles usually work more when babies are younger. And some babies just don't like being covered up. Try to give the baby a little skin. Skin-to-skin is always great and has continuous benefits for mom and baby. Once mom and baby are in a comfortable position. Hold the breast in a C or U shaped hold with fingers away from the nipple and areola complex, therefore not blocking the baby from getting a deep latch. Use an anatomical latch technique by positioning the baby chin to breast nose to nipple. Use the nipple to tickle from the nose downwards rolling out the bottom lip therefore causing the breast to land above the tongue and deep into the oral cavity.

I also teach what I call tickle back away which is; tickling the lip or nose area of the baby with the nipple to trigger rooting, yet, slightly backing away, and coming back to allow the baby to open wide.  Once the baby actually gives you a nice wide open mouth with the tongue down allow the breast to land deep into the mouth above the tongue and get up to the pallet to trigger the suck reflex.

Shirley Morales who used a blue bicycle horn manual breast pump in Copenhagen in 1973 and such got such a surplus of milk that she sold it to the Childrens Hospital for premature and sick infants. A Milkman who come 4 mornings a week and pick up the milk. She would sell the milk in 1/2 liter bottles and she was paid $2.50 per bottle. Now Human milk is sold in milk banks all over the world for $3.85 per ounce.

Its mothers like Shirley who set the pace for the future of Human Milk Banking

When using or recommending the use of a nipple shield, it is important to remember not become too dependent on the shield. A nipple shield is a wonderful tool for a mother when she is experiencing difficulties with Breastfeeding. However, it was always intended for temporary or occasional use. It is not a permanent solution. The long term use of a nipple shield will not only reduce your milk supply, and reduce milk transfer during nursing, but it can mask the true problem, create the need for supplementation and lead to premature weaning. I worked with a mom who was told she had flat nipples and was given a nipple shield. When I met her, her infant was 71/2 weeks old and she did not breastfeed without a shield. During our first home visit, I noticed her nipples were not flat. I also noticed her babies frenulum was a little short. But clipping it was not an option. I recommended we try latching without the shield and mom said " nope, I'm fine to just use it forever" On our second visit I offered again "she said no". I explained extensively how to properly latch without it. I also suggested to her that she try it when ever she felt good and her infant wasn't too hungry and she felt like it was a good time for her. I also suggested she get herself mentally ready to let it go. By our third home visit, mom had not used it for two days. nipples did start to get a little sore by the third day. We worked on latching without it to improve technique a little more. Shortly after that visit, she no longer uses the shield, her milk supply has improved and she is even breastfeeding in public.

 

I also met a mom who was given a nipple shield due to pain with latch. Her baby was already 7 months old when I met her and she had never breastfed without a shield, not even at night or away from home. Her complaint today was that her infant will not latch to her breast without a shield. It was not about pain anymore. This infant has gotten a custom to the shield. He has never used a bottle and even uses a sippy cup for water, but won't breastfeed without a shield.

Before using a shield, seek clear answers as to why the problem exist. Look for and plan for resolve. Most problems related to latch can be improved with better technique. For example: better positioning, that offers comfort and a good vantage point. A calm mother who is aware and patiently looking for an open mouth with the tongue down.

 

Cracked nipples can be painful and a nipple shield can help for a few days to allow some healing to take place. however,  if technique is not improved the problem will just reoccur.

Of course, some issues are not fixable today. For example: an infant who has a tongue or lip tie ( see blog post the uncuttable frenulum ). With these moms the problem can go on for many months. Initially a nipple shield can be used to allow healing and give mom time to gain confidence and perfect her techniques. She will really need some tips on latching with a tongue tied baby. She will need to learn to adapt to what cannot be immediately fixed.  She needs to Always work to get a deep latch and may still get a little sore from time to time. When latching the tip of the shield still needs to get up over the tongue and deep into the center of the mouth or the infant will fuss with it but not suck.

 

When things improve she can choose to use a shield occasionally but should work to not need it anymore. For some moms it still hurts even with the shield on. It is important to give instructions on how to use it. If it is not on properly and it's sliding around, it will limit the amount of milk the infant gets based on the the lack of negative pressure created by the sucking. Make sure the size of the shield is accommodating also, some women use two size shields one that is more comfortable and one that gets more milk. Even with a shield an infant needs to learn and be reminded to open wide and put its tongue down to achieve a deep latch. If not, the infant will only be on the nipple. If just on the nipple, he will be gassy and fussy and he will get considerably less milk.

Hello everyone It is soo good to talk with you! So much has happened since I last blogged. I must let you all know right away that you my readers have really become a major influence in my journey. Your support and encouragement is truly inspiring! When I get weary or a little unsure I can read your comments and once a gain know I am on the right path and people are watching and taking this journey with me. Thank You, please know that each and every comment is read and appreciated. 

Well, we qualified for free business consulting from the Chamber of Commerce. We qualified because I hired a couple of people and a allowed an intern to get hours by volunteering with us. Basically by employing people in our community we are creating economic change. My consultant said we have done a lot of good work and he was really surprised our website is doing so well in search, especially when we have not paid any money in advertising.  Now don't get me wrong, my phone rings off the hook with calls from Yelp, Google, Yellow Pages, US Directory, Merchant Warehouse, Play My Ad and so many more people trying to get me to pay them, but so far I have just done it myself. See it is all about back links. A back link from my understanding is a link from another website that can lead back into yours. So I go into the computer and find places to put my information and links in for free. As of today we now have over 120,000 hits on our website. Although we are getting home visits now pretty regular we are still not at the point of sustainability so I had to get a job. I became the Prenatal Health Educator for St.John's Well Child and Family Center in June of 2012. My business consultant said no don't take a full time job or my business would die. I did it anyway! Lucky for me the position I took still put me around pregnant and breastfeeding mothers. I continued to do home visits at night and on weekends. The Best Babies Collaborative Funded by 1st 5 LA, allowed me to teach prenatal & Breastfeeding classes at four St. John's Clinics, LEMA High School, and Riley High School for Pregnant Girls in East LA and the Blanding location in Watts. Our classes were open to the public and offered snacks and incentives. Since the classes were open I began allowing Bachelor of Nursing Students from West Coast University to attend and help me with my classes since they needed it for their course. It is such a win win situation, I get to have more numbers for my classes, they get the hours they need and I get help. Teaching at Riley for Pregnant girls has been really awesome the students were attentive and willing to learn. I am always amazed at the strength these young women have. I know we are making a difference in their lives and the choices they will make moving forward. Thanks to Mrs. Diana Lindsey and Mrs. Brenda Bright for allowing us into their classrooms. Also while at St. John's I was blessed to get some good training's that I know will help as we go. Comprehensive Prenatal Services Program (CPSP), Breastfeeding Basics, Female Reproduction, Contraceptives, STD's, Infant Adoption, Intimate Partner Violence, Building Empathy in Trauma and  Communication and Maternal Depression. Unfortunately our grant ended on December 31, 2013 and so did that job. I will maintain my relationship with Riley High School and teach classes there periodically on my own. I am also staring a teen blog with the girls from Riley. We are looking forward to sharing their stories and encouragement with teens from all over the world. We will name it Mamma Tigers and it will be available on my website in early 2014 so keep an eye out for it.  We have moved our office from UR Business Here to a new location in Bixby Knolls in Long Beach called Baby Awareness Studios. Here we collaborate with Owner Chai B. Benson who is Marriage and Family Therapist, a RN and newly certified  IBCLC Christina Rodriguez, and inventor of hand made Sunshine Cloth Diapers Deja Allison. Here at Baby Awareness I offer a Saturday Lactation Clinic and Breastfeeding Support Group, one on one consultations and an outreach event on 1st Fridays. We are also blessed to have our West Coast University Students helping us on a weekly basis. Chai and I are partnering up to bring breast pumps to the Long Beach area. We currently offer Phillips Advent Double Electric and Manual Pumps, nursing pads day & night, Nipplets, Nipple Shields, Breast Shells and we are looking forward to working with Medela in the near future.  I am really happy to announce that I have been approved by Aetna to start taking insurance. I applied to them, they sent me to the CAQH Universal Provider Directory. They credentialed me and notified Aetna. Aetna called me and said they were sending out the contracts and they will be here any day now. Also we just went live with a new area of Google called Google Helpouts. This new area allows people to get real help from licensed professionals face to face over live video. It's the future and we are a part of it from the begging, Very Exciting! 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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