Breastfeeding Hurting?

What is Happening


We all know that breastfeeding is not meant to hurt, so why is pain so commonly described by mums?

Although there can be several reasons why breastfeeding could be hurting, the most common cause is positioning and attachment that could be better.

When a baby does not take a large mouthful of breast into his mouth as he attaches to the breast, the skin of the breast and nipple can rub against the hard palate and cause pain and discomfort for mum. The other disadvantages of baby attaching in this way are that he will find it harder to remove milk efficiently from the breast, will get less milk, and this will send a weaker signal to mum to make more milk. Focusing on  positioning and attachment can really mum to position her baby in a way that enables him to take a big mouthful of breast, and achieve a pain free, efficient attachment.

Positioning of baby relative to mum
No matter what position is used, the principles of positioning are the same.

  • Baby held very close
  • Baby’s head neck and body all in line
  • Baby facing the breast, nose opposite the nipple
  • Baby’s head free to tilt  back
  • Comfortable, sustainable position for both mum and baby

Attachment of baby to breast
Once you have baby in good position, you need to wait for right moment for good attachment.
For good attachment information please click here

Signs of good attachment
You should be able to see all of these –

  • Mouth open wide
  • Cheeks full and rounded
  • Chin touching the breast
  • If areola visible, more seen above top lip than below bottom lip (mum may not be able to see this)
  • Lower lip flanged back (mum may not be able to see this)
  • Fast, short sucks, quickly changing to slow, deep rhythmical sucks with swallowing
  • No pain for mum

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Using the `Laid Back’ approach can be helpful too.
Please click here for more information and pictures.

If working on these principles doesn’t seem to be helping, the pain could be due to a different cause. Possible other causes include:

Nipples already damaged:
remember, if your nipples are already damaged from previous attempts, even if you attach the baby perfectly now, the initial attachment will hurt and this may take 20-30 seconds to subside.  Be patient.  If the attachment is correct now, the nipple will be symmetrical and undistorted after the feed.

Thrush or Candida: Pain typically begins after the feed and can continue for up to an hour. This may follow a period of pain free breastfeeding. Thrush can occur at the same time as other causes of pain especially if you have had a course of antibiotics. If thrush is suspected, seek further help from her Midwife, Health Visitor or GP. The Breastfeeding Network leaflet  is very useful for discussion and as a resource.

Raynaud’s Syndrome: Blood vessels in the nipples contract giving a typical blanching of the skin. This can be very painful, and sometimes triggered by cold weather. (Whitening of the nipples can also be caused by compression and poor attachment, so check the attachment first). Helpful tips include using 10cmx10cm squares of thick fleece as breast pads, conscious trying to choose a warm place to feed, using a warm gel pad or warmed wheat bag on nipples just before and just after feeds, and drinking tea.

Pregnancy: Pregnancy can cause the nipples to become tender. Could this be the cause?

Teething: Acidity changes in the saliva can cause irritation of the skin, and teething babies sometimes pull and chew at the breast to ease their own discomfort.

If you are still experiencing pain when feeding, it is really important to suggest she seeks the help of someone with expert skills. Locate breastfeeding support in your area here:

The National Infant Feeding Survey (2005) suggests pain associated with feeding is one of the most common reasons why women stop feeding before they wanted to. Pain and discomfort is not something indicating you have failed, it just means that you might need a bit of help getting the baby attached well. Focus on your positioning and attachment and try and get your midwife to take a look and / or access local breastfeeding support.