Difficulties with breastfeeding

Breastfeeding, like parenting, is not always uncomplicated, especially in the first few weeks after birth. It can be easy to forget at this time that, like all new skills, breastfeeding can take a while to learn and become really good at.

Not all women experience sore or cracked nipples, however if you do it may really test your desire to breastfeed. At times you will feel that it is not worth it, and that breastfeeding is just not for you.

This information sheet has been written to assist women who are experiencing problems with sore and cracked nipples. It is strongly advised that if you are experiencing difficulties with breastfeeding to seek the advice of a midwife or lactation consultant.

Why are they sore or cracked?

Sore and cracked nipples are generally caused because:

• your baby is not in the correct position for feeding. The baby will chew on your nipples if it doesn’t get the areola into it's mouth
• you have sensitive skin
• you may have inverted nipples (this is very rare however).

What to do

• seek help from a midwife or lactation consultant. Get them to help you 'position' or 'latch' the baby to the breast correctly. Once the baby is correctly positioned the nipple will heal within 2 or 3 days
• sit comfortably to feed your baby. If one nipple is more sore than the other, start feeding from the less painful side so that your baby does not feed furiously on the sore breast. Some women find that feeding from one breast per feed (rather than both) allows them to 'rest' the nipple for a longer duration and helps with healing. Your baby may or may not think this is a good idea!
• iIf the baby does not 'latch on' to the breast well, take care to release the suction by gently sliding your finger between his or her mouth and the breast. Don't pull the baby off the breast while they are enthusiastically sucking
• try expressing a little milk first before breastfeeding. This will soften and lubricate the nipple. Do not use creams or drying agents on the nipples.

The pain

• some women use a warm hot water bottle or wheat bag to relieve pain. Others find that they get good relief from cold packs
• go without a bra if it is more comfortable
• paracetamol is considered safe to take for the pain. You may be reluctant to take pain relief. It is wise to remember, however, that it is very difficult to establish a healthy, breast feeding pattern if you are in pain.

Inverted nipples

If you are concerned that you have an inverted nipples or nipple seek advice from your doctor, midwife or lactation consultant. Don't forget that babies breast feed, not nipple feed and that it is very, very rare for women to not be able to feed because of an inverted nipple.

Thrush

Sore, itchy or cracked nipples may also mean you and your baby have thrush. It can affect your baby as a red nappy rash or white spots may appear inside your baby’s mouth. It is easily treated with medication from your midwife or doctor. You should continue breastfeeding.

Further information

For further information and support talk to your midwife, doctor or Plunket nurse. Your midwife may be able to put you in touch with a lactation consultant if she feels it is appropriate.

Plunketline offers advice, freephone 0800 933 922, 7am to midnight seven days a week, 365 days a year, or ask your Plunket nurse for advice. Website: www.plunket.org.nz

La Leche League has counsellors. Look in the telephone book for the contact telephone number of your local branch. Website: www.lalecheleague.org.nz

Also see the Ministry of Health's websites, promoting the benefits of breastfeeding via a national campaign: www.breastfeeding.org.nz and offering detailed information for mothers, supporters, employers and health practitioners about breastfeeding: www.moh.govt.nz/breastfeeding - you can also phone the Healthline (including Well Child line) on freephone 0800 611 116 for advice about breastfeeding.

Look for marae-based clinics in your area. Mother Support Groups are in most towns and cities. Ask at your local Parents Centre www.parentscentre.org.nz or Plunket Family Centre.

Written by Anna Mickell RCpN. Reviewed by everybody.