Why does breastfeeding or lactation sometimes cause pain?

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There are various reasons why a breast or both breasts, a nipple or both nipples may have pain during lactation. This may be related directly to the act of breastfeeding, or could be something going on with the process of lactation. The experience can range from mild discomfort to acute pain, short term pain to persistent pain. Sometimes pain is due to more than one factor. 

 

All parents experiencing pain deserve evidence-based support to become pain free, and compassionate emotional support to help them through the experience as it can be a lonely and overwhelming time. 

 

Bear in mind that whatever the reason behind any nipple pain and/or damage, if a baby is not effectively latched then they may not be driving the supply optimally, which in turn can lead to weight gain issues in the baby, and reduced milk supply in the parent. In these instances, it is likely to be helpful to protect supply by expressing and giving baby expressed milk on top of breastfeeds whilst working on solution/s. 

 

In general, cracked nipples/trauma/fissuring is most likely due to poor positioning and attachment to the breast, but many of the factors below can cause this. 

 

In the first instance, support the parent to optimise positioning and attachment. If this does not improve the pain, explore possible underlying reasons and signpost on as per your role.

 

When there are open wounds, cracks and grazes, support with healing is likely. See below for healing suggestions. If wounds are not responsive, or have further symptoms as outlined below, see GP regarding potential dermatosis and infection. 

 

For nipple and/or breast rash, see GP regarding potential dermatosis and infection. 

 

Provide parent with emotional support during this time if they would like.