When breastfeeding hurts

This post was contributed by Dr Candice O’Sullivan. Previously a medical practitioner, Candice now owns a healthcare communications agency, helping doctors and other healthcare providers to produce high-quality patient information.

My breastfeeding story

When I was pregnant with my first child, I assumed that breastfeeding would come naturally and just work. Even so, I still did a lot of reading on the topic, so by my third trimester, I felt well-educated and well-prepared.

Then four weeks before my due date, my waters broke unexpectedly, and I ended up having an emergency caesarean in the middle of the night. My little boy came out ‘borderline small’, meaning he wasn’t quite small enough for the special care nursery, so we stayed on an ordinary maternity ward. And therein began my very long, lonely, painful battle to breastfeed a tiny baby with a tiny mouth who couldn’t latch properly.

I won’t go into the ins and outs of what happened next and all the different things we tried but suffice to say, it would take months before latching on became a seamless process for him, and breastfeeding became ‘natural’ for us both. I distinctly remember giving my son a bedtime feed when he was around 9 months old and feeling amazed at how easy and ‘natural’ breastfeeding had finally become. In the end, I breastfed my first son for a little over 13 months. This was a massive achievement given where we had started.

When I was pregnant with my second son, yet again I assumed that breastfeeding would come easily. What I didn’t take into consideration was the possibility that I could come up against a whole other range of breastfeeding issues. You see, my second son could latch brilliantly, but by about Week 3, breastfeeding not only hurt – it was pure agony. I couldn’t understand why until I was diagnosed with thrush, which not only affected my nipples but also the milk ducts inside my breasts. This led to an 18-month battle with recurrent thrush. I ended up on some heavy-duty medication, taking it for weeks and sometimes months at a time, to try and keep the infection under control. It wasn’t pleasant but when the infection was at bay, breastfeeding was easy and painless, so I kept going even though I had to deal with recurrent flares. This time round, I ended up breastfeeding even longer, for around 22 months.

The ‘moral’ of my experiences is that breastfeeding doesn’t always come easy. It can be really hard work but it can become second nature if you receive the right information and support. So if, like me, you want to persist with breastfeeding despite any challenges you may be facing – and you have the energy and ‘mental space’ to keep trying for a little while longer – there are people who can help you and your baby to figure it all out. Or to at least give it a good old try.

Common causes of pain with breastfeeding

Some of the most common causes of pain during breastfeeding include:

Poor latch: Latch problems are the most common cause of breastfeeding pain. They usually involve a latch that is too shallow, meaning that your baby’s tongue rubs against your nipple when feeding rather than your breast. Milk engorgement can make latching difficult, so sometimes it can help to express some milk before putting baby on your breast. Other times, a small change in positioning can make a huge difference.

Thrush (yeast infection): An overgrowth of yeast can lead to thrush around your nipples and/or in your milk ducts. This is often described as a burning pain, or sharp and stabbing, and is usually accompanied by a rash. The skin over your breast may also look smooth and shiny.

Tongue-tie: When you look inside baby’s mouth, you see that the thong of skin under baby’s tongue (the frenulum) is tight or short, and the baby isn’t able to stick his tongue out or lift it up. That means he can’t bring it forward or cup the breast as he needs to, and his tongue rubs against the end of the nipple, causing pain.

Vasospasm: This is when blood vessels in the nipple tighten and go into spasm, so that blood does not flow normally. You will usually feel sharp pain, burning or stinging in the nipple. It is typically accompanied by sudden whitening of the nipple, followed by a colour change from red to blue.

Plugged duct: This is a sore, tender area in the breast. It may feel like a lump under the skin and the skin may look red. This usually indicates that a milk duct has become blocked. The milk backs up and creates pressure behind the plug.

Mastitis: You will have a hot, red, very tender area on your breast. You will also usually have a fever and feel unwell. Mastitis may develop suddenly or may follow an unresolved plugged duct. When a plugged duct stops the milk from flowing, bacteria may grow in the milk leading to an infection and inflammation. Sometimes cracked nipples may also allow bacteria to enter the breast. If you suspect you have mastitis, call Chris on (03) 9418 8299 for advice.

Where to seek help

Your local lactation consultant or clinic: the hospital you gave birth in will usually have a specialist lactation nurse or clinic who can assess and diagnose your breastfeeding issues. If Chris delivered your baby at Epworth Freemasons, you can contact the Freemasons Lactation Clinic on (03) 9418 8310. You can book a face-to-face consultation or the lactation consultants may be able to provide all the help you need just by talking things through with you over the phone. If you delivered elsewhere, call Chris’ rooms on (03) 9418 8299 for a list of lactation consultants he recommends in your area;

Your maternal child health nurse: you’ll have appointments with a maternal child health nurse at Weeks 1 (home), 2, 4 and 8. This is a great time to ask questions and find out where you may be going wrong with your feeds;

The Australian Breastfeeding Association (ABA): this website has lots of useful information for women at every stage of breastfeeding;

The sisterhood: mums, mums-in-laws, sisters, etc. can relay their own experiences, but they can also just be there to make you a cup of tea or hold baby while you take some time for yourself;

Online baby and motherhood forums: while you do need to fact-check the advice of non-professionals, peer-to-peer support can reassure you that you are not the only person facing these types of issues. They can also help pinpoint the source of your problem and guide you in the direction of where to seek help;

Your mother’s group: these women can be a great source of useful tips and hints, as you all muddle through this new experience together.

What to remember in the middle of the night

Everything always seems worse in the middle of the night, especially when you are sleep deprived. This is when you need to tell yourself that this moment in time will pass and that you will look back one day and think: ‘I can’t believe I got through that’. But for now, while you are caught up in the midst of it all, just breathe, then keep doing what only you can do best: love your baby and love yourself. If you can just keep doing that, you will find a way to get through. It may not always be pretty or graceful or elegant. In fact, it will probably be downright messy, particularly if you throw in another kid or two and a needy husband, but you will get there.

And if you really do need a laugh, imagine what the lovely Kate Middleton might look like if she didn’t have people to do her hair, organise her outfits, take care of her children, cook all her meals, and give her time to exercise. Blimey, it would be a bloody shambles!

Jokes aside, it’s also important to be able to recognise the possible signs of postnatal depression and anxiety. If you think the sleep deprivation and stress of breastfeeding are catching up with you, don’t be afraid to reach out for help. After all, we’re all in this together.

Lastly, don’t forget your 6-week post-partum visit with Chris

Every new mum should have an appointment with their obstetrician 6-weeks post-partum. This booking will usually be made before you leave hospital. If you need to contact Chris before this time, please call (03) 9418 8299 or simply book online.