No pain, no gain? What EXACTLY do we mean by breastfeeding pain?

This post was most recently updated on February 24th, 2019

This article is inspired by a post I wrote on facebook. The post prompted a very long thread of thoughts and feelings. Here is what I wrote:

The breastfeeding myth about pain being normal is a tough nut to crack. It is common because women haven’t grown up learning how to latch a baby and because skilled support is often lacking. But evolution didn’t intend it. Please don’t tell women that it is bound to hurt: it makes women who never have sore nips feel like people think they are smug liars and stops women in pain reaching out for help. There is always a reason for pain. And it can almost always be resolved. Please help us spread the word.

I got many, many replies telling me that pain when breastfeeding IS normal. That nipples need to “toughen up”, that nipples have to “get used to” breastfeeding, that pain for a few minutes, a few hours, a few days, even a few months is a normal part of breastfeeding. Stories came in thick and fast detailing the “toe curling” pain, the blood, the cracks, the blisters, the masitis.

Some of those women, quite understandably, felt that saying pain is not NORMAL is an implication that perhaps I thought they were

“DOING IT WRONG”

NO! I think you didn’t grow up surrounded by breastfeeding. Humans learn through having behaviours modelled by their tribe. It’s well known that if babies never saw anyone walking on their hind legs, they would never get up and walk. No-one would think of blaming them for that. You were just missing your tribe.

If you grew up in most Western countries, your tribe BOTTLE-FEEDS. This is the imagery you grew up with. And this may be how you try to nurse: bottle feeding with your breast. This is the most common reason for sore nipples that I come across in my practice. We are beginning to understand that often things are much more comfy when we work WITH the neonatal reflexes (ie the wonderful skills your baby is born with to help her to breastfeed) and the mother’s instincts, rather than using sitting upright postures that necessitate the mother being taught how to latch her baby on and so often result in the mother stooping over her baby, needing lots of cushions and struggling to see how to latch her baby. Watch these videos of more laid back, baby-led latching;

https://youtu.be/obX1dGtO-mE

Some women seemed to find the concept that pain can mostly be fixed, or at least helped, rather difficult to believe. I can’t blame them. I, too, was told many times by people I trusted – midwives, health visitors, GPs, that if I just persevered, the pain would go away. I believed them. It wasn’t until I trained as a Breastfeeding Counsellor and began supporting women that I began to really believe that, YES, pain can be helped. And YES, women deserve to be helped and NO, pain is not an inevitable part of nursing our babies.

Now, after more than a decade working as a breastfeeding counsellor and doula I must have met many hundreds of breastfeeding mothers. I have sat with them and listened and tried hard to hear and understand and empathise and find ways to help them reach their goals. I’ve learned a thing or two. I’ve learned that breastfeeding is a dance. It takes two. And just like a dance, if things don’t flow; if you don’t move together in tune with the rythmn of the music, you will tread on each other’s toes. And it hurts both of you.

If, when your baby latches on, your toes curl, your shoulders shoot up to the same level as your ears, the tears spill over onto your cheeks and you need every fibre of your being to stop yourself grasping your baby in an vice-like grip, this is NOT what nature intended. What possible advantage to us as a species would there be for evolution to make this a NORMAL, physiological part of breastfeeding?!

And wait! When you feel like this, it’s not a walk in the park for your baby, either. She feels your muscles tensed up against her. She feels the stress hormones slowing the flow of your milk. She finds it hard to use her jaw and tongue to massage out all the milk she wants, at the speed she wants. It feels tiring…and stressful…and she comes off and shouts at you, or gives up and shuts down in a big, sleepy sulk – only for hunger to wake her and make her try again 20 minutes later.

While she sleeps, you do everything you can think of. You dollop massive handfuls of lanolin on your nipples. You try heat and cold and cabbage leaves, and walking around naked, and not walking around naked. You try nipple shields and then read something about how shields are the devil and what a dreadful mother you are for even thinking of using them. Perhaps you spend hours watching youtube videos of The Latch. And in and out of the door stream more people telling you what. you. should. do.

On day 3 or 4 or so. Your boobs are hard and hot and the nipples are flat. And now she can’t latch at all. Or it’s even worse. Someone says express a bit. So you buy an expensive piece of plastic and set to.

On day 5, along comes the midwife. She weighs your baby and she has lost 10% of her birthweight. You decend into your own personal black hell-hole of panic and guilt. Out comes the pump again. Or your bloke heads off to the supermarket for bottles and formula.

We all know the sorry story, don’t we? This is just one of the faces of the cold breastfeeding statistics from the NHS.

Pain is not something to be ignored. Pain is always a message. A message we need to act on. But you weren’t doing anything wrong. You were just trying to learn to dance…in a world without music, inhabited by people who don’t know the steps, who all believe dancing should come naturally, but that it’s normal to get blisters (“it’s not your shoes – your feet will toughen up, believe me!”)

As some wise people on facebook pointed out. We have to be specific with our language. So let’s look at the definition of ‘pain’:

highly unpleasant physical sensation caused by illness or injury.

So when we talk about pain, we mean something physical is causing damage. It might be the latch, causing the nipple to be squished, rubbed and damaged between the tongue and the hard palate. For those of you who persist in believing this is a normal part of breastfeeding, explain to me why a nipple would be damaged when the latch is deep and the nipple is w-a-a-a-a-y back in the baby’s mouth, where the hard and soft palates meet – the place we call the ‘sweet spot’ or ‘comfort zone’ – which is the point that stimulates the suck reflex. If you are a mother, or a midwife, or a breastfeeding peer supporter who can’t completely visualise this. Have a look at this video and go find your local friendly Breastfeeding Counsellor or International Board Certified Lactation Consultant and ask her to explain. She might make you put your thumb in your mouth – humour her, it might just help you ‘get it’.

But let’s be clear. It can be a bit sore in the first couple of days as the baby perfects the skill. We women aren’t used to our nipples being drawn up erect with the aid of negative pressure (ie a vacuum) very often – even if we’ve been used to that in sexual play, that’s not every hour or two round the clock, on no sleep. At first the baby might ‘slurp’ in the nipple and it might be ouchy as the nipple finds its way to the correct position (I call that spaghetti sucking and it often results in a mother sounding like this:

“ow ow ow ow ow oooooow, ahhhhhh, oh that’s fine”

But bleeding, blisters, a squished, bent out of shape nipple is not meant to be ignored! 10/10 pain is a puzzle that needs to be solved. You don’t deserve to be fobbed off because no-one knows how to help you. There are some myths that really, really need to be debunked. And let’s be specific here. This is not just little old me spouting my opinion. I am a qualified, experienced Breastfeeding Counsellor so I have to check out that what I say is as evidence-based as possible. So here goes.

No. Some people don’t just ‘have more sensitive nipples’ and will therefore have more pain. In the absence of breastfeeding problems, women with nipples that feel the world intensely should still be able to breastfeed without suffering.

No. It isn’t because your baby is big. Or small. Or hungry. Or because you have ginger hair. Or because your baby is a boy. Or a girl. Or because your nipples/breasts are too small. Or too big. Or because your nipples point East. Or West. Or North. No, nor South either. Nor is it to do with the price of fish.

(OK, so sometimes a teeny-tiny prem baby might have a problem latching comfortably onto anything else other than his mum’s ginormous nips. I grant you, there might be a bit of an issue there that will pass with time as he grows. I have however, seen lots of what look like jigsaw pieces that are NEVER going to fit together – but a bit of work, creativity and teamwork and we have lift-off…comfy latch!)

OK then, I hear you ask. What HAS it to do with?! WHY was I bloody sore for days/weeks and then it just disappeared? Well. Have you got a day? A week? a month, a year to learn some stuff about breastfeeding? Here are just a FEW of the things that could have been going on:

~You and your baby hadn’t yet found postures and positions that maximised the chances of baby getting a large mouthful, with the nipple landing in the ‘sweet, safe spot’.

~You and your baby were recovering from a birth experience that may have resulted in a less than perfect scenario for the initiation of breastfeeding. Babies can be sleepy, jaundiced, stiff, drugged or have a headache in the early days; all things that can affect the baby’s ability to latch deeply.

~Someone, soon after your baby’s birth grabbed her head with one big hand and your boob with the other and attempted to sort of squish, mush and bang the 2 together. Your baby now screams at the breast and latches half-heartedly and shallowly.

~ Because you are sore, every time you bring the baby to the breast, you flinch away, just a little, at the last moment before the latch. Instead of a comfy deep latch, this shallow, painful one continues.

~Your baby may have had a tongue tie. Some ties only affect tongue function minimally. Lots of use of the tongue in the early weeks sometimes result in tongue function improving and pain resolving (or you unconsciously find the positions that work for you both) It doesn’t mean we should MAKE women put up with it while they wait for some possible but not guaranteed future green pastures of pain-free nrsing though, right?

~You might have been fine in the early days, but then your milk came in. And your football boobs were so hard that your poor baby couldn’t get a deep latch and perhaps kept slipping off. This is when you got really sore and started seeing scabs on your nipples. Someone could have given you a cool compress to take down the swelling and taught you Reverse Pressure Softening to make the front of your breast softer and easier to latch on to:

~Perhaps you had a shallow latch that damaged your nipples in the early days. But you got the hang of things and your nipples seemed to heal a bit. But the pain didn’t seem to go away and those fissures (cracks) subbornly remained despite all and sundry telling you the latch looks “perfect”. Did anyone ever offer you a swab of your nipple? Fungal and bacterial infections are more common in women who have, or have had, damaged nipples.

~Your latch might be a bit less than perfect, which compresses the nipple, closing down the blood vessels and causing what is called a ‘vasospasm’. The nipple looks white when the baby comes off. When the blood vessels open up again, it can be super-ouchy. Sometimes a mother’s milk comes fast and furious, and the baby clamps down to stem the flow. This can also cause a vasospasm. As can Raynaud’s Disease, which is circulatory problem.

Other types of pain, in the breast or in the nipple:

Blocked Ducts, masitis, abcess, intense sensation of ‘milk ejection’, ‘time of the month’, pregnancy, engorgment, milk blister (sometimes called a ‘bleb’, which is a blockage of the duct, right at the surface, on the nipple), eczema on the nipple, allergic reactions, dermatitis, the acidic saliva of a teething baby can cause soreness sometimes, anatomical issues of the tongue and/or palate etc etc

Many of these things MAY resolve by themselves in time. The human body is a pretty marvellous machine and babies are hardwired to breastfeed. Give them enough time and opportunity, most of them will find a way. But what’s wrong with daring to suggest that women could have less pain? Pain is never your fault. If it were a pain in your toe, wouldn’t you go to the doctor? Woud you feel guilty for having a poorly toe? 

So, to sum up: YES pain in the early days of breastfeeding is common. But just because something is common, does not make it a normal, physiological part of the human experience. Telling a pregnant woman or a new mum that pain is normal does not teach her to be able to tell the difference between the hit and miss latches of the early days when they are both learning and serious pain that indicates she needs some skilled help. (Oh and we need to teach mums how to recognise skilled help – and we helpers have to recognise when we’re not helping and go find someone who can – none of us are perfect.)

Blood, cracks, blisters, pain that continues throughout a feed. Pain that has you on the ceiling, with tears shooting horizonally out of your eyes, pain BETWEEN feedings, pain that carries on. And on. These are your signals to shout for help. The skilled suggestions, the spirit of teamwork as you and your breastfeeding supporter work together to solve this pain-puzzle, the emotional support, empathy and sense of connection she can bring you will hopefully help you feel more positive and nurtured through your breastfeeding journey. And maybe, just maybe, you’ll suffer less than if you just waited it out, thinking it’ll pass.

So why do I get my poor old knickers in a twist about this stuff? Because everywhere I go – facebook, twitter, my breastfeeding clinic, the postnatal ward, the mother’s groups – I encounter women suffering. They peel off their breastpads and take the scabs off with them. They dissolve into tears as soon as they sit down next to me. They tell me that they don’t know if they can do it. They worry they are not bonding with their babies. They feel guilty because they kind of RESENT the baby that is causing so. much. pain. They cry as they tell me “I suppose I’ve just got to toughen up”.

We are not weak, broken, fragile women. We are strong. Capable. With bodies that work! Isn’t that the message you want your daughter to take into motherhood?

Next time the flippant words “breastfeeding pain is normal” come to your lips, maybe you’d consider thinking of those women. The ones who were told to expect the pain. The ones who sat at home for ages, not coming to see someone like me because they thought they just had to sit. And wait. And perserve.

I don’t think we should send mothers away from antenatal classes JUST with the “breastfeeding is natural, just put her skin to skin after birth and let her latch on and it’ll be fine and it won’t hurt” guff either. Mums need to know about the potential hurdles so they can jump them, or walk around them. They need information and FACTS, not myths, about how breastfeeding works.

We don’t have to be martyrs to be mothers. And remember, what’s good for you is almost always good for the baby. 

Sources of good quality support other than that awesome midwife or health visitor who knows her stuff and has more than JUST her training and a 2 day Unicef course under her belt. Fantastic as it is, if your problem is complex, you need a specialist.

abm.me.uk
https://www.laleche.org.uk/

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