SORE NIPPLES

When nursing, you must hold the baby close enough for its chin to touch her breast. Frequent, short nursings promote speedy healing. Let the baby suck first on the least affected breast. The initial sucking is the strongest, and thus the most painful. Again, if both sides are equally painful, very careful hand milking may elicit the ejection reflex, and the baby can then be put to the breast when the milk flows. You can apply a thin coat of edible oil to the nipple between feedings. This often gives symptomatic relief.

A mother’s nipples may become sore at any time during lactation, but it is more common in the early weeks. It may encourage you to know that the soreness seldom lasts more than a week (although one week in this case may seem a very long time for you).

The most common kind is the ‘positional’ sore nipple, which is self-explanatory.

Soreness can also result from:

1. Sudden exposure to the unaccustomed action of sucking;
2. Faulty sucking technique
3. Letting the infant suck too long in a bad position
4. Soreness is more likely to occur in engorged breasts; and
5. When the nipples are flat and it is difficult for the baby to grasp the nipple properly.
6. Bite by older children (with milk teeth).

Sore nipples do not have nice looking wounds. Often one sees a little redness. But the nipples are so well supplied with pain fibers that even very small lesions are extremely painful. The pain is worst when the baby first begins to suck, and the skin is stretched. It gets less as nursing proceeds, especially after the ejection reflex is working, and the milk is flowing. The early pain is often so strong that a mother may be found bracing her whole body to ‘take it’. Sometimes the severe early pain inhibits the ejection reflex, which leads to further problems.

When nursing, you must hold the baby close enough for its chin to touch her breast, and so that nipple and areola can both go completely inside its mouth.

If, in spite of taking these precautions, sore nipples start to develop, there are a number of things that have proved helpful:

• It may sound brutal –but frequent, short nursings promote speedy healing. It would seem logical to suppose that letting the nipples ‘rest’ for as many hours as possible would have a healing effect. This is however not the case. If a crust is allowed to cover the wound, it only cracks open again as soon as the baby sucks. The wound however heals in spite of frequent feeding.
  
  
• Let your baby suck first on the least affected breast. The initial sucking is the strongest, and thus the most painful. When the ejection reflex has started to work, change him over to the sorest side.
  
  
• If both sides are equally painful, very careful hand milking may elicit the ejection reflex, and the baby can then be put to the breast when the milk flows. If oxytocin preparation are available (either in the form of a nasal spray or of tablets which are absorbed through the mucosa of the mouth) this may be the kind of situation in which they are helpful in eliciting the ejection reflex.
  
  
• Nursing the baby in a different position from usual may also help. In this way, the parts of the nipple, which are subjected to most traumas by sucking, are changed.
  
  
• You can apply a thin coat of edible oil to the nipple between feedings. This often gives symptomatic relief. Lanolin and Vaseline are good and harmless agents, and do not have to be removed before the baby sucks. But you must allow the skin to dry before applying the ointment. Wetness held on the skin by the ointment, makes the skin softer and weaker.
  
  
• Never apply tincture of benzoin or surgical spirit. They cause severe pain, and can damage the nipple skin even more.
  
  
• There are several substances of both modern and traditional origin that people claim are helpful for healing sore nipples, such as lemon-juice, oestrogens, disinfectants, vitamin-E-containing ointments, etc. Some of the recommended methods for treating sore nipples are dramatic, others more ordinary. In the end, only the common sense and general experience of the doctor can help you decide whether or not to encourage or discourage any particular remedy.
  
  
• If a nipple becomes extremely sore, it may become necessary to temporarily discontinue breast-feeding until the nipple responds to treatment. But it is essential, both to prevent an abscess forming and to maintain milk production. You should express the milk (either manually, or if that is too painful, with a breast pump). Unfortunately, in this situation, the milk production often diminishes. It may be necessary to stimulate it to increase again.