Breastfeeding And Breast Pain

Introduction

Breastfeeding is one of the best ways to ensure a child's health. The WHO recommends that mothers exclusively breastfeed for the first 6 months, and continuously breastfeed until 2 years old, with foods added into the diet at 6 months old.¹ It is a skill that can be tricky to grasp; it takes time to get the hang of it, but once you have, many child bearing parents find it very fulfilling. Breastfeeding brings with it many benefits for the baby and childbearing parent, but there are also some challenges which may be experienced, one of which is breast pain. There are many different causes for breast pain related to breastfeeding including breast engorgement, blocked milk ducts, and inflammation.

Breastfeeding should not be painful so keep on reading to find out more about the causes of breastfeeding breast pain, how to solve it, and when to seek medical attention. 

Benefits of breastfeeding 

Breast milk is the best thing to feed your baby in the first six months of their life because it provides everything they need to grow and develop well.¹ This is because it contains important nutrients, vitamins and minerals, and is readily available. As well as that, breast milk contains stem cells and antibodies, which help the body to repair and protect itself from diseases and illnesses. 

Breastfeeding helps the brain to develop healthily, prevents infectious diseases, provides great nutrition, increases intelligence, and reduces the risk of obesity and chronic diseases such as diabetes later in the baby’s life. As well as benefits for the baby, there are also many benefits for the nursing childbearing parent. Breastfeeding protects against breast cancer and also may protect against type 2 diabetes and ovarian cancer.^2,3 Furthermore, breastfeeding speeds up the process of your uterus returning to normal size. It is a fantastic way to feel connected with your baby. Oxytocin, a hormone which is released during breastfeeding makes you feel relaxed and bonded with your baby. 

Breastfeeding process

How to know when to feed

Your baby will give you signs when they want to be fed. These can include: licking their lips, putting their fists in their mouths, and opening their mouths. You can feed your baby as often as they like, but in the first few weeks, you can aim to feed your baby 8-12 times or more every 24 hours. It is also okay to feed your baby whenever your breasts feel full as you will not overfeed your baby.

Latching on

Latching on is when your baby attaches to the breast in order to feed. It is harder than it looks and can take time to learn how to do. These steps can help:

• Hold your baby so that their nose is level with the nipple
• To help your baby open their mouth, let their head tip back a little
• When your baby opens its mouth wide enough, first their chin should touch your breast, with their head tipped back in order to allow their tongue to reach as much area as possible
• Your baby’s nose should be clear. Once your baby is attached, you should be able to see much more of the nipple above your baby’s upper lip than beneath their bottom lip

Positioning

There are many different positions that work best for different people. Make sure you are comfortable and use pillows or cushions if you need to. Your baby’s head and body should be in a straight line and you should be holding them close to you facing your breast. To allow their head to tilt back, support their shoulders, neck and back. Avoid holding their head. Allow your baby to latch on themselves. 

Before starting to feed your baby, attending antenatal classes can teach you the technique. You can also find out about breastfeeding from your midwife. 

Breast pain during breastfeeding

There are many reasons why you could have breast pain while breastfeeding. It is normal to feel a bit of discomfort especially at the very beginning of feeding, however this should ease and breastfeeding should not be painful. Always talk to someone such as your midwife if you are having any problems as you may just need to adjust your technique or take some simple measures to stop the pain. Despite the fact that breastfeeding should not hurt, 30% of women do experience pain after 2 weeks of birth during breastfeeding.⁴ This often causes women to stop breastfeeding. 

Common causes of breast pain and how to manage them

Breast engorgement

This is when your breasts have become too full, causing them to feel tight, hard and painful. This can happen when your milk first comes in. It can take a few days for your body to adjust and make the right amount of milk to match your baby’s needs. Engorgement can also happen if your baby hasn’t been fed for a while.

If you are suffering with breast engorgement, you can try to express some milk by hand, however only express just enough to ease the pain because your body will just produce more if there is too little. It may also help to wear a breastfeeding bra that fits well and is not restrictive. You can use warm flannels on the breast before expression by hand. Over the counter painkillers such as paracetamol and ibuprofen can also ease the pain and are fine to take whilst breastfeeding.

Too much milk

Sometimes, too much milk is being made which can cause pain. Talk to your midwife or health visitor so they can figure out why that is happening and to give you ways to decrease the amount of milk being produced.

Blocked breast milk ducts 

Within the breast, there are narrow tubes which are called ducts. These carry the milk from the glands within the breast which produce the milk, towards your nipple. The glands which make milk are split up into segments. If some of the glands are not being drained adequately this can cause the duct to become blocked. If this happens, you might feel a tender and small lump within the breast.

To help this you should try to wear loose clothes and well fitting bras to make sure milk can flow easily from all areas of the breast. Trying to feed from the affected breast as much as possible can also unblock the duct. Using warm compresses or taking a warm bath can encourage milk to flow. You can also try massaging the lump in the direction of your nipple during breastfeeding. 

It is important to not ignore a blocked duct, as it can possibly lead to more problems, such as mastitis. 

Mastitis

Mastitis is common and usually gets better with some measures you can take yourself. It can happen when a duct becomes blocked or if the breast is engorged, which leads to inflammation.

The symptoms of mastitis usually arise quickly, and normally only one breast is affected. There may be an area of the breast that is swollen, hot, painful and red. Redness may be hard to see if you have darker skin. There may be a firm lump shaped like a wedge in your breast. You may be experiencing a burning pain in the breast or have nipple discharge. This may be white or have streaks of blood. You might also have some flu-like symptoms e.g. muscle aches, feeling hot and having a high temperature, chills or fatigue. 

It is important to continue feeding your baby from the affected side. It will not harm your baby. Breastfeeding can reduce inflammation. Make sure your baby is positioned properly. Use a warm flannel or take a hot shower to try and improve the flow of milk. Using a cold compress might ease inflammation and pain. Make sure you rest and stay hydrated. You can use over the counter painkillers such as paracetamol or ibuprofen to help pain or fever. You can also try stroking from the top of the breast down towards your nipple gently. 

Breast abscess

If mastitis does not resolve, it may lead to a breast abscess, which is a build up of pus caused by infection. This is why it is important to try and relieve mastitis and seek medical attention if it doesn’t improve. Your GP may refer you for an ultrasound scan of the breast and prescribe antibiotics. You may also need further treatment of the abscess which involves removing the pus. 

Thrush

Sometimes, women can develop a candida, or thrush, in their breast which is caused by a fungus. This may happen if the nipple is damaged or cracked, which allows the candida (which is naturally present in our body) to enter the skin and develop. Thrush may develop after a course of antibiotics, because antibiotics decrease the amount of helpful bacteria in the body which protect against thrush. Other things such as exhaustion, stress, or diabetes may allow candida to overgrow in the body. 

Often the pain is new and occurs in both breasts or nipples and can range from mild to severe pain. It usually lasts up to one hour after a feed. Nipples may feel itchy or sensitive, and the skin may be flakey, red, or have some white patches. 

Thrush can also develop in the baby’s mouth. They may have white creamy areas in their mouth which don’t come off when wiped. The baby may have candida nappy rash. 

You can carry on breastfeeding as thrush in babies is easily treated. You need to visit your GP to have treatment for your thrush as it can easily spread. It is usually treated with a cream which is applied around your nipples after feeds. You need to maintain good hand hygiene, and wash anything that has been touched at a high temperature e.g. bras, towels, dummies or toys. Do not freeze and save your milk whilst you have thrush, as this may cause it to return later on. 

Other causes of breast pain

1. Bacterial infection
2. Shallow latch
3. Eczema or psoriasis
4. Vasospasm
5. Muscle strain

Prevention of breast pain

• Get help early on- contact your midwife or health visitor as soon as possible if you experience pain. You may just need to adjust your feeding technique or positioning to help attachment
• Attending antenatal classes so you can be prepared when your baby arrives
• Wear well fitting cotton bras

When to seek medical advice

If you think you have mastitis and it doesn’t get better after 12-24 hours, contact your GP or call 111. If you have been prescribed antibiotics and your symptoms are not getting better 48 hours after starting antibiotics seek medical attention.

Your GP may decide to prescribe antibiotics if they think an infection is present. 

See your GP if you have symptoms of thrush. 

If you have symptoms of engorgement or a blocked duct which doesn’t improve with home measures, speak to your midwife, health visitor, or GP. You may need to just make some adjustments to your breastfeeding technique, but you may also require further treatment. 

Support and resources for breastfeeding mothers

• If you are struggling, experiencing any pain or discomfort, or you feel like you need some support, the best thing to do is contact your midwife or health visitor as soon as possible. You can find their details in your baby’s red book
• Start4Life Breastfeeding Friend - available 24/7 to talk to and ask questions to on Amazon Alexa, Google Home and Facebook Messenger 
• Local baby drop-in clinic 
• National Breastfeeding Helpline- 0300 100 0212

Summary 

According to evidence, breastfeeding is extremely important for your baby’s health, and has a multitude of benefits for both the childbearing parent and baby. Breastfeeding can be very difficult to get the hang of and can come with challenges, including breast pain. The causes of breastfeeding-related breast pain include: engorgement, blocked milk ducts, mastitis and thrush. Breastfeeding can be a very positive and fulfilling experience, and should not be painful. It is essential to speak to someone such as your midwife early on so that you can be given practical tips on latching, positioning and how to help other issues.