24/07/2023
Its National Pain Week and whilst the aim of the week is to offer support to those in chronic pain, it is important to highlight that pain can present in all sorts of situations, including breastfeeding, where we are told pain isn’t normal, but perhaps it is? According to a study by Lucas, “over 90% of women experience pain during breastfeeding initiation and lack strategies to self-manage breast and ni**le pain”.
Pain initiating breastfeeding is typically an issue with positioning and attachment – ideal attachment of a baby to a mother’s breast ‘should’ be painless if baby has a wide-open mouth and takes in a big mouthful of soft ar**la and ni**le, so that the ni**le is drawn to the junction of the hard and soft palate. With the tendency for mums and bubs to be discharged from hospitals early, there is a risk breastfeeding is not under control, or it starts well, then the milk comes in once home, breasts become very engorged and then trouble starts.
What is a good plan?
Prepare for breastfeeding though reading and/or a reputable course such as through the ABA.
Ensure for at least 60 minutes post birth, that there is uninterrupted skin to skin time between mother and baby – this is called the ‘golden hour’ baby being weighed and measured can wait. Baby has the ability crawl slowly from the mother’s stomach to chest over an hour and self-attach to the breast.
Ensure future breastfeeds are set up so that baby is position as close as possible to mum with face to ni**le oriented ‘just right’ so baby is not twisted attempting to attach.
If breasts become engorged, try reverse pressure softening (press ar**la backwards into breast for 2 mins) before attaching baby which will soften a hard ar**la.
If breasts become engorged, very gently massage each breast, stroking away from the ni**le towards the collarbone and armpit where veins and lymph vessels can take excess fluid away from the breast back into circulation
If ni**les are already traumatised or the above strategies are not working, seek skilled help ASAP such as with a Lactation Consultant. There is little to evidence creams and lotions on ni**les do anything and the addition of ni**le covers and shields are variable – sometimes are fantastic and sometimes make things worse. Successful positioning and attachment and frequent feeding in the early days post birth are essential for establishing a bountiful milk supply and to continue breastfeeding.
Lucas R, Zhang Y, Walsh SJ, Evans H, Young E, Starkweather A. Efficacy of a Breastfeeding Pain Self-Management Intervention: A Pilot Randomized Controlled Trial. Nurs Res. 2019 Mar/Apr;68(2):E1-E10. doi: 10.1097/NNR.0000000000000336. PMID: 30829925; PMCID: PMC6400324.
