There are lots of hormonal changes to your breast in pregnancy and whilst breastfeeding. Your breast and nipples will be doing lot of hard work to feed baby and so they may need a little TLC during this time.
If you develop pain and infection this can interfere with your breastfeeding relationship and cause health problems for you and baby. It’s important to learn about nipple care for breastfeeding to to prevent nipple or breast problems occurring.
Basic Breast Care
It’s a basic step, but hand washing is the easiest way we can prevent spreading infection we can easily pick up in our home or in public places. Think of all the things you touch throughout the day which can carry germs including surfaces, animals and numerous dirty diapers! Basic hand washing before each feed will help prevent you spreading the germs to your breasts which will then go into baby’s mouth.
You may have noticed small bumps on the dark park of your nipple, these are known as Montgomery’s glands. These glands secrete an oil which helps keep your breast clean, lubricated and bacteria free.
Washing – It’s important not to disrupt this natural process, it’s recommended you only use plain, clean water to wash your breasts every day. Soaps can cause dryness, cracking or even leave a residue which baby dislikes. If you prefer to use a body wash look out for soap free washes that are dermatologically recommended.
Drying – Try to air dry your nipples as often as possible. Vigorous rubbing dry with a towel can cause sensitivity. If you need to dry your breast quickly, a gently patting with an old cotton t-shirt is the best method.
Creams or Ointments – Its best to avoid using regular creams, oils or skin butters on your breasts as they can cause clogged nipples, or discourage baby from breastfeeding. After a feed rub some breast milk over your nipple and allow to air dry. The anti-bacterial properties will help keep your nipples healthy and bacteria free. See our advice below if your nipples are sore.
If your breasts leak during or between feeds you will probably want to wear nursing pads. The problem with breast pads is that it’s the perfect dark, moist environment soaked in lovely sugary breast milk that bacteria love, making it easy for infection to occur.
The best type of breast pads for your skin the washable type made from breathable fabric such as cotton or bamboo. If you prefer to use absorbent disposable breast pads its important you change these regularly as they hold in the moisture, making it easier for bacteria to grow.
Occasionally nipple problems can occur whilst breastfeeding, which can make it easy for you to become discouraged from breastfeeding. Let’s explore the most common nipple problems and steps you can take to resolve them.
It’s normal to feel slight breast tenderness within the first two weeks of breastfeeding. As your body adjust to the suckling and hormonal changes your breast will adjust to nursing and expressing. If the pain continue past two week there may be a few causes including:
- Poor positioning or attachment
- Baby Tongue Tie
- Skin problems (e.g. eczema, dermatitis)
- Poor use of breast pump
- Ill fitting Bra
- Nipple infection
- Treating Sore nipples
It’s not normal for breastfeeding to be painful or nipples to bleed or crack. The first step is to find the find the cause. It’s best to have a lactation consultant watch you feed baby so they can spot any issues. If you feel it’s a medical issue for you or baby you should consult with your doctor or pediatrician.
Comfort measures for Sore Nipples
Express milk – If it’s too sore to put baby back to the breast you may want to hand express some milk so baby can continue to receive breast milk while your nipples rest and heal.
Nipple Cream – A good nipple cream will work by allowing your nipples to heal without scabbing over. You can choose from a lanolin based cream or a herbal based cream. These can provide instant relief, but always choose a cream which you do not need to wash of before nursing as this can add to the problem. Check out our guide to choosing the best nipple cream.
Breast Shells – If your breast are so sore you can stand having any material rubbing try breast shells. These are plastic casings which cup around the nipples and provide a cupped area to hold your clothes off the nipple. Breast shells allow your breast plenty of air time to heal, although they do look weird under your clothing if you’re out in public. Check out our guide to buying breast shells.
Hydrogel Pads – These gel nipple pads are around the nipple between feeds to provide you with relief for pain between feeds. Some brands come with the option to heat or cool the pad for thermal relief depending on the cause of the pain.
Flat or inverted Nipples
Flat or inverted nipples are a shape of nipple that does not stick out when stimulated with touch or cold, or have a flat or ‘inward’ appearance when the areola is pinched.
It’s not impossible to breastfeed with flat or inverted nipples. The most important step is to consultant a lactation adviser who can show you the best way to position and attach your baby when your nipples are flat or inverted.
Techniques to draw out the nipple
Breast Shells – For some women breast shells may successfully help to apply slight pressure and protrude the nipple. It’s best to try this technique in the last trimester of pregnancy in preparation for your baby arriving. Some brands such as Medela have breast shells specifically designed for flat or inverted nipples.
Hoffman technique – This is a technique which you can try to loosen the nipple base, result between women are varied. The following technique should be performed should be performed around 5 times a day:
- Place a thumb on each side of the nipple base (at 9 and 3 o’clock)
- Press the thumbs firmly into the breast tissue
- Keep the thumb pulled in and pull the thumbs in an out ward motion
- Repeat steps 1-3 with the thumbs at a 12 and 6 o’clock positions
Nipple Everter – These are mini suction device which create a vacuum around the nipple to pull the nipple out. Nipple Everters are easy to use and inexpensive and often have great results for moms who have used them.
Breast Pump – If you already have a breast pump for baby or plan to use one these can be useful at drawing the nipple out before feeding baby. It best to use the pump for around 30 seconds to a minute before attaching baby as the suction can help to protrude the nipple and make it easier for baby to attach.
Nipple Shields – These should be uses as a last resort, if the above techniques do not work. A nipple shield is a plastic cover the baby suck on to help protrude the nipple during a feed. They are effective for moms, but babies can become attached to them and need weaned from use.
Thrush is a fungal infection which thrives is moist, warm sugary environments such as the breasts and babies mouths.
Symptoms for mom
- Intense and sudden onset of Nipples/breast pain (shooting sensation)
- Itching burning nipples
- Red, shiny, flaky or small rash like blister on the nipples
- Cracked nipples that won’t heal
- Vaginal thrush
Symptoms for baby
- White patches on tongues, cheeks or gums (may bleed or look red if wiped)
- Refusal to nurse
- Blister like diaper rash
- Gas or fussiness
If you suspect you and baby have thrush, you need to see a doctor for anti-fungal treatment. It is important you and baby are treated at the same time otherwise you will continue to pass the infection back and forth. If the thrush is frequently recurrent you may also have to get your partner and any other children treated.
Hand hygiene – particularly important after changing baby’s diaper as thrush will often be present there too.
Sterilization– If you are using a breast pump, all possible parts need cleaned and sterilized after each use, including bottles and teats. If pacifiers are used, these need regularly sterilized.
Breast Pads – It’s important to regularly change your breast pads as they provide perfect growing conditions for yeast. Try to avoid the plastic disposable type and use cloth disposable pads as they do not retain so much moisture.
Underwear – Switch to using underwear made from breathable fibers such as cotton. Wear a clean bra every day and launder as soon as possible to destroy the thrush.