Nipple Pain and Trauma Treatment Plan
A. Direct breastfeeding: How you position yourself and baby before you start the latch is of highest importance. To see a video of “Magic Latch”, go to nursingnook.com. Click on Breastfeeding Help Videos, then click on Magic Latch for easy to follow suggestions. Start each feeding on the less painful side first due to newborn's more aggressive suck to obtain initial let-down of milk. Make yourself comfortable first and bring the baby to you, rather than taking your baby to the breast. Remember to “think drink” when bringing baby to breast – how would your body be positioned if you were the one drinking? Hold your baby across your body with one arm supporting the baby and the other arm supporting your breast. Each of the baby's hands should be around the breast (like holding a drink) and nipple should be lined up with nose instead of the mouth with his head free to rock back (like during drinking). With your wrist pressing gently into baby's shoulder blades, close the space between your bodies and let his chin touch the breast so he can orient himself to where he is supposed to “drink”. Refer to Magic Latch and Burping for more information.
B. Use a nipple shield: If the “Magic Latch” position adjustment does not relieve your pain, nursing with a Medela brand nipple shield over your nipple may help. Work with your IBCLC. You may have to experiment with which size shield works best and you must pump after nursing with a shield to make sure breasts are drained. Drained breasts tell the body to keep making milk and this also helps prevent infection. Refer to Nipple Shield Use for more information.
C. Pumping milk from your breasts: If nursing is too painful, breast drainage with a hospital grade rental breast pump (HGP) is the best choice for effective and comfortable milk removal (see nursingnook.com). Draining your breasts 8-12 times every 24 hours in the first 2 weeks is essential for establishment and maintenance of milk supply as well as to reduce risk of severe breast engorgement and/or mastitis. Manual expression of milk or expression with a small motor pump (i.e. Medela Pump in Style provided by insurance) may be utilized for a short time in the event of inability to obtain a HGP, but you will need frequent follow up with your IBCLC. Transition back to breast ASAP. If pumping is uncomfortable, check for proper breast shield fit. See Right Pump for You, Pumping Tips, Plan P.S., and Getting Back to the Breast.
D. Daily washing of nipples will help limit bacteria on skin and prevent infection. Gently wash nipples with soap and water once daily in the shower.
E. Pain relieving medicine as prescribed by your OB. The anti-inflammatory pain relieving medicine, Ibuprofen (brand names Motrin, Advil), is preferred during breastfeeding (reference ABM protocol #15) due to it's safety rating (very little if any crosses into breast milk) and it's ability to reduce inflammation and relieve pain.
F. Application of expressed breast milk, which has anti-microbial properties is helpful. Other topical agents applied either prior to pumping and/or following nursing can also promote wound healing. Check with your health care provider as needed and check your personal allergies before using.
Probiotic capsules to help prevent nipple and breast yeast infection, particularly if you were exposed to IV antibiotics during labor or following your C-section. Culturelle brand capsules are the most widely recommended probiotic and can be found without a prescription at any pharmacy and most grocery stores. Mom takes 1 capsule twice daily x 2 weeks minimum. Baby takes one “finger roll” daily x 1 week. For baby's “finger roll”, you open one of the capsules, wet your finger and roll your finger in the powder. Allow baby to suck the powder off your finger. You don't have to give the whole capsule, just a heavy finger roll.
Call your OB with any symptoms of infection or persistent pain. Also contact your IBCLC.
Copyright © 2017 Gloria Dudney, RN, IBCLC, RLC