Pain and Breastfeeding: How to Avoid Pain

Although breastfeeding is often described as a natural and instinctive act, it can sometimes be accompanied by pain, especially at the beginning, while you and your baby are still finding your rhythm. How can you relieve nipple pain and pain inside the breasts? Which breastfeeding positions should you favor? When should you be concerned about pain during breastfeeding? Pain and breastfeeding: let’s take a closer look.

Pain and breastfeeding: the importance of a good breastfeeding position

Newborns are born with all the psychomotor and neurobehavioral reflexes needed to suck effectively. However, the intergenerational transmission of breastfeeding culture has largely faded over time. Today, many young mothers have rarely seen another woman breastfeed before experiencing it themselves. They therefore have not had the opportunity to become familiar with the gestures, mechanisms, and techniques specific to breastfeeding.

According to research conducted in Denmark in 2009 by Professor H. Kronborg, improper positioning of the baby at the breast is involved in 61% of cases where mothers experience breastfeeding difficulties. There is not just one correct breastfeeding position, but a wide variety of possibilities depending on your needs. Breastfeeding can be done sitting, lying down, standing… The most important thing is that you and your baby are comfortably positioned. Here are a few examples of breastfeeding positions:

• Biological Nurturing (BN): also called the physiological position, it consists of reclining in a semi-leaning position with your back slightly tilted backward, with your baby resting against you, tummy to tummy. This posture encourages the expression of your newborn’s innate reflexes thanks to the many sensory stimulations they perceive through contact with you.
• The cradle hold: this is the most common position. You are seated, ideally with support under your feet to flex your hips and relieve your lower back. Your baby rests on your forearm, their head near the crook of your elbow and their body turned toward you. A pillow can be placed under your forearm to adjust the height and align your baby with your nipple.
• The football hold: your baby is positioned at your side along your waist, with their legs pointing toward your back. They are supported by the forearm on the same side as the breast being used, always tummy to tummy. This breastfeeding position is particularly suitable if you have large breasts or after a cesarean section.
• The side-lying position: you lie on your side facing your baby, who is also lying down and turned toward you. Very practical for nighttime feeds, this position is also suitable for mothers who have had a cesarean section or who experience perineal pain when sitting.

A baby who frequently cries at the breast may sometimes signal poor latch or a sucking difficulty that should be identified quickly. Breastfeeding also places significant strain on your back, neck, shoulders, and wrists.

Poor posture can cause persistent muscle pain. Remember to support your arms with pillows, keep your shoulders relaxed, and bring your baby toward you rather than leaning toward them. Good to know: skin-to-skin contact immediately after birth helps initiate breastfeeding and helps your baby spontaneously find the breast.

Want to learn more? Feel free to download the May app, where you’ll find plenty of resources to support and guide you throughout your journey as a new parent.

Nipple pain during breastfeeding: pinching and cracks

The nipple is both a very sensitive area and one that is heavily used during breastfeeding. It is not uncommon for mothers to experience nipple pain while breastfeeding, especially during the first few days. When identified and treated quickly, this pain usually fades within a few days.

Pain and breastfeeding: pinching during feeds

At the beginning of breastfeeding, you and your baby need to find the right position(s) so that feeds are effective and comfortable. If your baby is not positioned correctly or has difficulty sucking, they may pinch your nipple and cause pain. Unintentionally, of course!

What to do if pinching occurs during feeds?

If your baby pinches your nipple during feeds, we encourage you to check the following points:

• Their head should not be tilted too far back or to the side, which could pull on the nipple. When at the breast, your baby’s ears, shoulders, and hips should be aligned. To help with this, place your hand behind their shoulder blades during feeds.
• They open their mouth wide to latch onto the nipple. To help with this, offer your breast above their upper lip or even under their nose and watch how they open their mouth wide. They will approach the breast chin first and guide your nipple toward their palate with their tongue. To make latching easier, you can gently compress your breast between your thumb and the rest of your hand (forming a C shape) or lightly press the base of your nipple.
• You are comfortably positioned. Your own position is also essential during feeds. You will spend a large portion of your time breastfeeding, so it is important that you are comfortable and free from muscle tension. Do not hesitate to use plenty of pillows and elevate your legs on a small footstool.

Pain and breastfeeding: cracked nipples

A crack is a small fissure on the nipple. Cracked nipples generally appear during the first weeks of breastfeeding. In most cases, they are caused by an improper position during feeds or a sucking problem.

What to do if you have cracked nipples?

The first step is to ensure that your baby’s position during feeds is correct and that they do not have difficulty latching (they open their mouth wide and do not pinch the breast). To care for your nipple, you can apply breast milk compresses or a healing cream suitable for breastfeeding. Some ointments are available at pharmacies. To prevent cracks from appearing, you can massage your nipple with a few drops of breast milk after each feed. Your milk will moisturize your nipple and help heal any micro-cracks, which will gradually disappear.

Pain inside the breasts during breastfeeding: engorgement, mastitis, blocked ducts, thrush

During breastfeeding, you may experience pain in your breasts that can have different causes. Here are the main possible causes of this pain and how to relieve it.

Pain and breastfeeding: engorgement

Breast engorgement most often occurs when milk comes in or when breastfeeding stops. The most typical symptoms of engorgement are:

• hard, swollen breasts,
• redness,
• a feeling of warmth,
• the formation of a hard lump in the breast,
• for some women, a mild fever may also occur.

As the name suggests, engorgement is caused by too much milk in your breasts. Because you produce more milk than your baby drinks, your breasts become overfilled. This is why engorgement is common at the beginning of breastfeeding (your baby drinks little) or at the end (your baby no longer feeds as often).

Beyond the pain, prolonged engorgement during breastfeeding can have consequences for both you and your baby. Because of the swelling (the hard lump inside the breast), your baby may have difficulty latching onto your nipple and therefore feeding, which worsens the situation. For you, untreated engorgement can become complicated and progress to mastitis, an inflammation of breast tissue that we describe below.

What to do in case of engorgement?

As you can see, engorgement is mainly an imbalance between your milk production and your baby’s “consumption.” The solution is therefore to drain the breast as much as possible. To correct this imbalance and avoid engorgement, start by ensuring your baby does not have difficulty feeding. If that is not enough, we encourage you to express your milk yourself (using a breast pump or manually). Be careful not to express too much milk, as this could stimulate lactation and have the opposite effect. If you suffer from engorgement, here are our tips to relieve the pain:

• Apply heat to your breasts: you can easily do this by placing a washcloth soaked in warm water on your chest. Heat helps relax the breast and facilitates drainage.
• Apply cold to your breasts: as with a sprain, cold helps reduce swelling. For example, you can wet a diaper with water and place it in the freezer. It is very effective and easy to have on hand.
• Place a cabbage leaf on your breasts between each feeding. The effectiveness of this traditional remedy has actually been scientifically demonstrated by an American study. Remember to wash the cabbage leaf well, crush it beforehand to release the juices, and replace it as soon as it wilts.

Pain and breastfeeding: mastitis

Mastitis is a localized inflammation of an area of the breast affecting the mammary gland. It is sometimes nicknamed “breast flu” because its symptoms are very similar to those of the flu: fever, body aches, extreme fatigue, and a general feeling of illness. The affected breast becomes warm, tender, painful, and shows redness usually located in one area and asymmetrical. In cases of mastitis, the taste of milk may change and become saltier. Your baby may temporarily refuse to feed from the affected breast.

What to do in case of mastitis?

As with engorgement, the priority is to ensure effective drainage of the affected breast. Frequent feeds should continue and the same measures used for engorgement can be applied, including cabbage leaves if they bring relief. However, avoid strong massages, intensive use of a breast pump, or vibrations (for example with an electric toothbrush), as these practices can increase inflammation.

Instead, use gentle and light massage. Paracetamol can be used to relieve pain and reduce fever. If you notice no improvement within 24 hours, it is important to consult a doctor quickly. Mastitis may require treatment with antibiotics and/or anti-inflammatory medication, most of which are compatible with breastfeeding.

Pain and breastfeeding: blocked milk ducts

Milk ducts, which carry milk to the nipple, can become blocked and cause pain inside your breast and nipple during breastfeeding. A blocked milk duct usually affects only one breast. It is characterized by the appearance of a hard, warm, painful lump near the blocked duct. In some cases, you may also notice a “milk blister” on the nipple. This is a small swelling of the skin containing milk. A blocked milk duct is usually caused by engorgement, inflammation, or excessive pressure on the duct (for example due to a bra or tight clothing).

What to do in case of blocked milk ducts?

Even though it may resolve naturally and quickly, it is recommended to treat it. This limits pain and prevents your baby from being bothered during feeds throughout breastfeeding. To do this, we recommend draining your breasts, placing them in a bowl of warm water, or gently massaging them under warm water with the back of an electric toothbrush. It may sound unusual, but the vibrations from the toothbrush can help unblock the duct.

Pain and breastfeeding: thrush (candidiasis)

Candidiasis is a skin infection caused by a fungus that develops mainly in warm and humid environments. It can affect different areas of the body: the nipples and breasts in breastfeeding mothers, but also the vagina, mouth, or a baby’s diaper area. It is often referred to as “thrush.” The nipple and areola may appear pink, shiny, and sometimes slightly flaky. In terms of sensations, the pain is often described as deep, present during and after feeds. It may be accompanied by burning or itching.

Some mothers describe very intense sensations similar to stabbing pain or crushed glass, making even clothing contact difficult to tolerate. To help guide the diagnosis toward possible candidiasis, you can try mixing either one tablespoon of white vinegar or one teaspoon of baking soda in a glass of lukewarm water. Soak a compress in this solution and apply it to your breast. If a feeling of relief appears, this may suggest the presence of candidiasis.

What to do in case of candidiasis?

At first, it is possible to try natural treatments to limit fungal growth. Baking soda, for example, helps modify the skin’s pH, which can slow its development. Coconut oil or grapefruit seed extract are also sometimes used for their antifungal properties. However, hygiene remains essential. It is recommended to:

• Change bras frequently.
• Use disposable nursing pads and replace them regularly.
• Wash nipple shields, bottle nipples, pacifiers, or any objects your baby puts in their mouth thoroughly and often.
• Because the fungus develops in warm, humid, poorly ventilated environments, it is recommended to expose your breasts to the air whenever possible.
• Avoid occlusive situations as much as possible (thick creams, nursing shells, compresses left in place for long periods).

If these measures do not improve the situation, it is best to consult your healthcare professional. An antifungal treatment may then be prescribed if necessary. Sometimes the baby also develops candidiasis.

It often appears as a persistent white coating on the tongue that does not disappear with gentle cleaning and may be associated with discomfort during feeds. Bright, unusual redness in the diaper area may also point to this diagnosis. In this case, an antifungal treatment suitable for the baby, usually in the form of syrup or oral gel, may be prescribed.

How to get support during breastfeeding to avoid pain?

Breastfeeding should be a pleasure for both you and your baby. To fully enjoy this special moment, you can seek help from breastfeeding professionals who can guide you from the first days through to weaning. IBCLC lactation consultants (International Board Certified Lactation Consultant) are breastfeeding experts trained to support you at every stage of breastfeeding. Their certification is renewed every five years, allowing them to stay up to date with the latest knowledge about breastfeeding.

Pain and breastfeeding: taking care of your mental health postpartum

Breastfeeding is often presented as a natural and instinctive act. However, the reality can be very different from what you imagined. When the experience does not match your expectations, you may feel disappointment or even deep guilt. Some women minimize their journey, blame themselves for their “failures,” or feel they did not “really” breastfeed.

Pain and breastfeeding: constant pressure

From pregnancy onward, the question of how to feed your baby brings many opinions and recommendations. Between medical advice, input from relatives, and social expectations, there are many pressures. Whether breastfeeding or bottle-feeding, every choice seems subject to others’ opinions. This external pressure is often combined with internal expectations: wanting to be a perfect mother, efficient at work, and flawless at home. Yet the postpartum period is a time of major physical and emotional change. Remember that perfection does not exist.

Pain and breastfeeding: matrescence

The birth of a child is also the birth of a mother. This profound transformation, called “matrescence,” refers to the physical and psychological changes linked to motherhood. It is a sensitive and sometimes destabilizing period that deserves gentleness and kindness toward yourself. There is no single right way to be a mother, nor an ideal breastfeeding duration. Your bond with your child does not depend solely on how they are fed.

Three weeks, three months, or a year: the duration that was yours was the one that fit your reality at the time. Instead of saying “I only breastfed for three weeks,” why not think “I breastfed for three weeks”? In summary, pain related to breastfeeding is common, especially at the beginning, but it should never be trivialized. Pinching, cracks, engorgement, blocked ducts, or candidiasis: in the vast majority of cases, these situations have simple and effective solutions when addressed quickly. Remember that breastfeeding is something both you and your baby learn. Adjusting a position, improving latch, draining engorgement, or consulting a professional in case of persistent pain can transform your experience. You do not have to face pain alone.

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Photo credits: YuriArcursPeopleimages | zamrznutitonovi | monkeybusiness

This text was translated from French by an artificial intelligence. The information, advice, and sources it contains comply with French standards and may therefore not apply to your situation. Make sure to complement this reading by visiting the May US/UK app and consulting the healthcare professionals who are supporting you.