Lauren Wong, an IBCLC (international board-certified lactation consultant) in the Peppy network, talks about how pain can be completely unexpected for breastfeeding mums, and what can be done to help

Breastfeeding can be an unexpectedly painful part of motherhood. Amid the soothing talk of early nourishment and bonding, the discomfort of cracked nipples and sore breasts can all too easily be forgotten.

Yet the agony of breastfeeding can be intense. In an American survey of new mothers, 5% described the experience as the “worst possible pain”. Online accounts from recovering women often include mention of excruciating levels of sensitivity and bleeding.

And that’s just the physical side. The pain of breastfeeding can also be a highly emotional burden in the weeks after birth. Feelings of grief, disappointment and guilt can build up to the extent that feeds are dreaded and feared.

According to lactation consultant Lauren Wong, pain is one of the most common reasons for women deciding to stop breastfeeding. She says: “Some mums experiencing pain may think that this is normal, and carry on without seeking support, but this can lead to worsening soreness and nipple damage”

In the UK, the majority of new mothers (over 80%) start out breastfeeding, but the proportion who continue for three or six months drops considerably.  Of course, breastfeeding is not necessarily for everyone, but as Lauren points out: “We know from research many of these mothers stopped breastfeeding before they felt ready to.”

“The issue lies not with them, but with a society and health care system sending very mixed messages. Families are regularly told they should breastfeed, but are sometimes provided with very little support when obstacles arise.”

Finding support

The pain of breastfeeding can come as a shock to many mothers, says Lauren, and they may not know where to look for help.

“Many new mums were not breastfed themselves, may not know anyone who has breastfed or even seen anyone breastfeed,” she says.

“We are now far removed from the days when at the first sign of trouble you would be quickly provided with support, practical help and reassurance from sisters, mothers, aunties, friends and grandmothers who may have experienced the same problems.”

She adds: “This gap is often partly filled by fantastic voluntary organisation such as La Leche League, the National Breastfeeding Helpline or the Association of Breastfeeding Mothers.

The first symptom of painful breastfeeding is usually pinching or compression of the nipple (often described as ‘lipstick’ shaping) at the end of a feed. This is a sign that the baby needs to be latched on more deeply, in order to compress further back behind the nipple.

After a while, this can lead to cracking or bleeding and sometimes deeper breast pain. It also increases the risk of developing mastitis (inflammation of the breast).

Small changes, big effects

When breastfeeding is painful, it can be very difficult emotionally. At a time when women are already feeling vulnerable and tired, they may feel low in mood and begin to dread the next feed.

But, Lauren explains, mothers shouldn’t have to feel torn between what is best for them and what is best for their baby.

She says: “The most important thing is receiving effective and early support to improve the situation and make feeding more comfortable, ideally before women get to the point of being extremely sore and fed up.

“This will usually mean simple changes to positioning or attachment, but can also involve treating other causes of breast pain (such as thrush) or checking for tongue tie.”

Lauren said a recent client had experienced extremely painful feeding was astonished by the relief that came after expert advice.

“She was crying her way through feeds, had significant nipple damage, and had been told by a well-meaning but misguided health care professional that her nipples simply needed time to toughen up.

“She was amazed at the difference that simple positioning techniques could make and we were able to turn painful, desperate tears into tears of joy. We talked about how to get baby to root, and wait for a wide open gape before bringing baby swiftly onto the breast.

“We looked at exaggerated latch techniques and used laid-back and under-arm positions to help her get comfortable and to stop baby from slipping off. This story is unfortunately all too common. “

It’s this kind of personal intervention that could help many more women struggling with the extreme difficulties painful breastfeeding can bring. It may come from a midwife or nurse with specialist training, or an international board certified lactation consultant (IBCLC) who specialises in the clinical management of breastfeeding.

Lauren stresses: “Women who find themselves in this situation, at such a special time in their lives, should not hesitate to seek the support that is available.

“At the first sign of trouble, look for somebody who has the knowledge and skills to help breastfeeding mothers.”

Lauren works as an IBCLC across Bedfordshire, Hertfordshire and Buckinghamshire and is also a registered nurse. You can see her Peppy profile here, and find out more about what it means to be an IBCLC here.