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Info Centre - Breastfeeding and your nipples
Nipples come in all shapes and sizes; most stick out, but flat or inverted nipples are also common. Surrounding your nipple is darker skin called the areola. Your nipples may also have a number of small bumps called tubercules; these produce an oily substance to protect your nipple.
Once you are pregnant, the hormone progesterone may make your areola swell, your nipples may become sensitive and your breasts may tingle or feel tender as your milk-producing cells and ducts start to grow. This is your body preparing your breasts to feed your baby. Giving your baby breastmilk means that he or she has less chance of becoming ill.
Breasts contain lobes, which look a bit like bunches of grapes; these are where milk is made and stored. Each lobe consists of a cluster of little cells that produce milk; the milk then flows along ducts to tiny openings in the nipple. Women have a number of these ducts, so the milk will come out of several tiny holes, rather like water from a watering can. The rest of the breast is made up of tissue and fat. The size of your breasts depends on the amount of fat, which mainly depends on your genes, and has no function as far as breastfeeding is concerned.
During pregnancy your body has high levels of the hormone oestrogen and this tends to prevent milk production, unless you are already breastfeeding another baby. Colostrum, the very early milk that is so good for your baby, also starts to be produced. Some women find their nipples leak, or get crusty, as the colostrum dries. As birth approaches, your nipples and areola may become darker and more obvious.
You may be faced with an array of creams, sprays and lotions, all of which suggest that breastfeeding will hurt and you’ll need medication to keep going. In fact, breastfeeding shouldn’t hurt, and you don’t need to buy any special creams or lotions.
Good attachment
The most important thing to prevent sore nipples is for your baby to take a large mouthful of your breast so that your nipple is at the back of your baby’s mouth. Your baby’s body needs to face yours so that she doesn’t have to turn her head to reach the breast.
Can I breastfeed with flat or inverted nipples?
Yes, these are quite normal and your baby will often draw them out when she feeds. Getting your baby in the right position is the most important thing, and you may need to use your nipple stem as a mental guide when bringing your baby to your breast. (Your nipple stem is the harder core felt if you squeeze your areola gently between your fingers.) Your baby’s mouth needs to be wide open so that the nipple is in the top part of your baby’s mouth. Then her tongue can lie underneath a long stretch of your breast.
Should I limit my baby’s time at the breast, to avoid getting sore nipples like my sister? We are both very fair-skinned.
Limiting time at the breast is rarely helpful as it means your baby may not get all the milk she needs. Also, it could reduce your milk supply if your body doesn’t receive enough stimulation to produce the right amount of milk. If your baby is well attached, she can feed for as long as you both want without you getting sore. It’s a myth that fair-skinned women are more likely to get sore.
Sore nipples – reasons
It’s miserable if you have sore nipples, but remember that breastfeeding has many benefits for you and your baby. Once you have tackled the cause of the problem, your nipples will heal very quickly. Most sore nipples can be helped by changing how your baby is attached to your breast, so talk to a breastfeeding counsellor (a woman who has breastfed a baby and received specialist training in giving women support and information on baby feeding). Your midwife, health visitor or other specialist may also be able to help.
Many women have sensitive nipple skin for a while after the birth, and breastfeeding can feel slightly uncomfortable, especially as you are not used to the strong sensation of your baby’s feeding action. Try to relax with slow deep breathing at the beginning of the feed, and try to help your baby latch on when she is just waking up, before she starts to cry. When your baby starts to feed, wait for a short time, and if you feel uncomfortable, take her off by putting your little finger into the corner of her mouth to break the suction and start again. If pain continues, or if your nipples are damaged or distorted in any way, then your baby is probably not in the best position, so talk to your midwife or a breastfeeding specialist.
Another, less common, cause of sore nipples is thrush. This is possible if you are prone to thrush, or if you or your baby have recently taken antibiotics. Thrush causes nipple pain, and sometimes deep breast pain; your nipple skin may look shiny and lighter than usual, and your baby may have white flecks in her mouth. Both you and your baby will need medical treatment for thrush.
Treatment
If your nipples become damaged or cracked, then they will be very painful, although they will heal quickly. Keep asking for help until you find someone who can show you a more comfortable position in which to hold your baby. A very small change in the angle of approach can make all the difference. Try to keep feeding your baby if you can, as your body needs to receive the right messages in order to maintain your milk supply. If you stop breastfeeding now, it may be difficult to restart once your nipples have healed. If the pain is worse on one side, then a temporary option might be to start a feed on the other side. You can then swap breasts once your baby is feeding less hungrily.
It may be suggested that you use a nipple shield to prevent further damage and to protect your nipple, although suction through the nipple shield can open the cracks. If feeding does not feel possible without a shield, then this may be one option. The main problems are that using them may reduce your milk supply, as your body would be receiving fewer messages to produce enough milk, and they may alter your baby’s sucking action. Many women find it hard to get rid of nipple shields afterwards – their babies seem to prefer the super-stimulation of this artificial nipple. (Your supply will also reduce if you start formula feeds.)
Cracked nipples are rather like chapped lips. Although there is little research to show what helps healing, some women find it is helpful to gently spread some expressed breastmilk over their nipples at the end of a feed. Alternatively, you could use some highly purified lanolin ointment on your nipples until they heal. This prevents scabs forming and keeps the nipple skin moist. Women also find it soothing. Pat your breasts dry before applying it. You don’t need to remove it before the next feed.
Sore breasts – other reasons
When your baby is feeding, your breasts ‘let down’ milk. A few women find this sensation painful. You may also feel your womb contracting. It should pass quickly; try to relax through it.
Blocked ducts will feel like tender areas or even lumps that won’t go away. An engorged breast feels very full, hot and uncomfortable. Mastitis is an inflammation and will make your breasts feel very tender. Try to rest and keep feeding your baby, as stopping breastfeeding will make the problem worse. Usually mastitis results from blocked ducts, attachment that is not quite right, untreated engorgement or delayed feeds. Often your GP may prescribe an anti-inflammatory drug. If you can correct the problem, the mastitis will ease, and you will not need medication. In a few cases, mastitis results from an infection so needs antibiotics. There’s a chance it can lead to an abscess. Antibiotics, though, may upset your baby’s tummy, and make you both more likely to get thrush. If you can identify why you got mastitis, you can prevent it happening in the future, so talk it through with a breastfeeding counsellor.
Problems, problems…
Remember that most women encounter few, if any, difficulties. Keep your morale and energy levels up by eating when you are hungry and drinking when you are thirsty. You don’t need to eat or drink anything special, or eat or drink any more than you feel you want to. Frequent, effective feeds are what drive your milk supply.
If you require further copies of this information sheet, or others in the series, you can obtain them from NCT Shop.
Further Support
The NCT holds a special experience register to enable mothers to talk to other mothers who have had similar experiences. Contact the enquiry line on 0300 330 0770 or email enquiries@nct.org.uk
Further Information
The NCT Breastfeeding Line (8am-10pm) 0300 330 0771. Breastfeeding counselors are volunteers working from their own homes. Breastfeeding Network Supporter Line (BfN) 0870 900 8787 (9.30am-9.30pm) (BfN also has leaflets on thrush and mastitis. www.breastfeedingnetwork.org.uk) La Leche League 0845 120 2918
If you would like further copies of this information sheet (Code 1708), or other sheets in the series, they can be obtained from NCT Shop at www.nctshop.co.uk or on 0845 8100 100.
Page lasted updated 2009.
