After the first few days of nursing my little neonate Willow, my nipples looked like raw hamburger. They cracked, they bled, they oozed, they throbbed. Squashed between her hard palate and tongue, my nipples were pulverized.
No thanks to the hospital’s lactation professionals, Willow and I persevered and saved our breastfeeding relationship with plenty of skin to skin snuggles and latch readjustments.
Healthy Children faculty and Department Chair of the Maternal Child Health Lactation Consulting and Health and Wellness Programs at Union Institute and University Anna Blair, PhD, IBCLC, CLC has conducted extensive research on sore nipples and positioning and latch.
“Women have come to expect nipple pain and it’s normalized,” she says. “That’s really a problem. It should be a sign that mom needs help.”
A nursing mother should not feel any sensation more painful than a gentle tug while her baby is at the breast. If she reports any pain on a gradient scale, something is up.
Sore nipples are far too common in nursing mothers and far too often lead to early weaning. Because sore nipples generally mean baby is latched improperly, milk production can suffer. And if baby isn’t effectively removing milk from the breast, mother may develop mastitis or other infections from her injured, vulnerable nipples.
Without receiving skilled help, “so many moms are weaning right from the start even if they don’t mean to be,” Blair says about mothers limiting feedings to allow her nipples to heal or simply to avoid the pain.
Avoiding nipple pain with skin to skin
Immediately after birth is the optimal time for mom and baby to establish a comfortable, effective latch.
“What we really like to see is baby go through all nine stages of skin to skin,” Blair says. “It’s something very simple that we can do.”
While skin to skin contact between mother and baby immediately after birth is an effective way to avoid maternal nipple pain, sometimes logistics like weighing and identifying baby inhibit infants from going through all nine stages.
“Some of our technology has gotten in the way,” Blair says.
Health care professionals often have a difficult time taking the hands off approach and allowing baby ample time to self attach to the breast.
“Use words, not hands,” Blair advises health care professionals.
Fixing the latch fixes the nipple
There are less common causes of nipple pain like Raynaud’s phenomenon of the nipple or infant tongue-tie for example. But when nipple pain is a result of positioning and attachment itself, it can be easily remedied through latch assessment and correction.
Properly trained lactation professionals become invaluable resources to mothers experiencing nipple pain. (See this study about the importance of support for the breastfeeding mother: http://www.ncbi.nlm.nih.gov/pubmed/17253455)
Lactation professionals across the nation find the Latch Assessment Tool (LAT), developed by Healthy Children Project faculty and colleagues, to be useful in helping mothers find a comfortable latch.
The LAT provides a step by step approach to assessing things like pre feeding behaviors, latch and mother’s comfort. The LAT is a duplicate form, which allows both parties to retain a copy.
“It is very important that care provider and mother get a copy,” Blair explains. “[Mom] needs something to help her remember what happened during the consult.”
No need for nipple creams
Blair and her colleagues conducted a study to assess pain reduction and treatment of sore nipples in nursing mothers in Latvia about a decade ago.
To compare healing, change in nipple pain, and mothers’ satisfaction with treatment for sore nipples, the researchers combined participants into three groups:
Nursing moms given breast shells and lanolin cream
Nursing moms using glycerin gel therapy
Nursing moms given no gadget
Latch assessment, education and corrective interventions were provided in all three groups.
“What we found was there really wasn’t a difference between any of the groups,” Blair says in terms of healing and reduction of pain. “So why on earth are we using all of these gadgets? Why do we have all of these extra devices when what we need to do is focus on fixing latch?”
Blair agrees that there may be roles for different devices. But if we think these items will heal the damaged nipple faster, research doesn’t support this theory.
Further, Blair’s and colleagues’ sore nipple research shows that pre-feeding behaviors, like rapid eye movement, rooting and gaping, are just as important as positioning and latch.
“When you walk into a consult and baby is already at the breast, you have missed half of what you’re looking for,” Blair says of applying research concepts to practice.
Educated lactation professionals boost breastfeeding success
Healthy Children faculty work diligently to train health care professionals and future lactation care workers through a variety of extraordinary courses.
Combining evidence based practice, counseling, global issues and practical and technical skills allows The Lactation Counselor Training Course participants to leave the program looking a breastfeeding in a different light.
“[It] can be really transformative for participants,” Blair says.
Likewise, Union Institute & University’s health degree programs offer students evidence-based skills coupled with a transformative experience.
“Students have a different outlook than when they enter the program,” Blair says. “I learn so much from all of our students.”
She reports being most impressed with their resilience; they manage significant life events and still do incredible work.
The success of our lactation professionals is so intimately related to the success of our breastfeeding mothers.
“Make a commitment to being evidence based and stay up to date through your work and lifetime,” Blair advises lactation care workers. “Curiosity is one of the finest gifts that we can have as humans.”
A gradual shift in our nation’s perspective on breastfeeding has allowed for a deeper appreciation of the importance of offering breastfeeding mothers support.
“People really know now how important breastfeeding is,” Blair says. We have so much good evidence to support breastfeeding and the benefits of breastfeeding.”
Blair experienced this first hand while flying home from Hawaii when her oldest son Warren, now 10, was a baby: A flight attendant approached her and said in a somewhat snarky tone, “Were you breastfeeding on this flight?”
“Are you kidding me?!” Blair thought but calmly replied “yes”.
“I could tell,” the flight attendant responded. “Your baby was so great! Breastfeeding is the best thing you can do for him.”
Years ago, lactation professionals had the task of convincing people that breastfeeding is great, Blair continues.
“Now I feel like because of the great evidence and good breastfeeding promotion, we are starting our conversations in a different place.”
And on a government level, Blair says she’s more optimistic than she was a decade ago thanks to continued breastfeeding interest from the Surgeon General and programs like Michelle Obama’s Let’s Move campaign.
“As a nation, we have so many people who are passionate about breastfeeding and improving birth practices and caring for mothers and babies in an ethical way,” Blair expresses her optimism. “We’re going to continue to see improvements.”
In other words, pulverized, hamburger nipples don’t have to be a reality for nursing mothers. Instead, through appropriate, evidence-based training of health care workers, mothers’ nipples will be saved two by two. Viva la nipples!