Mothers are often surprised to find breastfeeding feels more awkward, complicated or painful than they were prepared for. Breastfeeding is a learned skill for mothers. Like with learning any new skill, it can take some time to get the hang of breastfeeding. Sometimes breastfeeding feels difficult because mothers have been given traditional advice to position their babies in a way that feels uncomfortable. Uncomfortable breastfeeding positions can cause your baby to squash the nipple as they feed. Squashed nipples can be painful, become damaged and may restrict the flow of milk. You may find that the positions that are comfortable for you and your baby are not how you imagined or have seen done, but there is no one ‘right’ way to breastfeed.
Human babies are mammals and have instincts and reflexes that help them breastfeed comfortably and efficiently. Babies sometimes become annoyed if we accidentally interfere with how they want to position themselves. If breastfeeding feels awkward or like you’re having a fight with your baby, it might be time to try letting your baby lead the way. Baby-led attachment allows your baby to position their chin, head and neck in a way that feels comfortable to them, so they can open their mouth widely and swallow easily.
Baby-led attachment may feel worrying if you already have sore nipples as your baby will bob across your breast, peck with their chin and use their hands to find the nipple to position themselves. However, even with very sore and damaged nipples, once a baby is attached deeply, you will most likely find that breastfeeding is suddenly much less painful. This video shows several babies self-attaching and some techniques that are mother-led but work with your baby’s instincts.
Going along to your local group meeting that has a breastfeeding counsellor in attendance is a great way to get support with positioning in person; sometimes that extra pair of eyes can make a big difference. Some simple first-aid treatment and a little time are usually all that is needed to solve the problem of nipple damage once positioning is comfortable for you and your baby. Once breastfeeding is working well for your baby they will become more efficient and feeds will get quicker and easier. Don’t worry that you will always have to use self-attachment or always breastfeed in a laid-back or side-lying position just because that’s what works to begin with. Over time you will find many positions that work for you both in all sorts of situations at home and when you are out and about.
What else causes sore nipples?
There can be a few causes of sore or cracked nipples besides poor attachment. Please contact one of our trained breastfeeding counsellors by phone or go along to a local group meeting. Members can also contact a breastfeeding counsellor via email. They can help you work out what the cause may be. Working out the cause is important, as this helps to find the right solution in your case.
In most cases, sore or cracked nipples are the result of incorrect positioning or attachment. However there are medical problems that cause sore nipples such as infection or dermatitis on your nipples, or anatomical problems such as tongue-tie in your baby, or damage from incorrect use of breast pumps.
Sometimes the crack in the nipple skin can be seen on the nipple itself or where the nipple joins the areola, or the crack can be very fine and hard to see. Breastfeeding with a cracked nipple is often painful and cracked nipples may bleed during breastfeeds.
Please note: Although bleeding looks scary and blood may sometimes show up in your baby’s bowel motions or vomit, it is not harmful to your baby. It is quite safe for you to keep breastfeeding.
Here are some suggestions to help whilst your nipples are healing:
- Offer a feed before your baby starts crying, when your baby is showing early feeding cues.
- Make yourself comfortable and relax as much as you can.
- Massage your breasts gently and apply warmth to help get your milk flowing.
- Express some milk to soften the areola to lubricate the nipple.
- Offer the less sore side first.
- Make sure baby is properly positioned at and attached to the breast. For help with this, please call our Breastfeeding Helpline.
- You don’t always have to detach the baby if breastfeeding is pinching, try pulling them in closer, lean back a little more and check they are positioned in a straight line.
- Try different feeding positions.
- You may need to take your baby off the sore breast for 12–24 hours to rest the nipple and allow healing to begin. In such a situation, you can express to maintain your supply, keep your breasts feeling comfortable and feed your baby your expressed breastmilk using a cup.
If you wish, restrict comfort sucking while nipples are tender. Gently break suction with clean finger inserted in the corner of baby’s mouth before removing baby from the breast.
- Check your nipples for signs of stress, such as red stripes or a squashed look.
- Express a few drops of milk and smear on the nipple.
- It is important you speak to your midwife, lactation consultant or medical adviser before applying anything else to your nipples to check if this is the right choice for you.
- If you usually use soap as a part of your personal hygiene routine, it is OK to include your breasts/nipples as a part of this once/day. If your nipples are damaged, doing this may help to prevent infection.
- Using anything on your nipples that is drying or may damage your nipple skin (eg alcohol based products, rough towels).
- Wearing poorly-fitted bras and plastic-backed nursing pads.
- Using breast pumps that have strong suction and hurt your nipples. You may find that hand expressing is more comfortable and just as efficient once you master the technique.
- Using a nipple shield. Seek face-to-face expert help before using a shield.
See your medical adviser if you need pain relief or you suspect a medical cause. Contact an Australian Breastfeeding Association counsellor, your child health nurse, midwife or lactation consultant for further help. Please see your medical adviser if healing is slow.
- Huml S 1999. Sore nipples. A new look at an old problem through the eyes of a dermatologist. The Practising Midwife 2(2): 28-31.
- Winter GD 1962. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature 193:293-294.
- Cable B, Stewart M, Davis J 1997. Nipple Wound Care: A New Approach to an Old Problem. Journal of Human Lactation 13(4): 313–318.
- Brodribb W (ed) 2019, Breastfeeding Management in Australia. 5th ed. Australian Breastfeeding Association, Victoria
- Walker M 2013. Are there any cures for sore nipples? Clinical Lactation 4(3), http://dx.doi.org/10.1891/2158-07126.96.36.199
The information on this website does not replace the advice of your health care provider.
Breastfeeding: breast and nipple care
Breastfeeding: Breast and Nipple Care tells you what to expect as your breasts change during pregnancy and briefly covers how breastfeeding works.
© Australian Breastfeeding Association April 2020