Breastfeeding FAQs: Pain and Discomfort

Whether you're a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

Is it normal to have cramps while nursing?

Yes. During the first few days to weeks after delivery, you may feel strong, menstrual-like cramps in your uterus when your milk lets down. This is your uterus shrinking back to a smaller size.

Is it normal to feel pain during or after nursing?

If your baby is latched on properly, you may have 30 to 60 seconds of pain (from the nipple and areola being pulled into your baby's mouth), then the pain should ease. But if you continue to feel pain, stop feeding momentarily and reposition your baby on your breast. If the pain persists, something else might be going on.

If your baby consistently latches on wrong, sucking on your nipple without getting much of your areola in the mouth, you'll probably feel discomfort throughout each feeding. Some moms say it's painful or feels like a pinch as their babies nurse. And you'll probably have sore, cracked nipples in no time. Consulting with your doctor or lactation consultant can help with these situations.

What else can cause breast pain?

If your breasts are sore and you have flu-like symptoms, fever, chills, a hard or red area of the breast, or red streaks on your breast, you may have an infection in your milk ducts called mastitis. If you have any of these symptoms, call your doctor. If he or she finds that you have mastitis, the infection can be easily treated with antibiotics.

You may also have a yeast (or thrush) infection of your breast. It's important that you call your doctor if you have any of these symptoms:

• shooting or burning breast pain either during or after feedings
• pain deep within your breast
• strong pain in the breasts or nipples that doesn't get better after properly latching on and positioning your baby
• nipples that are cracked, itchy, burning, or are pink, red, shiny, flaky, or have a rash with little blisters

Babies with oral thrush may have cracked skin in the corners of the mouth, and whitish or yellowish patches on the lips, tongue, or inside the cheeks.

Sore breasts with a lump also may be a sign of a plugged milk duct, in which a particular duct gets clogged. To help unclog the duct and ease your pain:

• Take warm showers or use warm compresses on the area, massaging the area, several times a day. Then, breastfeed your baby immediately.
• When breastfeeding, position the baby so the nose is pointed toward the clogged area.
• If that doesn't work, try using a manual (hand) or electric pump for a few minutes to help draw out the clogged milk.
• If the lump doesn't go away within a couple of days, or if you have any fever, chills, aches, or red streaking, call the doctor.

Women who have inverted nipples (that turn inward rather than protrude out) or flat nipples (that don't become erect as they should when your baby is nursing) also may have trouble breastfeeding and may have frequent nipple pain. If either is the case, talk to your doctor or a lactation consultant about ways to make nursing easier and reduce any pain.

Can I still breastfeed if I have a breast infection?

Yes. Contrary to what many people think, you can continue to nurse your baby while treating your breast infection. In fact, continuing to breastfeed can help clear up the infection.

How can I ease my breast or nipple pain?

When dealing with sore breasts or nipples, here are some pointers for avoiding pain in the future as well as making yourself more comfortable while your breasts heal:

• Make sure your baby latches onto your breasts correctly every time.
• Ask your doctor or lactation consultant to recommend a cream to put on your nipples in between feedings to help sore nipples heal.
• At the end of a feeding, massage some breast milk on your nipples, and then allow them to air dry.
• Consider wearing breast shields in between feedings (not to be confused with nipple shields, which are used during breastfeeding) to protect sore nipples. Breast shields are dome-shaped covers that prevent nipples from rubbing against clothing and help them heal faster.
• Ask your health care provider if a nipple shield is a good idea to use while nursing. These shields are placed over the areola and nipple during a feeding to protect sore or cracked nipples. Nipple shields may interfere with a mother's milk supply, so it's important to only use them under the supervision of a doctor or lactation consultant.
• Some women find it helpful to nurse more often but for shorter periods of time, rather than nurse for extended periods.
• Try to nurse first on the side that's less sore.
• Gently break suction when removing your baby from your breast. (Slip your finger in the side of your baby's mouth, between the gums, and then turn your finger a quarter turn to break the suction.)
• Vary breastfeeding positions to help drain all areas of your breast.
• Use wet or dry heat on your breasts (a warm water bottle, heating pad, washcloth, or warm shower) right before feeding. (However, if you have a yeast infection in your breast, you'll need to keep your nipples dry because the yeast thrives on moisture.)
• Put ice packs or cool compresses on engorged breasts after feedings.
• Gently massage the sore area before nursing.
• Get plenty of rest and fluids.
• Some mothers with cracked or sore nipples find that pumping for 2 to 3 days allows their nipples to heal.

If you find that you're consistently unable to nurse your baby without pain, be sure to call your doctor or a lactation consultant.

Is it normal for my breasts to become engorged?

No. If the breasts are emptied frequently, engorgement (when the breasts become overfilled with milk) won't happen. Engorgement can lead to mastitis and should be avoided.

But the longer you wait to breastfeed or pump — both initially and throughout your time nursing — the more uncomfortable and engorged your breasts may become.

If you can't feed your baby right away, use warm compresses and try to pump or manually express your milk. One way you can express your milk is by holding onto your breast with your fingers underneath your breast and your thumb on top. Gently but firmly press your thumb and fingers back against the chest wall, then roll your thumb and fingers toward your areola over and over to help push the milk down the milk ducts.

Also, nursing often (approximately every 2 to 3 hours) and trying to empty your breasts can help with the initial discomfort and prevent engorgement.