For many mothers – particularly first time – breastfeeding can prove a challenge, not least in the way it affects your skin.
Some studies have shown that as many as 96% of women experience nipple pain when they commence breast feeding. It often begins because the child is not latching on properly to the nipple which can cause grazes and other damage. To minimise this type of injury, consult a maternal and child health nurse or other lactation specialist who will be able to educate and assist with good techniques and positioning for breastfeeding.
Nipple or breast soreness can also be due to preexisting skin conditions like atopic dermatitis and contact dermatitis. Many topical treatments have been trialed in an attempt to reduce the symptoms of nipple dermatitis, though none stands out as being significantly better than the others. These remedies have had varying effectiveness in nursing mothers:
- Expressed mother’s milk (EMM)
- Hydrogel dressing (has been linked to greater occurrence of breast infection)
- Tea bag compress
- Warm water compress
- Chlorhexidine spray
- Polyethylene film dressing
- Nipple protectors/breast shells – plastic caps with holes which shield the nipples and allow air to circulate
Women with a record of allergies or other dermatoses are more prone to nipple dermatitis. Common sources of allergic reaction include the fabric or rubber in nursing bras or lanolin used to alleviate sore nipples.
Plugged ducts and mastitis
When milk is not fully drained from the ducts within the breast they can become clogged, causing soreness and inflammation. On the surface, this often appears as a small, tender (sometimes red) lump or as a painful, uncomfortable spot deeper in the breast. Excess milk can build up behind the blocked duct and spill into the surrounding breast tissue, leading to inflammation known as mastitis, or milk fever. Mastitis has flu-like symptoms of fever, aches and chills. The breasts become increasingly painful, swollen and warm to the touch, the skin may appear red or streaked.
Some things you can do to help prevent and treat plugged ducts or mastitis:
- Ensure that lactation bras are fitted properly so that the ducts can clear, and loosen or remove your bra when breastfeeding
- Gently warm the affected breast with water (shower or bath), heat packs, hot water bottles or a damp face washer prior to feeding
- Regularly drain the breasts well by a) feeding frequently, beginning on the sore breast when the baby’s sucking is strongest, or b) hand expressing if the baby won’t feed or if breasts feel full between feeds
- Massage the breast down towards the nipple in the shower or whilst feeding to try to clear the obstruction
- Try a different feeding position
- Get plenty of rest
If you feel ill or feverish, or the blockage does not resolve within 12 hours, contact your doctor for treatment and to avoid further complications, such as breast abscesses.
Stagnant milk, due to blocked ducts, mastitis or infrequent feeding/expressing can lead to bacterial or fungal infections. If you suspect you may have mastitis you will need to consult your doctor who can determine the type of infectious agent and prescribe the appropriate antibiotic or antifungal.
Cold temperatures, caffeine and strong emotion can cause a condition called Raynaud’s phenomenon, in which blood vessels become restricted. In nursing mothers, it may cause the nipples to constrict and the small arteries to spasm. This may result in pain, which can last for several minutes, and/or a loss of colour until the flow of blood returns. Affected women should avoid the situations which trigger their symptoms and see a doctor to discuss what can be done. Treatment may include stopping medications which tighten blood vessels, wearing looser clothing, keeping the nipples warm or taking medication to relax the spasming arteries.
The Australian breastfeeding Association offers a Helpline, online forum, breastfeeding classes and written information, all available on their website at http://www.breastfeeding.asn.au/index.html.
American Academy of Dermatology, n.d, ‘Safe Skin Care During Pregnancy and Breastfeeding’, retrieved 16 March 2011, <http://www.aad.org/media/background/factsheets/fact_pregnancy.html>.
Australian Breastfeeding Association, 2010, ‘Mastitis’, retrieved 16 March 2011, <http://www.breastfeeding.asn.au/bfinfo/mastitis.html>.
Lochner, JE, Livingston, CJ & Judkins, DZ 2009, ‘Clinical inquiries: Which interventions are best for alleviating nipple pain in nursing mothers?’, The Journal of Family Practice, 58(11):612a-612c.