One breastfeeding topic about which I can claim to be an expert, is nipple trauma. If you ask me, nursing a baby with a damaged nipple is like trying to climb a mountain with a compound fracture. It hurts like hell and makes the journey a nightmare.
(Note: I am not actually an expert, and this is not meant to be diagnostic or prescriptive, but merely to share my experience in the hope that maybe it will help another mom.)
There are different types of nipple issues the breast feeding mom encounters: soreness due to poor or shallow latch, a wound due to a bite, vasospasms caused by a circulatory disorder called Renaud’s Syndrome, and the pain caused by thrush (a yeast infection of the nipple and/or milk ducts) to name a few.
I have had all of these issues, plus I burned off half my areola with a breast pump.
Flange Burns and Tongue Ties
My first born, Jack, had a tongue tie that was not diagnosed until a couple weeks after his birth. Due to the tightness of his latch, my nipples cracked and bled. Thinking that pumping would be less painful, I dispatched my mom to the baby store to buy me a premium breast pump. Desperate to get the milk out of my jugs and into my baby boy, I strapped on the pump and enthusiastically started pumping.
After 15 minutes of frantic pumping, there was not a drop of milk in the little bottle. I still remember my horrified gasp, then screech of pain as I removed the flange from my breast along with an inch of pink flesh.
In hysterics, I called the maternity hospital’s “warm line” and described my situation. “Oh, you gave yourself a flange burn,” said the nonchalant nurse on the other end of the line. What?! I thought. A flange burn? This is a thing?
As it turns out, yes, there is such thing as a flange burn. It happens from the friction of the pump on the areola. The lesson learned: use the correct size flanges, do not put the suction on your pump too high, and use plenty of lanolin before pumping. (I’m pretty sure that this story is the female equivalent to a guy hearing about another guy getting kicked in the nuts.)
The underlying issue that needed to be fixed in order for us to nurse effectively and painlessly was Jack’s tongue tie. A tongue tie is when a baby’s frenulum (the membrane under the tongue) is too tight. Jack was not able to get his tongue out past his lower lip, and could not latch onto my breast and suckle well.
This condition causes pain for the mom and frustration for the newborn, who may not be able to stimulate proper milk production due to the poor latch. Left untreated, tongue ties can also cause speech impediments. From what I understand, tongue ties are fairly common. My daughter Emily had one too. Emily’s tongue tie actually made her tongue appear heart shaped at the tip.
Thankfully, with both children, I was seen by kind and competent lactation consultants who diagnosed the tongue ties, and referred us to an ENT to release the frenulum. The frenulectomy (snipping of the tongue tie) sounded like a scary ordeal, but really was nothing more than a second of the doctor clipping the membrane under the tongue with a little pair of surgical scissors. In most cases there is barely any bleeding. The baby comes to the breast straight after. Although it sounds like a scary thing to put your child through, I can’t recommend it enough, if you plan to continue breast feeding.
Bites and Wounds and Infections, OH MY!
With Jack, my nipple issues were resolved within two weeks of his birth, especially after the tongue tie was released. I went on to nurse him until he self weaned at 23 months. With Emily, my nipple trauma was much more complicated. I had both bacterial and fungal infections that made my breasts burn and buzz with pain like they were stuffed full of broken glass and bees.
Correcting her tongue tie did not seem to help with the pain. Her latch looked picture perfect, and yet nursing continued to be excruciating. I took medication for the infections, and still, discomfort. Our LC suggested that her latch would loosen up as she grew, and that she needed time to get used to her released tongue. (This did prove to be the case, but not for some weeks.)
Around three weeks, Emily bit me. Even though she didn’t have teeth, she still tore open my already fragile nipple. Every time she nursed, her suction opened the wound. It bled.
The good news is that if your nip is bleeding, the blood will not harm your little one. The bad news is, blood can upset baby’s stomach and cause a scary-looking, bloody spit-up.
You might be thinking that when you get to the point of gaping nip wound and bloody-spit-up that breast feeding is just a little too cray-cray for you. I would be lying if I said that I didn’t think this as well, but the desire to feed my daughter from my own body, as I had when she was in the womb, was so great that, as the saying goes, I kept calm and latched on.
It was recommended that I use cool gel pads for my sore nipples. You can buy these at Target or the baby store. Initially, these seemed soothing. But then my breasts started burning so intensely that I couldn’t sleep through the pain. I thought I was going insane at this point, because the cold compress was supposed to be healing.
Through some research and consultation with my lactation consultant, I learned that I had a circulatory condition called Renaud’s Syndrome that causes the nipple to blanch and then turn purple as it fills back up with blood. I am not qualified to get into all the science behind this condition, but I am over-qualified to tell you that it hurts like a bitch.
Using warm compresses and covering up my nipple as soon as I finished nursing helped to relieve some of the burning associated with the Renaud’s. I also swear by the palliative and healing properties of extra virgin coconut oil. You can buy this solidified, white oil in your health food store. It liquifies as it warms up, and smooths onto your skin much more gracefully than lanolin, which I personally find gloppy. Coconut oil has both antifungal and antibacterial properties too, so if you are gunning for an infection, it might help to stave it off.
While I got these other issues sorted out, nothing helped with the gaping gash on the side of my right nipple. Every time I nursed it opened, and pumping made it even worse. (I blame my nip trauma on the difficulties that my body has had responding to a breast pump.) My left nipple looked like a perfect little pearl, but the right looked so damaged that I became nauseated every time I looked at it. I was taking fistfulls of ibuprofin to help with the pain, and started to worry that my stomach would resemble my nipple before too long.
I finally took an extreme measure, in collaboration with my lactation consultant. After reading about women who are able to nurse exclusively with one breast, I decided to let my right breast dry up and use only my left. I was concerned that I would need to supplement with either formula or donor milk, but for my sanity, it had to be done.
The first day was painful. I used ice packs and cabbage leaves to help with the engorgement. I was able to hand express enough milk to relieve some of the pressure. And finally, I used a bowl of warm water that I leaned my breast into, which also helped to release enough milk to make me comfortable.
Happily, Emily seemed fine with just one breast. The true miracle was that my nipple healed in mere days. After about 10 weeks of nursing with excruciating pain, I felt comfortable again. The nipple trauma had made me physically, emotionally, and mentally miserable, but with its healing, I started to feel like myself again. Since it had been less than a week, I was able to ease Em back onto the damaged nipple and re-establish my supply without too much effort.
With both kids, the pain of nipple trauma left me feeling robbed of a part of my maternity leave. I had to give upt the fantasy of the perfect nursing relationship to deal with seemingly endless problems. But the other day, as my 15 month old Emily tucked in for her night time nursing session, I thought about how perfect it is now. We nurse in bliss, and she pats me and shows affection. She has infinite patience for those days around my cycle when my milk is a little slower, and there is never any pain. In the end, I did get a perfect nursing experience. It just came in a slightly different form.
For more information on ways to deal with nipple trauma, (from an actual professional) go to http://www.kellymom.com, or contact your local La Leche League. If you have any other questions for Charlotte, please feel free to comment, or email at firstname.lastname@example.org.