Breast pain while breastfeeding

Some mums experience pain in their breasts from time to time when they are breastfeeding. Read about the causes and how to remedy them here.

What can cause pain in my breasts while I’m breastfeeding?

The letdown reflex
You may feel a fleeting tingling, sometimes painful, sensation in your breasts when your milk lets down.

The letdown reflex is set off when you think about your baby, or when she suckles at your breast. This triggers the hormone oxytocin, also known as the love hormone, to stimulate your breasts to squeeze out milk.

Because oxytocin can be released by thinking about your baby, you may even find that your breasts leak when you hear her cry, or think about her or look at her things.

Different women feel the letdown reflex in different ways. You may feel:

• tingling, or pins and needles, before or during a feed
• twinges deep in your breasts
• pressure and slight pain, ache or discomfort

As time goes by, and as you get used to breastfeeding, these sensations usually disappear.

Producing too much milk
Some mums who produce lots of milk have painful twinges deep in their breasts during feeds.

This painful letdown reflex usually fades in the first three months of breastfeeding. If your baby latches on well each time she feeds, your milk supply should quickly settle down to match her needs.

Engorgement
In the first few days after your baby is born, your breasts fill with mature milk, and more blood flows to your breasts, making the tissues swell. Your breasts may feel heavy, warm, firm, and sometimes lumpy.

This is normal fullness, and your milk should flow well. It's your body’s way of making sure your new baby has plenty of milk.

Put your baby to the breast as often as she wants to feed. Check she's latching on well, and feed her for as long as she wishes. Your breasts will adjust the amount of milk your baby needs, and any early discomfort should pass.

If you don't feed your baby whenever she wants to, your breasts will become full, and then engorged. Your baby may struggle to get a good latch, as your breast is so full it's become hard.

If the engorgement doesn’t settle with frequent feeding, see your doctor or a breastfeeding specialist as soon as possible. If your breasts stay overly full, you're more vulnerable to mastitis.

Mastitis
Engorgement or a poorly flowing milk duct can lead to an area of your breast becoming inflamed, in a painful condition called mastitis. It happens when milk stays stuck in your breast, and is forced out of the duct into the surrounding tissues.

The affected part of your breast will be red and tender, and you may feel feverish.

Keep breastfeeding your baby, to remove as much milk as possible from your affected breast. Ask your doctor or a lactation consultant to check your baby's latch and positioning.

Breastfeeding with mastitis may be painful, hard work, but it will help to get rid of the inflammation. You can also express milk to clear the milk away. Applying a cold pack at the site of inflammation helps settling it. Try and avoid the application of heat on the affected area.

If the mastitis doesn't go away with breastfeeding after a few days, see your doctor for treatment. Sometimes, infection sets in with mastitis, and this needs to be cleared up with antibiotics.

Thrush
Thrush, a common fungal infection, can develop in your baby’s mouth and on your nipples. You may develop thrush after you or your baby have had antibiotics for another infection.

The moist, warm, sugary environment of your baby’s mouth, while she is feeding is the perfect place for thrush to flourish.

Unlike letdown pain, thrush pain continues after a feed for up to an hour, and can be quite severe.

If you or your baby has a thrush infection, you’ll need to see your doctor, so you can both be treated. If you are sexually active, your husband might need to take treatment as well.

Are there any other reasons for breast pain?

Things that have nothing to do with the act of breastfeeding may be giving you pain. It may be:

• A badly fitting nursing bra or overly tight top, which could lead to blocked ducts and mastitis. The side seams should be on your ribs, not your breast, and the cups should not squash or press on your breasts. If you have uncomfortable bras, have a proper fitting by an experienced store assistant before buying new ones. Along with taking care of the fit, also ensure that the bra is made of cotton and does not have underwires.
  
• Period-related breast pain. This pain starts a few days before your period, and improves at the end of your period. It is caused by hormonal changes. You’ll start to recognise this pattern if the pain is related to your menstrual cycle.
  
• Fibrocystic breast disease happens when lots of lumpy areas in your breasts fill with fluid and feel tender and painful. It is harmless, and it's fine to breastfeed if you have it. But if you think you may have fibrocystic breast disease, see your doctor so that she can rule out other possible causes of your pain.

What can I do to ease breast pain?

Continue nursing
Because most problems are caused by not feeding often enough, offering your baby a feed more often and for as long as she wants will help in most cases.

Reduce swelling and engorgement
If your breasts are engorged, your baby may not be able to latch on well enough to suckle fully.

You may need to start with gentle hand expressing or a breast pump until your baby can draw your breast comfortably into her mouth.

Try using warm, damp washcloths on your breasts before a feed to help the milk to flow. After feeding or expressing you could use cold, damp washcloths, cold gel packs or cold, green or white cabbage leaves on your breasts.

Cabbage leaves may relieve discomfort and reduce the swelling, though there isn’t much firm evidence for this.

Check your letdown
A strong letdown from over-full breasts can also make feeding difficult. If your baby comes off your breast spluttering from too much milk, try this technique:

• Put your baby to your breast, as usual.
• When you feel your milk let down, gently break the suction and catch the initial spurt in a towel or tissue.
• Let your baby latch on again when the flow slows down a bit.

The more often your baby latches on well, the more quickly your supply will settle down, and you will become more comfortable.

Try relaxation techniques
If you learned ways to relax at your antenatal classes, try bringing them to mind as you breastfeed. They may help you to cope with discomfort during letdown.

Some women also find that gently massaging their breasts from time to time during the day provides some relief.

Use painkillers with care
You can also take paracetamol or ibuprofen to help ease the pain. Some mums also find homoeopathy helps, but you should only take medication after consulting a specialist. Keep in mind, aspirin is not suitable while you're breastfeeding.

If you have tried these methods, and your breast pain does not go away, see your doctor to rule out causes that need treatment, such as thrush or mastitis.

If you are finding it difficult to get your baby to latch on, try to get help from a lactation consultant. Your doctor or paediatrician will be able to refer someone, or you could contact a breastfeeding organisation for advice.

Reviewed by Geetika Gangwani, birth educator and lactation consultant.

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