Cracked or sore nipples.

Some mums find that breastfeeding is a bit uncomfortable during the first few days.  If this continues or if it is more than just slight discomfort, then this is a sign that there may be a problem with the way baby is feeding. 
The most common cause of sore or cracked nipples in the early weeks is the baby not being latched on correctly.  Pulling the baby off the nipple without carefully breaking the seal (place your little finger in baby’s mouth to do this) can also cause sore nipples.  Other causes are; not using the breast pump correctly, thrush and tongue tie.

Management.

Ensure your baby is attached correctly to the breast – see the breastfeeding page for more advice on this and if you’re still not sure, ask your health visitor to watch you latch baby on.
If your baby is tongue tied, it can be snipped very easily and quickly – ask your midwife for a referral.
If you think your baby may have thrush, read the thrush section further down this page.
Begin each feed on the least sore side first.
There are many different nipple creams on the market; however these are only needed in severe cases.  If you nipple is cracked or has a scab on it, then apply a small coating of an oil based preparation. An application of an oil based preparation to a cracked nipple keeps the wound moist and promotes healing. Ointments of a thick consistency such as highly purified lanolin have been shown to be most effective.  You can also promote healing by applying expressed milk to the nipples after feeds.
Taking paracetamol will help to reduce your discomfort and are fine to take whilst breastfeeding.

Mastitis and blocked ducts.

Mastitis and blocked ducts affect one part of the breast, and usually only one breast. A blocked duct, if not unblocked to let the milk drain away will cause inflammation.  It may then become infected leading to infected mastitis which makes you feel unwell and gives you a temperature.
The signs of a blocked duct are, a tender lump, which may have a reddened area.  At this stage you will not feel unwell, but follow the tips below to prevent it from turning into infected mastitis.

Tips to unblock the duct.

• Continue to breastfeed frequently.
• Gently massage and apply a warm flannel to the affected area whilst feeding
• Begin each feed from the affected breast first. Baby has a stronger suck at the beginning of the feed and this will help to unblock the duct.
• Point the baby’s chin to the area of the breast which has the blocked duct.

Rest as much as possible.

If this does not work and you begin to feel unwell, continue with the advice above and also;

• See your GP as you will probably need antibiotics to help fight off the infection.
• Express from the affected side.
• Make sure your baby is correctly latched on.
• Check that your bra is fitting correctly and not digging into your breast.
• Breastfeed in different positions e.g. lay down or rugby ball style.

• Take pain relief- paracetamol or ibuprofen.

Inverted Nipples

About 10% of women have inverted nipples, so you're not on your own and there's no need to feel embarrassed. So if you need help latching baby on, ask for it.
Sometimes inverted nipples cause no difficulties for breastfeeding and baby latches on well and breastfeeds with no problems. If you are having problems feeding, then follow the tips below.
Just before feeding use a breast pump or a special device (such as a latch assist) to draw the nipple out which will make it easier for baby to latch on. You may only have to do this during the early weeks and baby may learn to latch on without the nipple being drawn out first.
Try not to let you breasts become engorged as this will make it more difficult for baby to latch on. If they do become engorged, express a little bit of milk of before feeding to make the breast softer and therefore easier for baby to latch on.
Make sure your midwife is aware that you have inverted nipples, as you may need some extra support with breast feeding in the early days.
Erect nipples are not essential to breast feeding successfully; it is breast feeding not nipple feeding.

Engorgement.

Your milk comes in a few days after delivery, your breasts may feel hard and lumpy.  This is quite normal and is easily resolved by allowing your baby to feed as often as she wishes.  You must ensure she is attached correctly; otherwise she won’t be emptying the breast properly.  Your breasts will soon get used to the amount of milk needed for your baby.
If baby is not feeding frequently, or is not latching on correctly, your breast can become over-full.  This can be very uncomfortable and even painful. Your areola may become swollen and the nipple can become flattened.  This can make it very difficult for baby to latch on.   If this happens, express just enough milk off to make it possible to latch baby on.
The main way to reduce the engorgement is to let baby have frequent unrestricted feeds.   Don’t be tempted to express your milk (except to help baby to latch on) as although it may offer temporary relief, it will make your breasts produce more milk than your baby needs and therefore make the engorgement worse.
Try applying a cold compress after feeds.  Cold dark green cabbage leaves have been shown to be soothing and can reduce the swelling and pain.  Use for up to 15 minutes after each feed.
Use ibuprofen to help reduce the swelling and the pain.

Thrush.

Thrush infection of the nipple can be very painful.  There are a variety of symptoms.  You may find your nipple is itchy, extra sensitive or you may find that your nipple burns or stings.  You may also notice your areola changes colour slightly or becomes shiny. 
Sometimes the only symptom is cracked nipples that won’t heal, even though baby is correctly attached.
Treatment for thrush is an antifungal cream for your nipples and an antifungal oral suspension for baby’s mouth.  Even if baby has no symptoms, it is still important that she is treated.
Sometimes the thrush can enter the breast tissue.  If this happens you will have deep breast pain and it will feel like needles being stabbed inside your breast.  This pain usually happens between feeds.  If you are experiencing this type of thrush, you will need fluconazole capsules for at least ten days.
Take paracetomol or ibuprofen to help relieve the pain.