As a Certified Breastfeeding Counselor (CBC), you help clients with typical breastfeeding initiation and ongoing common breastfeeding challenges. If you are a doula, you assist with breastfeeding initiation. As a CBC or doula, you are likely to encounter clients experiencing painful breastfeeding.
As non-clinical support, you can provide education, basic problem solving, and refer clients to healthcare providers. During your certification, you should be quite familiar with causes of painful breastfeeding. However, having this simple list can be a great reminder. When we are working with a client it is easy to forget a detail or two.
Some causes of painful breastfeeding include:
Poor Positioning
How a baby is positioned as well as the breastfeeder can impact latch and overall comfort. Sometimes, simply trying another position can reduce painful breastfeeding.
In some cases, baby’s position can cause pulling on the nipple or a shallow latch. In other cases, the feeder might be leaning down or pulling back and just generally uncomfortable.
It is not always that baby does not know how to latch, but rather baby cannot get a good latch in their position. You can read 5 Best Breastfeeding Positions For Newborns to learn more about positions.
Engorgement Causing Painful Breastfeeding
Around two to four days postpartum, engorgement tends to peak. Engorgement can also occur at other times due to missed feeds, baby sleeping long, etc.
Engorgement can create hard, warm tissue. It can range from uncomfortable to very painful.
Many find the following helpful:
- Warm compress before feeding
- Cold compress after feeding
- Allowing baby to stay at the breast with a good latch
- Empty breast
- Pumping/hand express for comfort
As a CBC, you can provide the above remedies as general advice some find helpful for engorgement. If they are experiencing severe pain, fever, or have any concerns, direct them to speak with their healthcare provider.
Nipple Vasospasm
While not as common as other conditions, this semi-common condition can be quite painful. When baby unlatches, if the nipple is white and painful, it could be a vasospasm.
A client experiencing this will often feel burning pain when their nipple is exposed to cold.
To reduce symptoms, they might find the following helpful:
- Wear extra layer(s) of clothing to stay warm
- Apply warm compress before feeding
- Use heating pad on shoulders and neck during feeds
- Avoid sudden temperature changes
- Gentle massage when experiencing a vasospasm
Nipple Damage and Painful Breastfeeding
For clients who experienced a poor latch which was fixed, ongoing pain is confusing. Sometimes the culprit is nipple damage. Even once the latch is corrected, it can take time for the nipples to heal.
Help the client ensure a good, deep latch. Then encourage her to correct a poor latch anytime baby is shallow. Reassure her that nipple damage can heal.
Some clients find ointments, salves, airing the nipple, etc. to be helpful in encouraging healing.
Blocked Duct
A blocked or clogged duct can cause painful breastfeeding. A blocked duct is often a small and painful lump. As a CBC you cannot diagnose, treat, or rule anything out. However, you can provide information about blocked ducts.
You can explain what a blocked duct feels like. Commonly used remedies include:
- Taking sunflower lecithin
- Using a warm compress before feed
- Massaging during feed
- Cool compress on the duct after feed
- Breastfeed or pump frequently on the affected side
Mastitis
If your client has a fever or flu like feelings, they should reach out to their midwife or doctor. A fever with a warm area on the breast, like a blocked duct, may be a sign of mastitis. This is an infection in the breast tissue.
In some cases, rest and frequently emptying the breast is all that is needed. In other cases, an antibiotic is necessary. As non-clinical support, we cannot tell a client if they do or do not have mastitis. We can share this information and encourage them to speak with their provider.
Thrush and Painful Breastfeeding
Thrush can be a painful condition for both baby and mother. Often shooting pain with latching and feeding. If there are white spots inside baby’s mouth that can be a clue. This is caused by an overgrowth of candida.
Thrush can appear similar to bacterial infections or nipple damage, so it is important they see a healthcare provider for accurate diagnosis.
If your client is experiencing painful breastfeeding, provide support and education. You can walk them through some basic problem solving. Ultimately, if you or the client have any concerns about conditions which may require a diagnosis or medication, refer them to their healthcare provider.