It's not supposed to hurt
Breastfeeding isn't supposed to hurt, but the fact of the matter is that most mothers will experience some degree of soreness during the early stages of nursing. It is common to feel some discomfort when the baby first latches on, especially in the first days after birth before the milk has come in. This type of soreness will usually ease up after the first few sucks, especially after the milk lets down and flows freely.
You and your baby both have to learn how to breastfeed. Babies are born with a strong sucking reflex (they even suck their fingers in utero), but they have to learn the mechanics of breastfeeding, at the same time you are learning the mechanics of positioning, supporting the breast, etc. While some babies seem to come into the world knowing just how to breastfeed correctly, more often it is a learning process for both of you.
Nipple soreness will usually begin during the first few days of nursing, will peak on the fourth or fifth day, and then ease off each day after that. Soreness should lessen greatly on days seven through 10, and by the time the baby is two weeks old, nursing should be pain free. If your nipples crack or bleed, if the pain persists during the entire feeding or between feedings, if you experience a burning sensation or the pain persists beyond the first week, you need to seek help from an experienced lactation counselor to identify and correct the problem.
By far the most common cause of nipple soreness is improper latch on and positioning. Remember the baby has to learn how to nurse correctly. It can take awhile for a newborn, with his immature system, to master the mechanics of nursing. The slightest improper movement of his lips, tongue or gums can abrade the nipple tissue and cause soreness. With every feeding, he will be better able to coordinate his movements, and will soon get the hang of nursing correctly and efficiently.
Here are the basics of correct latch on and positioning, which can minimize or eliminate soreness.
The classic cradle hold is the most common nursing position. Sit upright in a comfortable chair, with a pillow supporting your back, one under the arm holding the baby, and another in your lap to bring him up to the level of your breast. You will be spending a lot of time in this position, so make sure that you are comfortable, and are not straining the muscles in your arm, neck, shoulder or back.
Your baby should be positioned on his side, with his whole body facing yours. He should not have to turn his head to reach your breast (try turning your head to one side and swallowing -- you'll be surprised at how difficult it is to do).
Cradle his head in the crook of your arm, with his body along your forearm and your hand cupped under his thighs or buttocks. His ear, shoulder, and hip should be in a straight line.
When you offer your breast, use your free hand to support it with your thumb on top and hand underneath, forming a "C." Make sure your thumb and fingers are behind the areola (the dark area around the nipple). Gently stroke his lower lip with your nipple -- this will encourage him to reflexively open his mouth. Wait for him to open wide, like a yawn, then quickly pull him in close with the arm that is supporting him. Bring him to the breast rather than pushing the breast toward him.
His mouth should cover a large portion of the areola (at least an inch). If your areola is large, his mouth may not cover the entire area, but he should be far enough back on the areola so that his gums bypass the nipple and compress the milk sinuses underneath the areola. The nipple should be centered in his mouth, above his tongue.
He should be pulled in close so that both his nose and his chin touch your breast. Don't be afraid that he won't be able to breathe. If his nose does seem to be blocked, lift your breast or pull him in closer to you. If you press down on the top of the breast to create an airway, you may pull the nipple to the front of his mouth, which can cause nipple soreness.
When a baby is latched on correctly, his lips will be flanged out (not sucked in - if he tends to suck in his lip, just gently pull it out), and the nipple will be far back in his mouth, with his tongue extended over his gums and underneath the nipple. In this position, you will feel a pulling and tugging sensation as he compresses the milk sinuses, but there will be no way for his tongue, gums or lips to abrade your nipple tissue.
If he is nursing correctly, you should feel little or no pain. If he seems to be latched on incorrectly, or if nursing hurts, don't be a martyr. Slip your finger in the corner of his mouth to break the suction, take him off the breast and start over. Don't let him continue to nurse incorrectly. Keep trying until you get it right. If you get frustrated, stop for a minute and try again when you are calmer. You may want to give him your finger to suck until he settles down. Most babies will get the hang of latching on correctly within a couple of days.
If your nipples are extremely sore, alternating positions has the advantage of putting pressure on different parts of the nipple. The football, or clutch hold, is another popular nursing position. It is especially useful for the mother who has large breasts, flat or inverted nipples, or who has had a cesarean birth.
To position your baby in the football hold, use pillows to raise the baby up to the level of your breast. Hold his head in the palm of your hand and tuck his legs under your arm, close to your body. His buttocks will be up against the back of the chair or bed with his legs flexed upward. Remember, whatever position you are using, keep him pulled in close so that he can pull the nipple far back into his mouth and nurse effectively.
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