Nipple problems, care, etc.

December 3, 2010

I started to write this on another thread and it was getting too long, so I decided to start a new thread on it.

I have extremely sensitive skin, all over me, and I had lots of nipple problems, during the ten years total that I was nursing my kids. I have also learned things from lots of other moms.

For pumping, one thing that helps to avoid and/or treat soreness is to lubricate the nipple/areola area with something. The best thing, I think, is to hand express a few drops of breast milk and rub it around. When there is no milk yet, warm water is fine. Although I didn't think lanolin helped me, some moms like it.

For just general soreness, it is very helpful to keep the breasts well protected between feedings. I used squares of soft cotton flannel, folded into four layers. I didn't find the breast shells that helpful, but they hadn't come out with the ones with the flexible inner part, like they have now, so I would definitely try them.

I had a terrible time with Reynaud's syndrome, which is not uncommon. It makes the nipple tissue go into spams that cut off the circulation. It is similar to what happens in the cold, but much more extreme. The tissue turns white, first, which hurts. As the blood starts to flow again, it turns blue, and that is very painful. Having the tissue clamp down also makes it hard for any milk to get through the ducts. I didn't have the problem real bad while my kids were latched on, because of the warmth and moisture of a baby's mouth but, as soon as they unlatched and the air hit it, I was in trouble. What I found the most helpful was to take that folded flannel squares and put it between my and the baby, so that it would stay warm, while they were nursing. Then, when they unlatched, I immediately replaced the warm flannel over them. Since there was a little moisture from the baby's mouth that was absorbed, I didn't keep using that same spot after more than one feeding. I turned it over and used the other side, and then replaced the square, after that.

I also had a lot of trouble with thrush. Taking probiotics (and giving it to your baby so you don't pass it back and forth) and avoiding sugar helps. Gentian violet helps. Another thing I found helpful that I haven't seen anyone else suggest is to rinse with warm water after nursing (just put water in your hand, don't rub with a wet washcloth) and make sure it is completely dry before covering up again.

Sometimes what looks like thrush can really be eczema, caused by something touching your skin. Make sure any fabric touching your breasts is cotton and has been rinsed well to get out any detergent, and either no fabric softener or hypoallergenic one. If you are supplementing with formula, at the breast, something in the formula can be the problem, too. I learned that I am allergic to soy while trying to use soy formula in the Lact-Aid. It was like pouring acid on them. One way to tell if something in the formula is the problem is that the pain tends to get worse as the feeding progresses.

For fitting breast pumps, I think you just have to try different sizes and see what is the most comfortable. Sometimes, alternating two sizes is helpful. I don't think many women really fit the standard size with the insert that usually comes with them. It doesn't always have that much to do with the actual size of your nipples, but how your milk ducts are positioned. Some are farther back in relation to the nipple than others, so it is possible to have small nipples but need larger breast shields than what comes with the pump.

It is a lot to figure out by yourself, at first, so it is great to have online resources, like this, and also to have LLL leaders, lactation consultants. Most of these specific things apply to nursing mothers, in general, and not just mothers nursing babies they didn't give birth to.

There are a lot of things that can cause nipple pain, and I have experienced many of them (another I will address later is cracks around the base of the nipple that refuse to heal). But, nursing my babies was a blessing well worth it all!

I hope others will add suggestions, thoughts, questions. I didn't say anything about how a baby's latch and poor positioning can cause nipple soreness so it would be good if someone else wants to address that.

Darillyn

noelani2

December 27, 2010

I also wanted to address the topic of nipple/areolar preparation.

In the old days, they used to tell moms to pinch their nipples. I found that to be totally useless and so did my two sisters-in-law, who were told by their mother to do that. Unless there is a serious suckling defect, the baby isn't going to pinch them!

Some people also use maneuvers that involve grabbing the nipple and either pulling on it or twisting it. The problem with that kind of thing is that is tends to put too much stress at the base of the nipple, which can cause tears that may be very difficult to heal.

There are a few things that can be very helpful. One is just to get used to keeping soap off of your breasts while you are bathing. Warm water is sufficient for cleaning them, both before and after you start nursing a baby. Don't rub them with a towel, either. Blot them dry, or just let them air dry. If the skin feels dry or tight, use a little bit of lanolin or something like Eucerin cream, which is unscented a hypoallergenic. (Later, after you have some milk in, hand express a few drops to rub around and let dry.)

Another thing I found helpful was to wear a nursing bra with the flaps down. For women who spend most of their waking hours wearing a bra, an extreme sensitivity can develop and having gentle friction over them can help a great deal, in just a short time. It's like having an injury on a finger that is kept covered with a band-aid for a while. When you first leave the bandaid off, that skin is extremely sensitive, until after it has been uncovered for a while.

They used to say to wear something abrasive with a nursing bra with flaps down. From experience, I found that that practice was neither helpful, nor necessary. Wearing something like a woven (as opposed to knitted) cotton blouse will provide gentle friction that will help eliminate the extreme sensitivity, without discomfort. The idea is not to "toughen up" the nipples, but to help bring the amount of sensitivity to what it has been for most women who have lived on this Earth. I hope that makes sense!

One of the best ways to prepare the nipple and areolas is with a breast pump. This can be done whether you are taking domperidone and pumping a lot, to get a milk supply going in advance, or whether you have only a few days' notice that you will have a baby placed with you.

I first learned how helpful this could be while waiting for my third son, Thomas, to be discharged from the NICU where he spent his first 15 days. I had nursed my first two sons, briefly, but had lots of challenges, one of which was that my nipples became very sore and cracked. Five days before Thomas came home, I was sold a "Gentle Expressions", battery operated breast pump. I decided to see if I could head off some of the nipple damage by using the breast pump before he came home. I started with three times a day, on low suction, for about five minutes on each side. That was just a tiny bit uncomfortable, the first time but, by the third time, was fine. The next day, I did it four times, at a little higher suction, and increased the time by a minute or so, each time. I think it was five days that I did it before he came home. In just that short amount of time, I had gotten where I could pump 15 minutes on each side, with the suction turned up to medium-high, without discomfort. When Thomas came home and started nursing on demand, with the Lact-Aid, I had no trouble with nipple fissures (cracks) and only got a little bit sore.

It may seem that pumping to the point of pain would accomplish more than taking it slowing, especially if you only have a few days but, actually, it will work against you. Skin cells proliferate when tension is put on them. If the tension is gentle, normal cells will multiply. If the tension is too strong, scar tissue will develop. An illustration is the stretch marks that can come from pregnancy, versus the lack of them on the abdomen of someone who has just gained weight, gradually. Of course, starting out nursing a baby with your nipples all ready sore can really work against you, too.

I hope someone else will chime in here and offer some additional suggestions. I am hoping to add some posts here that address some of the common questions and problems that develop. I will continue to add or bump them up so they don't get lost, if no one else adds anything, but others' opinions and experience will make it all more beneficial.

Happy mothering!

Darillyn (Noelani)