Sample FAQ: Nipple compression pain

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Why do my nipples look squashed after breastfeeding?

When babies suck on a nipple, they use suction to hold it in place and squeeze it against the top of the mouth. Softer nipples can’t resist the pressure and change from having a cylinder shape to having a more pointed shape. In the process, the nipple is folded into a line. After breastfeeding, it looks like a tent or the pointed end of a lipstick. The resulting pain is called nipple compression pain. The pain is sharp as the baby latches, may decrease after a few minutes, or be sharp with each suck toward the end of the feeding. Nipple compression pain starts with the first feed after birth and increases with each feed. It is at its worst between days 3 and 5 and settles during the first two to six weeks after birth. Mothers who have this pain are more prone to nipple damage and to nipple vasospasm, a contraction of the blood vessels.

A) Describing nipple compression

The nipple being compressed by the baby's mouth.

1) The anatomy of the mouth and latch

The mouth is essentially a triangular space with the front being the wide base and the tip at the back where the tongue and roof of the mouth meet. The nipple is cylinder-shaped, with round sides and a flat face.

When babies latch onto the breast, they take the nipple deep into their mouth and hold it there with suction. When they suck, they raise and lower the tongue, squeezing the nipple and the part of the breast just behind the nipple (the nipple root) against the top of the mouth.

2) How nipple compression develops

Softer nipples may not be able to resist the pressure and suction in the baby’s mouth. They change from a cylinder shape to a more pointed shape that fills the triangular space in the baby’s mouth. In the process, the nipple is folded into a line along the middle or along the side (nipple compression line) and after breastfeeding the nipple looks like a tent or the pointed end of a lipstick.

Nipple compression traumatizes the skin as it is stretched and pinched to form the line. It is also more difficult for blood to enter and leave the affected area. This is seen when the line is white right after breastfeeding. Both the folding and the lack of blood result in pain (nipple compression pain).

The research on this is very limited but the nipple and nipple root characteristics, mouth shape, tongue movement, and suction strength probably all have a role (Sakalidis 2013).

3) Why nipple compression pain settles

Nipple compression pain decreases within two to six weeks after starting because:

  • The nipple gets used to its position in the baby’s mouth.
  • The feeds get shorter, reducing the amount of time the nipple is compressed (Sakalidis 2013).
  • The nipple root becomes softer.
  • The baby’s suction strength decreases (Sakalidis 2013).

There are a number of options for making compression pain settle more quickly.  

Once the pain is gone, the nipples may still look compressed after feeds. This is normal for some mothers. The pain will not return.

B) Diagnosing nipple compression

A pale fold is present on the face of this left nipple because of compression in the baby's mouth. The nipple appears tent-shaped.

1) The appearance of nipple compression

You can check for a nipple compression line by looking at the nipple face right after breastfeeding. If your nipple has a fold or line across the face, resulting in a tent or lipstick shape, your nipple is compressed. The line will be in the same direction as the line of the baby’s lips.

In mothers with nipple compression pain, the fold on the nipple face is tender to touch.

2) The type of pain

With each feed, mothers with nipple compression pain:

  • Have sharp nipple pain as the baby latches.
  • Have decreased pain after a few minutes of breastfeeding.
  • May feel sharp pain with each suck toward the end of the feeding.
  • Have tender nipples after feeds.

3) Mistaking other problems for nipple compression

Some mothers are told that having a compressed nipple is a sign of a poor latch. Rather it is a sign that the baby is latching and the nipple is near the back of the mouth. Mothers may then resort to repeatedly latching and unlatching the baby to get a “better latch”. This results in more nipple trauma and pain.

Some babies with true latching problems will clamp on the breast or areola. This is not true nipple compression pain but rather is caused by baby’s gums and mis-directed suction.

Some babies who cannot use a nipple shield properly will clamp on the tip. This too can cause a line across the nipple face and pain. While the nipple is compressed, the cause is the nipple shield and such mothers should stop using one.

C) Tented or lipstick-shaped nipples

Illustration of the two ways nipples can respond to being compressed in a baby's mouth when breastfeeding.

Nipples that are very soft will tend to have a fold across the middle (tent-shaped) once the baby lets go. Nipples that are slightly firmer tend to tip over in the baby's mouth and become lipstick-shaped.

D) Timing of nipple compression pain

Scabbing along a compression line (compression stripe) commonly seen around Days 3-5 after birth

Nipple compression pain:

  • Starts with the first feed after birth.
  • Increases with each feed.
  • Is the worst between Days 3 and 5.
  • Settles during the first two to six weeks after birth when properly treated.

Mothers with nipple compression pain and damage recover well when using proper treatment. The pain generally decreases each week, and most mothers are doing fine after four weeks. It is rare that it lasts longer than six weeks.

If the nipple is also damaged, the pain will last for as long as the damage is present and for a few further weeks. The severity of the pain usually decreases steadily during this time.

Some nipples always fold with breastfeeding, even after the pain is gone. This is not a problem. The pain and the damage are the problem and once these go away, they do not return.

E) Who is likely to have nipple compression pain

Compressed nipple (lipstick-shaped)

Research has shown that mothers with nipple pain from compressed nipples have babies who (McClellan 2008; McClellan 2015):

  • Use significantly more suction to stay latched.
  • Keep the nipple in a smaller space between the tongue and the roof of the mouth.
  • Take longer to get the same amount of milk.

We have found that nipple compression is more likely if:

  • The babies are vigorous.
  • The nipples are soft.
  • The nipples are at least 0.75 centimetre (5/16 inch) in diameter.
  • The nipple root is firmer, requiring a baby to use more suction to stay latched.

The relationship between nipple pain and nipple size and areolar firmess has been found by researchers (Ventura 2020). 

Tongue-tie may play a role.

F) Factors that can make nipple compression pain worse

Deep damage caused by nipple compression.

Nipple compression pain can be made worse by:

1) Poor positioning

When not positioned properly, a baby needs additional suction to remain latched which can further traumatize the compression line.

2) Excessive breastfeeding 

Excessive breastfeeding can traumatize the whole nipple and also make the pain caused by other problems, such as poor positioning and nipple compression, worse.

3) Nipple skin damage

Mothers with nipple compression are more prone to nipple skin damage along the compression line. This can be superficial (scab; blistering) or deeper with open skin. Such linear damage can also be called a compression stripe. The damage can also become infected, further increasing the pain.

4) Vasospasm

A sizeable number of mothers with nipple compression pain develop nipple vasospasm.

References

McClellan H, Geddes D, Kent J, et al. Infants of mothers with persistent nipple pain exert strong sucking vacuums. Acta Paediatr. 2008 Sep;97(9):1205-9
 
McClellan HL, Kent JC, Hepworth AR, et al. Persistent Nipple Pain in Breastfeeding Mothers Associated with Abnormal Infant Tongue Movement. Int J Environ Res Public Health. 2015 Sep 2;12(9)
 
Sakalidis VS, Kent JC, Garbin CP, et al. Longitudinal changes in suck-swallow-breathe, oxygen saturation, and heart rate patterns in term breastfeeding infants. J Hum Lact. 2013 May;29(2):236-45

Ventura AK, Lore B, Mireles O. Associations Between Variations in Breast Anatomy and Early Breastfeeding Challenges. J Hum Lact. 2020 Jun 2:890334420931397

 

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