Treating nipple compression

How can I stop nipple compression pain?

Nipple compression pain can be treated in a number of ways. Mothers can massage the nipple root to soften it and then ensure that the baby has a good latch, taking as much of the breast into the mouth as possible. This is often made easier by breastfeeding while using the sandwich technique, squeezing the breast until the pain is significantly reduced. Mothers can also change the baby’s position from one feed to the next. The cross-cradle and under-arm holds put pressure on the nipple in different directions. Some mothers like the laid-back hold. If the baby is latching well, mothers can even try changing holds during a feed. The baby should not stay on the breast for more than 20 minutes but rather should be taken off when the feed is done. If these approaches don’t work, mothers can occasionally express. As the pain goes away, the expression is gradually replaced by breastfeeding. A small number of mothers will use nipple shields until the pain is tolerable.

A) Addressing nipple compression pain

Nipple compression pain can range from mild to severe and there are a number of ways to treat it. Mothers respond differently, so don’t be afraid to experiment and see which ways are best for you.

Ensure that you have the right diagnosis as other problems can mimic nipple compression pain.

When properly treated, it should steadily improve and then settle during the first two to six weeks after birth.

In addition to the steps outlined below, mothers can use a range of other non-specific tools to manage pain.  

B) Latch the baby properly

Ensure that:

  • The nipple root is soft by massaging it before latching.
  • The baby is properly positioned.
  • Thebaby takes as much of the breast into the mouth as possible.
  • The baby has a good latch.
  • The breast is just touching the baby’s nose but not blocking it.
  • The baby’s arms circle the breast and are not between the baby and the breast.

C) Use the breast sandwich or the laid-back hold

Both the sandwich technique and the laid-back hold will soften the nipple root and mothers can choose between them. These are good tools if the breast is firm and both will decrease nipple compression pain and prevent further pain and damage

1) The sandwich tecnique

The sandwich technique provides the mother is more control over the baby's movements. This is an advantage if the nipple is very tender. It can be combined with the cross-cradle and under-arm holds. You may use the sandwich technique:

  • For the whole of the feed with very firm pressure on the breast to minimize severe pain.
  • For the whole of the feed with enough pressure to minimize or eliminate the pain.
  • To latch the baby but let go within a few minutes after the pain has settled.

Some mothers need to put a lot of pressure on the breast to control the pain as the baby latches and possibly for a few minutes afterwards. This is the right thing to do. Continue with the sandwich until the baby is settled in well and your pain decreases. When trying to let go, do so very slowly. If the pain increases, you will need to hold onto the breast for longer, even through the whole feed.

You will not always need to hold your breast during feeding. Once you are not having compression pain, you should stop using the sandwich technique.

2) The laid-back hold

The laid-back hold can prevent nipple pain and damage after delivery (Douglas 2017; Milinco 2020). It is also a comfortable breastfeeding hold. Mothers tend to choose this option if the pain is not too severe.  

In the laid-back hold, the breast tissues will sit on the mother’s chest rather than hang in the mother’s breast. This can soften the nipple root and make latching and breastfeeding easier and protect the nipple and is similar to the effect of the sandwich technique.

D) Change breastfeeding positions at each feed

If the sandwich technique or laid-back holds do not give you enough pain relief, consider changing the baby’s position at the breast with each feed. By doing this, a different part of the nipple will be squeezed at each feed, distributing the injury so that no one area is extremely tender.

To change the baby’s position, mothers will need to use different breastfeeding holds. The cross-cradle hold compresses the nipple in an up-down direction. The horizontal under-arm hold compresses the nipple in a side-to-side direction.

Once the baby comes off, have a look at the nipple fold. The fold should change direction with different holds. If it is in the same direction, you need to move your baby so that the mouth is in a different direction with the different holds.

We have seen several babies who always held the nipple in the same position in their mouth, no matter how it went in. These mothers had larger and slightly irregularly-shaped nipples. This meant that in some breastfeeding positions the baby was rotating the nipple 90 degrees in their mouth, causing even more pain. We could see the nipple return to its normal position as the baby let go. Therefore, if one position hurts a lot more than the other, don’t use it.

E) Change positions during feeds

If the pain does not settle within five minutes after latching the baby, you can change the baby’s position. Unlatch the baby and look at your nipple. If the nipple has a fold across it, massage out this line with your finger before re-latching the baby. Consider changing the breastfeeding position before relatching.

If you choose this approach, make sure the baby is growing well. Premature, sleepy newborn, or weak, sick babies may not be able to latch on again or continue breastfeeding effectively after having been unlatched in the middle of the feed.

You can also change to the other breast and then return to the first breast as your pain allows. If you favour one breast, you must express the other.

F) Don’t leave the baby on the breast longer than necessary

Avoid excess breastfeeding. Take the baby off the breast when the baby is done breastfeeding. Feeds should not be more than 20 minutes on each side.

Consider using a pacifier instead of breastfeeding the baby to sleep until the nipples have settled. If you choose this approach, ensure that the baby is getting enough milk. 

G) Express your milk

Some mothers may not be improving enough with the above approaches. They may choose to start expressing for few days or weeks. 

1) Expressing occasionally

Mothers who are in a lot of pain may consider expressing every other feeding or two out of three feeds for a few days. As the pain gets better, the number of expressed feeds is decreased and the number of breastfeeds each day is increased. 

Some mothers can’t express effectively. This can result in a decreasing milk supply and other problems.

2) Only expressing

For many reasons, it is best not to stop breastfeeding and just express.

If mothers interrupt breastfeeding completely for a period of time and express instead, the nipples can be more painful when resuming breastfeeding. However, the pain is rarely as severe as it was initially. Such mothers should slowly increase the number of breastfeeds each day as their pain allows. 

H) Consider nipple shields

While nipple shields can sometimes help reduce compression pain, many mothers have reported to us that they had just as much pain when using a shield. They say the above techniques have been more useful.

Nipple shields can also cause more problems such as the baby not taking in enough milk or clamping on the tip of the shield or causing more nipple pain. Some babies can also become dependent on the shield and unable to breastfeed without one. Therefore, shields should only be used if the above approaches are not effective.

I) Treat nipple skin damage

Superficial skin damage caused by nipple compression

Nipple compression pain can lead to nipple damage such as blisters, scabs, cracks or ulcers. Nipple damage can also become infected, further increasing the pain.

J) Preventing nipple compression pain

Nipple compression pain is most common and most severe with the first baby. It is generally less severe with each subsequent baby.

The best way to prevent nipple compression pain with your second baby is to breastfeed your first child for extended periods and even through the second pregnancy. This keeps your nipples used to breastfeeding.

After the birth of the new baby, mothers should ensure that their nipple root is soft by massaging it before each feed. Breastfeeding the current child and the new baby prevents excess breast filling and can also keep the nipple root soft.

The above techniques to decrease nipple compression pain are also helpful in preventing it.

References

Douglas P, Keogh R. Gestalt Breastfeeding: Helping Mothers and Infants Optimize Positional Stability and Intraoral Breast Tissue Volume for Effective, Pain-Free Milk Transfer. J Hum Lact. 2017 Aug;33(3):509-518

Milinco M, Travan L, Cattaneo A, et al.; Trieste BN (Biological Nurturing) Investigators. Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial. Int Breastfeed J. 2020 Apr 5;15(1):21