There are three things to consider when it comes to cracked, bleeding, or sore nipples.

The first is finding the reason the nipples are sore and fixing that problem so that breastfeeding can continue.

The second is feeding the baby in a way that supports returning to the breast.

The third is milk supply.

 

First, it is totally safe and just fine to feed your baby if your nipples are cracked and even if they are bleeding or there is blood present in your milk from the damaged tissue. Previously women were told never to wash their nipples or put anything on them except maybe small amounts or pure lanoline or nipple cream. Diana West (co-author of The Breastfeeding Mother's Guide to Making More Milk and The Womanly Art of Breastfeeding, 8th edition) tells us that if the skin is broken, cracked or bleeding,  like any other abrasion, the area needs to be washed once a day with soap and water to reduce the risk or infection. The last thing you need when you have a new baby and sore nipples is an infection!

 

Sometimes latch isn’t the issue at all, and sore nipples persist. If your nipples or your baby’s mouth have white patches that bleed when wiped off, and/or if your pain feels like needles sticking into your nipples, or your nipples feel itchy or have burning pain you could have a yeast infection called thrush. Thrush is common in women or babies who have had a recent dose of antibiotics. Thrush can be passed from mom to baby as well as from bottles, pacifiers, teething toys, breast pads, and nursing bras, back and forth to mom and baby. For some tips on dealing with thrush there is an article here (http://www.llli.org/faq/thrush.html).

 

Often the cause of sore nipples is a poor latch. Some suggestions for getting a better latch include, looking for early hunger cues, such as lip smacking, rooting, hand sucking etc. being in a comfortable supported position, using skin-to-skin contact, and using supplement methods that are conducive to breastfeeding.

 

Crying is a late hunger cue and it is much harder to teach and learn a better latch with a screaming baby. Once you notice some of these early cues get comfortable and ready to nurse! Many moms report having a lot of success in a reclined position, this allows gravity to support baby, helps baby achieve a good deep latch so that baby is taking the nipple and at least some of your breast tissue into his or her mouth, (sometimes refered to as laid back nursing or biological nursing read more here ). What ever position you chose to feed in there are a few things to consider; are you bringing the baby to your breast (and allowing your arms to be well supported) or your breast to the baby? Bringing your breast to your baby can cause undue pulling and tugging on your nipples; check your posture and place some pillows on your lap or lean back some, many moms have found using a foot stool to bring their knees up very helpful. Next, make sure your baby’s body is aligned; their sweet little nose should be in a straight line with their bellybutton so that they don’t have to turn their head to reach your breast (their tummy, not their side, should be touching your body).

 

Sometimes during the birth process babies can sustain minor injuries, and leave them feeling sore. Does your baby have any bruising? Do they seem to have any pain in the shoulders, neck or head? Is there a position they seem more comfortable in? Most babies dislike having their heads shoved into the breast regardless of any injuries, so it is usually best to support the neck and back not the back of the head.  Sometimes if a baby has been suctioned at birth they can have an aversion to anything near their mouths, if this is the case you may be interested in this article published by La Lech League International, and it my be helpful to contact a local La Leche League leader or a board certified lactation consultant from the International Board Certified Lactation Consultant website.

 

Once you are ready to feed your baby it is important to get your baby to open his or her mouth very wide (this is easier to do if they are not crying), you can do this by gently teasing their lip with your nipple or hand expressing a small amount of colostrum, then align your nipple to baby’s nose and while supporting their shoulders and back (never the back of the head) and bring them to the breast, this will allow for an uneven latch where the lower jaw has more tissue than the upper and this is exactly what you’re going for. If you were to imagine that you were going to take a great big bite out of a huge sandwich what would your hands be doing? Holding the sandwich with “C” shaped hands, squeezing gently? Some women have larger breasts, or long breasts, or low placed nipples and some babies have small mouths, and that’s fine, but sometimes we need to imagine that our breast is one of those large sandwiches. If your baby is laying in a more vertical position (as in laid back nursing) you would need to make your hands like the letter “C” and support your breast but if your but is lying across you (as in a cradle, cross cradle, or football hold) you many need to make your hands more like that letter “U” and support your breast. Once the baby is on the breast you can look to see if baby’s lips are flanged (Note: the bottom lip in the picture). If you are not sure it is very easy to use your finger to gently ease the lips to a more flanged position. At this point it is normal to feel some discomfort but if you are curling your toes in pain this can indicate a latch issue. Before removing the baby, you might want to again, check your positioning; can you bring the baby in any closer to your body? Are you sitting straight or leaning back or are you hunched with baby pulling on your nipples. If you can’t make yourself more comfortable with the latch by moving around gently break the seal using your finger (this is important to do so as not to cause farther nipple damage) and try again.

 

Some baby’s just don’t want to latch at all and many moms have found using skin-to-skin contact very helpful. Some suggestions to help maximize skin-to-skin contact are staying in bed for a day (or two) with your baby, having a bath with baby or my favorite, baby wearing. Moms who have their babies close to them for longer periods of time, such as when carrying them in a sling, tend to recognize hunger cues earlier and report more success with breastfeeding. Doing some skin-to-skin without the idea of nursing (reverse psychology works well on some children from a young age) may also be helpful.

 

The second part of  getting back to the breast deals with feeding baby a supplement that supports breastfeeding. You may not have had to supplement because of your sore nipples, and if that is the case you can skip this section. If you have had to supplement or think you may have to, you might want to consider how you chose to supplement. Bottle feeding can interfere with the breastfeeding relationship. But bottle feeding is not the only option! Did you know that babies can drink from small cups, off of your finger, or out of a syringe? Feeding baby this way may make the transition back to the breast easier. There is a great article list of resources here  about the alternative feeding methods.

 

And lastly there is the issue of milk supply. Many women do not realize that their milk supply works on a “supply and demand” basis; meaning the more milk re-moved from the breasts the more milk you will make, the downfall is that the opposite is also true, when milk is not adequately removed from the breasts your body is signaled to slow down milk production. So, if your baby is not properly latched there is a chance that he/she is not completely draining your breast of milk. You can tell if your baby is getting enough milk by the amount of wet diapers he or she is having, (diaper log guidelines) as well as by watching your baby’s jaw for a pause when nursing. A pause after a few sucks means baby is swallowing, and the best reason to swallow is milk. If you are temporarily supplementing it is important to keep your milk supply up by pumping or hand expressing. The great thing about pumping or hand expressing is that you will not only increase your milk supply but you might just get some milk (or colostrum in the earlier days) to feed your baby.