My Baby’s Latch is “Perfect” so Why Does Breastfeeding Hurt?

Stating “breastfeeding shouldn’t hurt” always draws a lot of comment from mothers who unfortunately did have a lot of pain with breastfeeding. Many mothers who are having pain find that the pain suddenly disappears after a few weeks or months. Why does this happen? Is it simply a case of it being  normal for some women to have pain? As I’ve mentioned before, I don’t think it is. Pain, especially “toe-curling pain” while nursing is NOT normal, but I do know that it is sometimes hard to find an answer as to what is causing the pain.

The most common reason for pain when nursing is that your baby is not latched on properly, but what if your baby’s latch seems to be OK? I work with a lot of moms who are having pain with breastfeeding, and they often tell me that they were told by another care provider that their baby’s latch looks “perfect” so there shouldn’t be any pain. This leaves moms feeling confused, frustrated and feeling like they are doing something wrong. How a baby’s latch feels, is far more important than what it looks like from the outside. Some latches do look “perfect” from the outside and yet something is going on inside the baby’s mouth that is causing problems (and some latches look “wrong” from the outside, yet mom isn’t having any pain and baby is nursing effectively, so everything is good!).  If a baby is truly latching on well but mom is still in pain, the two main reasons for it that I see in my practice are tongue and/or lip-tie and structural restrictions caused by delivery or position in the womb.

Tongue and lip-tie: Many years ago, tongue-tie was routinely checked for, and clipped at birth. As society turned more towards bottle feeding, this practice fell out of favour because tongue-tie doesn’t usually cause any problems with bottle feeding (although it certainly can!). Because of this, the knowledge about tongue-tie has been lost and many health care providers know very little about it, or don’t see it as a problem. Today, as more and more women are breastfeeding, we are struggling to regain that knowledge because tongue and lip-tie certainly have an impact on breastfeeding.  Posterior tongue-ties in particular, (where the frenulum, or membrane under the tongue is attached towards the base of the tongue rather than the tip of the tongue) are sneaky, and easily missed by many health care providers. If you are having pain with breastfeeding and your baby’s latch looks good then it’s important to have your baby checked for tongue and lip-tie by someone knowledgeable.

Structural restrictions due to birth interventions or baby’s position in utero: This one is largely overlooked, and is probably the biggest cause of pain in those situations where everything “looks” ok, tongue and lip-tie have been ruled out,  but breastfeeding is still painful. Birth and breastfeeding are closely linked, and there are many things during labour and delivery that can have a direct impact on breastfeeding. Birth interventions such as vacuum, forceps or c-section tend to be the most common causes of structural issues, but sometimes even in an intervention free birth there can be structural issues due to the baby’s position in utero.

Forceps and vacuum extraction can cause bruising and swelling of the head and face, and due to the pressure exerted, they can cause distortion of the cranial bones. Although a baby’s cranial bones are designed to move over one another as baby descends through the birth canal, the forces exerted by vacuum or forceps can often cause shifts in the cranial bones that are not easily self-corrected by the baby after birth. All of these things can cause irritation to the baby’s cranial nerves, and it is the cranial nerves that control everything through the mouth and jaw. This irritation can lead to alterations in sucking patterns that result in pain for mom, and/or ineffective milk transfer. These babies may also be generally fussy due to discomfort. Imagine how you would feel if you were pulled or vacuumed out of a tight space by your head!

Babies are meant to pushed out by mom’s uterine contractions, so when a baby is delivered by C-section, or even when a well-meaning doctor tries to speed up a vaginal delivery by pulling on the baby, it can cause structural issues within the baby’s spinal cord that can affect sucking. It can also result in a strong preference for nursing on one side over the other, pain on one side but not the other, or even an inability to latch at all on one side. Even when there are no interventions during delivery, sometimes the position that a baby is in while in utero can have an impact on breastfeeding. If a baby is stuck in a certain position it can cause tightening of the neck muscles on one side, or even torticollis. I’ve also seen jaw distortions in babies who spent a lot of time in utero with their hand pressed against the side of their face. Again, these things can cause sucking issues or issues with baby being unable to achieve a comfortable latch/position.

Many of these structural issues do work themselves out eventually, or the baby learns to compensate for the restrictions and is eventually able to nurse effectively. This is why many moms find that the pain eventually goes away. In the mean time though, mothers struggle with unnecessary pain and often a very frustrating breastfeeding relationship. There are however ways to help. Many parents find that in these situations, complementary therapies such as chiropractic care and or craniosacral therapy can make a big difference for breastfeeding. There are other complementary therapies as well such as osteopathy or Bowen therapy that can also be very effective. The important thing to keep in mind that when choosing a care provider is that you want to find someone who is trained to work with babies and has experience doing so. If complementary therapies are not a possibility, or not something you are comfortable with, infant massage may also be beneficial (and is a wonderful way to connect with your baby). If you’re wondering whether your baby may have structural issues that are contributing to your struggles with breastfeeding, this article by Dee Kassing provides great information about some of the things to look for. This post from Renee Beebe is a great example of the difference that skilled bodywork can make.

Comments

  1. Everyone forgot that the boys were supposed to get the wind chime in the conservatory; they only remembered that the friends had gone where only some had spied the mansion through the gates.
    7, 1969: Stereo mixing of “Come Together” and overdubs on “The End. The first thing is to realize that you need intervention.

  2. I had severe pain as well. It was only on the left breast too. My left nipple was so sensitive I would cause pain somewhere else on my body to try to trick my brain! It kind of worked, but I always thought, “this is NOT NORMAL, why do I have so much pain even though I have “perfect” latch!!!” I pursued advice from midwives/, La Leche Leagues, etc. No one knew why.
    Unfortunately, a lot of these reasons listed above didn’t fall into my category either. I had my son at home without any interventions at all. He also, does not have tongue/lip tip either. The pain has mostly gone away (he is 8 months), but still NOBODY knows the cause! :(

    • Christelle says:

      I can totally relate. I just had my 8th baby, he was born at home with a midwife. I have had pain with ALL of them. I saw lactation consultants, midwives … it cannot be that they all had a bad latch. They always told me the latch was fine. I tried all the tricks out there and every time have moments of discouragements because I would LOVE to just enjoy breastfeeding my babies. He is not tongue tie and is a good eater.
      I have come to the conclusion that for some woman that is just the way it goes. I think my nerves or ligaments are super sensitive and need time to stretch and adjust.
      It is encouraging to know I am not the only one though!

  3. Christina says:

    There can also be pain with vaso spasm (Raynaud’s), yeast infection, or bacterial infection.
    I love the sharing about the cranial nerves! What a great point. Chiropractors that are competent in this area can help with adjustments!

  4. Great post and even better conversation thread after it. This has really helped me to see that I am not alone in the pain and dissapointment I’ve been going through. My daughter was born via forceps, the scar is still on her face 5 weeks +4 days pp so it must have been traumatic for her being yanked out so strongly.

    I’m in pain every time I breastfeed & have nipple blanching when she finishes. My right nipple is flat and absolutely kills to nurse (even with a nipple shield on) so I express from that side as frequent attempts to nurse on that side have left the nipple cracked and bleeding. She has a super strong suck and clamps down really hard which I am sure is what is causing the pain. After reading this article I won’t give up and will try to persevere with the breastfeedig and cut down on the formula feeds as I only resorted to formula out of pressure from my mum & feeling that I didn’t have any other choice. Good to know some women experience pain till 8 weeks – doesnt make me feel like such an anomaly now.

  5. Tongue tie is SO common and do easy to fix if its caught early. My son was born 2 months premature and in the nicu for 6.5 weeks but no one ever noticed that he was a text book tongue tie case. It was months later when I developed thrush that my lactation counselor noticed the problem. Two seconds and a drop of blood was all it took to get a perfect latch!

  6. Hi,

    I was interested to note that you have not mentioned anatomical issues that can cause pain or vasospasm. Vasospasm affects up to 20% of breastfeeding women and can cause terrible pain. It look visiting my THIRD lactation consultant to diagnose the issue, and that was only because I mentioned how the nipple blanching in colour and hurting.
    Flat or inverted nipples can cause pain as the skin begins to stretch out.

    • Fleur (Nurtured Child) says:

      Thank you for your feedback. :) This wasn’t meant to be an exhaustive list of all the things that can cause pain (that’s coming as I continue to add to my website!). I was highlighting two of the common (but less well known) reasons for pain that I see in my practice. Vasospasm can certainly cause a lot of pain and it is usually triggered by trauma to the nipples from a poor latch, or other issues such as tongue-tie. Fixing the initial cause of the trauma is an important first step when it comes to dealing with vasospasm.
      Truly inverted nipples can cause pain as the nipple is drawn out and adhesions are broken down. Pain from “flat” nipples is usually related to difficulties with latch.
      I’m sorry to hear that it took you several tries to find an answer for your pain. Good for you for sticking with breastfeeding and for continuing to look for answers!

      • Help! My baby is 4 weeks and this week, he’s been sucking so hard that the skin on my nipples is peeling off- I am dying!!!! He was born naturally and I wasn’t having this problem until now! I bought the nipple shield, but that was a disaster! I cry every time he wants to feed- I have to embrace myself- my nipples are a mess- they burn in between the feedings as well!

    • Andy, can you tell me more about Vasospasms? I have an EBF 7 month old, and I’m still battling with pain daily. Obviously the beginning was the worst. Breastfeeding my daughter for 6 weeks was a bazillion times harder than her natural homebirth. Even thinking about it now makes me want to cry. Anyway, lately I’ve been frustrated that I’m still in pain because I am a HUGE breastfeeding advocate, and want to really love breastfeeding (I loved it with my son even though we did have a rocky start with pain), but I am often annoyed and irritated. My daughter sucks like a Dyson. She has always had a super strong suck. But I think there is something else going on. I do have some signs of Raynaud’s (often horrible circulation in my hands and feet). I would love any info on this. You mentioned you finally found out what was going on. What are some of the solutions. I’m so done battling with nipple pain!

      • Fleur (Nurtured Child) says:

        Hi Bri, I’m sorry to hear that you’re struggling with painful breastfeeding. Vasospasm can happen as a result of Reynaud’s, or can happen in response to trauma to the nipples. The symptoms are the same but the underlying cause is different. In either case, moms usually notice a colour change from pink to to white and then eventually back to pink. It happens due to decreased blood flow to the nipple and is usually very painful. Along with treating the underlying cause if the vasospasm is being caused by trauma, many mothers find applying heat to be helpful, and some moms find that vitamin B6 and magnesium supplements can help. In extreme cases, low doses of the blood pressure medication nifedipine have been found to be helpful. Has your baby been checked for tongue and/or lip-tie?

  7. Great post. I love that you mention complementary therapies for babies with structural difficulties, but I was disappointed to see that you didn’t mention Osteopathic Manipulative Medicine. If you can find a D.O. who offers it and has experience with babies, it can provide a lot of relief. Not to mention that because of the way our insurance system is set up in the US, it’s more likely to be covered by insurance than chiropractic care because it’s offered by a physician (I wish most insurance covered chiro or craniosacral, but it’s been my experience that they don’t.).

    • Fleur (Nurtured Child) says:

      An oversight on my part because in my own area, chiro and CST are far more common. There are certainly other types of complementary therapies that can be beneficial, and I’ve updated the post to reflect this. Thank you! :)

  8. I think it’s important that it becomes common knowledge that there are things like tongue tie, lip tie and structural issues. I had excrucuiating pain with my first for 8 weeks at every feed. It was horrible. I asked for help everywhere I could and all I heard was you’re doing so well the latch is great. Well, I wasn’t doing well. The only way to cope with it was to become cynical about the “there shouldn’t be any pain” statement. I stopped believing it. With my second I had no pain at all. I’ve since noticed a lip tie in my first… she was born by forceps. I wish I’d known this at the time and it could have saved me (and my daughter, who was a very unhappy camper, feeding constantly and screaming when not feeding) a lot of pain.

  9. This is a sensitive (so to speak, ha!) subject for me because I had an extremely difficult time nursing my son in the beginning. We stumbled onto a number of obstacles and somehow preserved. We are still nursing at 28 months. But my son had a terrible time latching. The IBCLC we saw in the hospital was invaluable. She gave exercises to use with him to teach him the right way to latch. This was not an overnight process, however and there were times I could not get him to latch at all and resorted to formula. Once I would get him latched, there was no way I was going to unlatch him if it was incorrect after spending 15 minutes or more trying to get a very frustrated and hungry baby to latch on. This obviously had an effect and caused pain for me and I had vasospasms too, but the pain I experienced was much more than that. I also had one flat and one inverted nipple. Latching him to the inverted nipple was excruciating at times. The pain went away around 5 weeks or so (vasospasms took longer but I could deal with those). Looking back, I think it was a combination of several factors but mostly, my body had to learn and make adjustments as he needed to learn how to nurse properly as well. What would have been far more helpful for me to hear is that for some women, it can be painful in the beginning but that will ease over time(and typically a few weeks really). Mentally I could be better prepared instead of continually reading about how I must be doing something wrong because it hurt. I understand we want to reach women with fixable issues so they don’t give up, but we need to be careful how that message is given, or else it may have the opposite effect. Hearing, hang on, it will get better, is so much better than thinking that pain is forever and I’m not getting it so I may as well give up. I think we should tell women, Most of the time if there is pain, there is a something that can be fixed so please see an IBCLC. And then noting that it is painful for some women in the beginning but gets better soon and an IBCLC can help you find ways to cope in the meantime. Personally I think that is a much more positive message for everyone and more accurate. And I wish you had covered anatomical issues in the mom too–like flat and inverted nipples!

  10. I had ALL of these issues with my twins. Eventually the combination helped and we are still nursing at almost 8 months. Now I’m dealing with milk blisters and have learned the hard way that I can NOT nurse laying down. Bummer.

  11. I enjoyed your post, Kerstin. I’m not sure I could go through it again as it took close to 6 weeks before we could latch with no pain but I know I’d try because we persevered and it’s a breeze now at 4 mo. It was frustrating for me to hear everything looked good and experience the curling toes and heat wave come over my body when he’d latch and I did dread hearing him wake up to eat and would just sob as I stuck him on. I have hope that any future children will have an easier time. He does have a super strong suck and I’ve never had to worry that he wasn’t getting enough.

    • If it offers you any hope, it seemed that it took my body less and less time to adjust hormonally after each baby. The first took 8 weeks, the second took 6 weeks, the third and fourth were both about 3 weeks. After that it was pretty much home free :-) But we’re all different!

  12. Tyra Spears says:

    I am so happy read this as it gives me.an explanation. Baby #6 born by c-section (My only c-section) 4 weeks ago. Had trouble latching on and lost 1. 5 pounds in 2 weeki s. We are doing well now and he has almost regained his birth weight. Many tears were shed and I had to really remain persistent. Doctor really wanted me to change to formula but I just kept going. Can’t wait to share this article with her.

  13. I was also a little disappointed. It wasn’t what I thought.

    I had extreme pain with one of my babies and everything was “just right.” After having my second, I found out why. My first baby had a tremendously strong suckle. She went at my nipples with incredible force. I thought it was normal. I thought all babies sucked that hard. She sucked so hard that the skin pigment came out of my nipples. They went from brown to light pink – lighter than ususal pink – in just a few days. I nursed and nursed and the pain disappeared at about six weeks.

    After having my second four years later, I was concerned he wasn’t getting any milk because he had this gentle little suckle. I fretted and worried because he didn’t nurse like my first had. But he was peeing huge quantities and obviously growing well, so I was wrong.

    In my case, my daughter had too strong a suckle. I suspect that some babies just really go at it and prefer an incredibly strong suction.

    • I forgot about that aspect! I literally had little hickey like marks on my nipples!

    • Fleur (Nurtured Child) says:

      That super strong suck is actually one of the signs that there is something going on structurally with the baby that could be helped by chiropractic care or craniosacral therapy. It seems to be that those babies who are not able to suck correctly tend to increase the amount of vacuum they use when sucking as a means to compensate (which usually causes pain for mom).

      • Considering the problem resolved without that care, after my hormones evened out (all FOUR times), I doubt that all four of my babies needed chiropractic care. They were fine. My nipples were sensitive from hormones. There is no one size fits all for these things, and turning everything into a “there’s something wrong with you or your baby” does a GREAT disservice to women, and undermines their confidence.

        • Fleur (Nurtured Child) says:

          Babies are often able to self-correct structural issues after a period of time, the bodywork simply speeds up the process so that mom isn’t in pain for as long.
          I certainly agree with you that that there is no one-size fits all answer to breastfeeding issues, and there are certainly other possibilities (such as hormonal issues) that could be causing pain. As I mentioned in my post, tongue and lip-tie and structural issues are simply the two most common reasons that I see in my practice. Unfortunately it’s not feasible in a blog post to go into all of the possible reasons for pain, but I always take an individualized approach with the mothers I work with. My goal with this post was simply to bring to light two possible reasons for pain that are often overlooked because most health care providers haven’t been taught about them.
          I think it’s wonderful that you were able to nurse all of your babies despite the initial pain. I’ve been there myself and I know it’s not easy! :)

          • I guess what I’m trying to put out there is that hormonal changes should be on every list like this–I think it plays in to a majority of nursing issues, since most women do have hormone changes post partum (think PMS breast soreness. Imagine nursing while you have those hormones times 100 going through your body–it will make those toes curl! ) And I think professionals don’t really consider it enough, because it’s not something to fix and it’s natural to look for things to fix.

            I want to have this as part of the conversation because I think too much focus is on what is WRONG and we’re not really (as a general population) empowering mothers. I want that to change! I want my voice to help that change, so that no other mommy has to assume from the get go that she must be messing it up :-) I feel like people like me are actually pretty common, but very much underrepresented in these lists! I feel compelled to speak up about it! But I’ll let it go now, and hope others will at least consider it after reading this…and still others will get checked when they’re experiencing pain, but also consider it may just be natural for their bodies.

            • Christelle says:

              Thank you so much for this comment. I have felt so discouraged when I hear over and over “breastfeeding SHOULD NOT HURT” well in my case and as I see many other cases it does hurt and there is nothing wrong with mom or baby.
              Thank you again, that has really given me a boost :)

      • Interesting info about the strong suck signifying potential structural issues — I’ve never heard that before. I didn’t have any interventions, but my daughter was posterior, I had to push for a long time, and she had a significant cone head when she came out. The cone head went away quickly but she sucked HARD and nursing was painful for the first five weeks. Meeting with a lactation consultant to improve latch definitely helped, but I never knew there were other treatment options. Luckily we’ve had no further issues and she’s still nursing at almost two.

  14. In my case, I think a SINGLE bad feed when my daughter was tiny caused lingering pain for weeks. I didn’t take her off the breast to reposition her, so there was damage, and then it just couldn’t heal. Hoping it goes a little easier this next time.

  15. I was excited to see this, but then disappointed to read it. I’ve successfully nursed 4 babies into toddlerhood, and every single one of them hurt. I am always SO frustrated to hear the “it’s not supposed to hurt” BS. For most people, sure, it’s not. But let me tell you, the very FIRST sign I was pregnant for me was that my nipples became incredibly sensitive, cracked, and chapped. At 5 weeks pregnant. 35 weeks before a latch was anywhere near my issue. When the baby came along (each time) with a super suction baracuda mouth, you better BELIEVE the nipples that hurt when water touched them hurt when my babies fed!
    I was one of the oh-so-lucky chicks who had ultra sensitivity, and I’m 99.9% sure that HORMONES caused it. Our latches were deemed perfect. My babies were fat and healthy. And breastfeeding hurt for the first 3-8weeks. And that WAS normal for me. If I had listened to the “it’s not supposed to hurt” people I would have given up the first go round. I almost did, thinking there was something wrong with me because of that statement. But my mom and sister confirmed their own painful beginnings, and thanks to that I questioned all the (very wrong) know it alls who had said that. We need to get that phrase OUT of lactation vocab and start looking at people as individual cases instead of cookie cutter “shoulds” and “shouldn’ts”. rant over. lol

    • Coudn’t agree with you more! I was excited to see the title, disappointed to read the article. I have successfully breastfed 3 children, and with my first (twins), I had such excruciating pain in the beginning that I considered pumping exclusively. My mother continued to reassure me that the pain was normal (although everything I read and every “professional” that I talked to told me that I shouldn’t be having any!). My nipples were so sensitive that it hurt to shower and for quite some time, I had to shield my nipples from the cold winter air! The pain went away at around 6 weeks. With my 3rd child, I had nipple pain for the first week and a half, and I ignored the LC at the hospital who told me that it shouldn’t hurt. The nipple sensitivity lasted for a few weeks longer. All of my babies gained weight and were perfectly content little newborns. And all 3 were delivered via C-section.

      • Fleur (Nurtured Child) says:

        Hi Julia, The situation you describe with your children is exactly the kind of situation where I usually find that there are structural issues with the baby that have been caused by either the delivery process, or the baby’s position in utero. These structural issues are often very subtle, and they usually don’t have a negative impact on the baby’s ability to transfer milk and gain weight (although they can), but they are enough to cause mom pain until the baby’s body manages to self-correct the issues in time. These are the kinds of situations that tend to benefit greatly from gentle bodywork for baby.

    • LOL, I was in labor when you posted this and had my daughter shortly thereafter. My first daughter, a big healthy 9 pounder had a suction that would put a shop vac to shame, came out that way…I had painful nipples and I just cringed to nurse… but my bloody nipples eventually healed and became shoe leather and my baby grew faster than anyone else I knew… Now my new baby, 10 lbs, has come out sucking like a machine as well and I am having the same issues. I am one of the lucky momma’s that have super high hormone levels. I barf until 14 weeks… super sensitive nipples…. daughters shed my hormones after birth and there is usually a bit of blood present…. the whole enchiliada with me… now.. it is great to read your posts. The suction is fantastic, i can hear the milk pour down, the latch looks text book, body position as well… still the pain… but it is subsiding. Thank you for mentioning the that this issue can be due to a super sucker… barracuda… is the BEST description… I call her a vampire…. and high hormone levels. My nipples are so sensitive during pregnancy… my bra turns me on something fierce… if ya get my drift.
      Your post has encouraged me that there isn’t something wrong with me or my baby. I will do as before and put my big girl panties on and take one for the team! Comfrey tincture helps immensely, just be sure to wipe it off before nursing and also lanolin. Oh, my nipples are so cold, that i asked my hubby to go kill a rabbit for me for the fur,…. cold weather hurts as bad as the babys hoover mouth…. don’t get me started on shower water………………….OUCH! Good luck ladies

    • thank you so much for posting! you are speaking my mind. whether the hormones or just the physical stimulus is what changes the pain later, the fact is, it is very NORMAL to have pain in the early stages of breastfeeding.
      mother of 3 healthy fat babies, all breastfed for more than 2 years!

  16. I ended up seeing a lactation consultant 3 weeks pp. I was having toe curling pain. That is the perfect way to describe it. In fact, the day I went to the appointment I had exclusively pumped/bottle fed for the last 6 days because the pain was so unbearable. She said his latch was great and the pain was mostly gone too. The only thing I can figure is that his latch wasn’t good to begin with which started the pain and my nipples just couldn’t heal while I continued to try to breastfeed. For me, giving my nipples the week long break was a life saver. He turned 1 last week and is still a breastfeeding champ. I know that there can be an issue with nipple confusion so this might not be the best idea for everyone, but for us it worked.

  17. Great post Fleur. I cannot tell you (but I am sure you can guess!) how many times my clients have been told “oh but the latch is perfect” even when their nipples are cracked and bleeding and they are crying at the very thought of latching their baby!

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