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Expert Q&A

	By Melissa Clark Vickers International Board Certified Lactation Consultant Moms & Babies Huntingdon, Tenn.

I have been breastfeeding for a month and, due to improper positioning at the beginning, suffered a deep tissue fissure in my left nipple. Through proper positioning, the nipple is now much better but it's still more painful than my right side. How long before this wound will completely heal and breastfeeding can be an enjoyable experience?

Ouch! You have learned the hard way how important proper positioning is! I'm glad that you were able to improve the positioning to make breastfeeding more comfortable. Breastfeeding is NOT supposed to hurt!

As for how to heal the fissure, you might try a technique called moist wound healing. In the past, the typical recommendation has included everything from air drying to heat lamps. New research--much of done with burn patients--indicates that skin tissue will heal more easily and quickly if steps are taken to prevent the natural internal moisture from escaping.

The trick is to cover the wound with something that keeps the internal moisture in and still allows the wound to breathe, all without the formation of a scab. La Leche League International recommends using an ultrapure modified lanolin called Lansinoh. This is lanolin, minus the environmental contaminants and allegy-producing components, purified to the point that it is not even necessary to remove it before nursing. A little bit goes a long way--just warm a pea-sized dollop between your fingers and then pat on your nipple. Not only will this aid in healing, but it also covers the raw nerve endings and makes nursing more comfortable.

If the fissure is so deep that even with proper positioning it is too painful to nurse, you can give that breast a rest for 24 hours or so and just feed your baby from the other breast. He'll get enough milk, although you may have to nurse a little more frequently. If you try this, remember that you will still need to remove the milk from the sore side, otherwise, you'll be inviting plugged ducts and mastitis (breast infection) to set in--and you don't need those on top of this wound! Many women find they can pump milk comfortably from a breast with a nipple fissue, provided they have a good pump. A hospital-grade pump such as one from Medela, Inc., or Ameda Egnell is a good choice. Hand expression works as well.

Generally, nipple damage will heal pretty quickly, provided whatever caused it in the first place has been discovered and corrected. In the meantime, use any pain-relieving techniques you may have learned in childbirth classes to relax as your baby latches on. Try to consciously push your shoulders down, and breathe out as your baby latches on. Ask your doctor about taking Tylenol or ibuprofen as needed for pain relief.

It will get better, and with the pain out of the way, breastfeeding will be ever so much more enjoyable for you! Hang in there!"

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