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Expert Q&A

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

I have not gotten my milk in yet, and my nipples are extremely sore. I have had to supplement my daughter's feedings with a bottle, because nursing is excruciating. My nipples are cracked, sore and sometimes bleed. My nurses at the hospital said that she is latching on properly, but if she is, why am I so sore? Could there be a serious health problem?

You don't say how old your baby is, but I'm guessing just days old since your mature milk hasn't come in yet. I'm wondering when the pain first started – whether it hurt with the first nursing, or if the pain gradually built up. Some tenderness in the early days is not all that uncommon, but the kind of pain you describe is an indication that something is not right. The ""something"" is most likely something that can be easily corrected and is NOT likely to be any kind of ""serious health problem.""

Some possibilities:
1. Your baby is not positioned well. You say that the nurses at the hospital say she is latched on well. I'm wondering if you have seen a lactation consultant, one with ""IBCLC"" after her name, meaning she is an Internationa l Board Certified Lactation Consultant and has passed a major exam after hours of study and consultation practice.

Nurses can be very helpful for new moms, but they are not routinely trained in lactation. Sometimes a minor change in position makes a major change in comfort, and a nurse might not recognize the subtle indications that might point to poor positioning.

The basics of a good position include having Baby raised to nipple height, using pillows as necessary, and she should be on her side so that her ear, shoulder and hip are in a straight line. Tickle her lips and wait for a WIDE open mouth, and quickly bring her onto the breast. Your nipple should point up to the roof of her mouth, such that when she's latched on she'll be slightly off center and have more of the bottom part of the breast in her mouth than the top. You will need to continue to support your breast throughout the feeding, at least until your baby is big enough and experienced enough at the breast to manage.

2. Your baby could be tongue tied. This means that the flap of skin underneath the tongue that attaches the tongue to the floor of the mouth comes too far out toward the tip of the tongue. It makes it very difficult for Baby to stick his tongue out far enough under the breast for a comfortable latch. These babies have a very characteristic heart-shaped tongue when they cry, because that frenulum (the attachment flap) is pulling the tip of the tongue inward.

If this is the case, the frenulum can be cut to free up the tongue. It is a relatively simple procedure and the change in comfort for Mom is immediate, and Baby is less frustrated as well. The hard part is finding someone who will do the procedure; too many well-meaning doctors don't believe that breastfeeding is important enough to ""bother"" with this effective treatment for these babies. An IBCLC should be able to help you identify whether this is a problem for your baby and can probably find someone to do the procedure.

3. Your baby may have nipple confusion. Depending on when she was given bottles in relation to when the pain started, this could be a factor. And even if it wasn't the initial factor, it is likely that it is aggravating the problem. A baby does different things to a bottle nipple than she does at the breast. Think about a bottle – it drips milk constantly, unless Baby clamps down on the nipple long enough to swallow. She'll keep that nipple in the front of her mouth. At the breast she must use her tongue as a muscle to help get the milk flowing, and the nipple needs to be in the back of the mouth.

There are other ways to feed a newborn who isn't nursing effectively. Again, an IBCLC is your best resource here.

4. You may have a yeast infection on your nipples. Are you prone to vaginal infections? Were you given antibiotics around the time of delivery? Since your baby is so young (I'm guessing the age again), this is less likely to be a problem, but could be. There is an excellent series on yeast infections (thrush) written by Mary Kay Smith, one of the other IBCLC experts here on the Breastfeed.com site. Check it out.

You really need to work with someone who is knowledgeable about breastfeeding and can narrow down the problems that might be involved here. If there is no IBCLC on staff, ask if there is one in the area, or check it out on the Web. Another excellent source of help with breastfeeding is your local La Leche League leader. Check the LLL Web site for a leader near you.

Get the help you need. Breastfeeding shouldn't hurt!"

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