In addition to using a nipple shield, both the health visitor and the NCT helpline lady suggested I try expressing milk and feeding it from a bottle, to give my nipples a bit of a rest. C’s response to the shield was not encouraging, so using a breast pump was really the only option I had left if I wanted to carry on. So far I’d just about been able to put up with the pain: if I gritted my teeth through the initial agony, the remainder of the feed was just about bearable. The sight of my nipples, however, was really quite perturbing. The open wound on the outside edge of one was so deep it looked as if the nipple were in danger of detaching. The psychological effects of seeing this type of damage were considerably worse than the pain. I could only assume it was getting worse with each feed, and therefore that I was mutilating myself further.
Despite the obvious arguments for using a pump, and possessing one that was bought before C even arrived, it took me another couple of days to get around to using it. I don’t know quite why I was so reticent, but I think it had something to do with feeling guilty and inadequate not being able to get it right on my own. The turning point was speaking to my friend Zara. It turned out that she’d had exactly the same problem – right down to the fissures in the same place – and had pumped to help with the healing. She’d also had the same feelings of guilt and inadequacy, but had come through the other side and said that it made a massive difference. I wasn’t going to get any extra points for prolonging the pain, so I should just get on with it.
Some women find expressing milk easier than others. The key is prompting the letdown reflex – after that getting milk out is reasonably straight forward. Without your baby actually suckling, however, letdown isn’t always that easy to initiate. Looking at a picture of your baby (or indeed your baby herself) is one way of getting the vital oxytocin flowing. The solution for me was pumping from the really mangled left hand side, while C fed from the slightly less injured right hand side. For about four days, I expressed on the left and fed on the right, feeding C the expressed milk in a bottle if she was still hungry.
Using the pump and feeding simultaneously gave me an interesting way to monitor the extent to which the expressing helped. I had the same injury on both sides (albeit not as badly on the right), but only used the pump on one. It definitely provided me with some relief – expressing was much less painful than feeding – and the nipple did heal eventually, but the right side also healed completely, without any intervention. The healing actually occurred slightly faster on the right hand side, although this might be expected, as the injury wasn’t quite so serious. It seemed that the midwife who told me that things would eventually improve of their own accord was right after all. I think the problem for me was caused by the fact that my nipples weren’t quite the right shape initially (for C’s mouth at any rate – I don’t know if it would be different with another baby) and the skin broke so they could be stretched into a better one. Certainly, they now look quite different to how they did originally – pointy where they were once quite flat. When they healed, extra skin grew over the fissures where they’d stretched, rather than the skin knitting together at the point where it was originally joined, providing further evidence that my nipples were simply going through a (very painful!) transitional process.
Although it seems that both nipples would probably have recovered of their own accord if I’d continued feeding C as normal, I would strongly recommend using a pump if your nipples are suffering. It really helps to relieve the pain, and if you plan to bottle feed later on (whether with expressed milk or formula), introducing it early (and continuing regularly) means you should meet less resistance later on. Even if you take into account the constant pump dismantling, sterilizing and constructing, it’s a win-win situation!
The Truth About Breastfeeding 
January 23, 2009 at 10:33 am
“The open wound on the outside edge of one was so deep it looked as if the nipple were in danger of detaching.”
this to me is serious. in danger of detaching? oucchhh!!! i had my share of nipple bruises, but yours is something else and you are one brave mama! you did the right thing, pumping that is. it will not disrupt your milk supply and the wound will eventually heal, faster than when you let C suckle it. good job! continue on doing what is best for you and for your baby. God bless!
January 25, 2009 at 9:55 am
Fortunately things are much better now – thanks for the support. 🙂
April 3, 2009 at 8:26 am
[…] with the bottle April 3, 2009 — Elizabeth Jay When C was a few weeks old, and I was expressing to take the pressure off my beleagured nipple, she would gulp down whatever ended up near her mouth – even milk straight from the fridge. I […]
May 30, 2009 at 10:17 pm
Hi Elizabeth…
I am a new nursing mom and I am having the same problem that you have… MUTILATED nipples with deep fissures on each one. I just started pumping yesterday. Did you really heal in 4 days? Your site has given me hope. How old was your little one when it healed? Thanks in advance!
~Alison
May 31, 2009 at 6:07 am
Hi Alison,
C was about 8 weeks when they healed completely, but they were much better from about 6 weeks, which was when I stopped using lanolin and started pumping/using the shells. The fact they improved at this point may have been coincidence of course – it’s difficult to know! I think my problems were partly caused by the way C was latching on. We were doing it in exactly the way we’d been told, which was technically the ‘right’ way, but I don’t think it was necessarily the right way for us. All mothers and babies are different so I think it’s worth experimenting until you can find a position that doesn’t hurt. I don’t know whether you’re aware of biological nurturing? I’ve so far only heard good things about it, and it’s something I wish I’d known about earlier.
Having said all that, my nipples did eventually sort themselves out, and nursing became a piece of cake – really easy and convenient (like they tell you it will be before you have your baby)! It’s highly likely that if you can grit your teeth long enough, the same will be true for you.
Elizabeth
September 30, 2009 at 3:32 am
This is a wonderful website. I am also a research scientist and going on my 6th week of horrible, bloody nipples, and have been outraged at the lack of actual medical or scientific information available on breastfeeding. I wish the process was better studied and the truth was more transparent. I still would have chosen to breastfeed, but it would have been nice to be more prepared. Of course, I may feel differently if things aren’t starting to improve soon… (I’ve also become familiar with nipple shields and shells, lanolin, and pumps with varying sizes of breast shields and have recently recovered from a bout of mastitis, so my fingers are crossed…)
September 30, 2009 at 5:21 am
Hi Sara – the lack of information is truly shocking, isn’t it? Your experience sounds very similar to mine… I really hope things start to get better soon!
August 23, 2010 at 10:27 am
You have given me hope! I’m in the same situation and almost gave up this morning when me LO threw up blood from my bleeding nipple! I feel so bad that he had to take that in! I blame my midwife who diagnosed tongue tie on day2 and did nothing about it even when I mentioned on day 5 that my nipple was bleeding! We are four weeks in and after Reading your post I feel normal and like I have a plan! Thank you!
September 1, 2010 at 8:19 pm
Sorry to hear about your experience – it’s such a horrible thing to happen. I hope everything goes according to plan!
June 22, 2013 at 12:43 am
I know this blog has been inactive for a long time, but I wanted to let you know how important it was for me in dealing with my severe nipple trauma. Both my nipples are inverted, and I have extremely large breasts – an L by the time I began nursing. My daughter mauled me her first feed (no LC at 4am!) and although the LCs pronounced my latch great, I had extreme pain every time we nursed and watched my nipples look worse and worse (“nearly detached” is a great phrase – I had deep cracks and an oval hole on one side and an entire horseshoe ring of raw skin with two tiny islands of regular skin on the other – they looked like raspberries made of ground beef stuck to my chest) until I finally went to the doctor at four weeks. Her verdict was that I should exclusively pump, use Bacitracin and nonstick dressings inbetween. EPing made me weep constantly so it lasted a day. Your blog gave me hope and I went with EPing the worse breast, and feeding the less bad one every other feeding. I had spent five weeks trying to “fix the latch” since everyone was insistent that if I was doing it right it wouldn’t hurt. When I went to the LC and she told me my latch was just fine, I nearly cried. I stopped trying to reattach the baby, her mouth got bigger and kinder to my extra large nonpointy nipples (gee, that size of mouth vs size of nipple thing would have been helpful to know), and I stopped crying and stomping my feet every single time she fed (at least, the first few feelings of the day were less painful.)
Things really started to improve when I rented a hospital pump, and I started feeding both breasts every other feeding at eight weeks, and then reduced the pumping to twice a day while my husband fed the baby a week after that. The worse breast fully healed at 11 weeks and the less bad breast is nearly healed now, at 13 weeks.
There is so little practical information out there about inverted nipples (“feed from the noninverted one!” “It’s not called nipple feeding, it’s breastfeeding, you will have no problems” but no videos, no pictures of making it work, just the assertion that it will even if you can’t pull roll or pump out a nipple long enough to get it in the baby’s mouth) and nipple trauma treatment (lanolin – oh, you’re allergic? Neosporin, no, Polysporin, no, salt water soak, no, stop having problems darn it, you’re wrecking our vibe, it shouldn’t hurt if you’re doing it right, stop having it hurt, you’re doing it wrong, probably you have thrush with no symptoms) and this blog empowered me. The look at research was great and just the knowledge that it hurt someone else and did heal eventually after trial and error made me feel better. So thank you, thank you, thank you for being the only useful link in a search for “nipple fissures” and luckily still on the first page of Google results.
June 22, 2013 at 1:05 am
I wanted to add this – how unique one’s individual solution may need to be. For instance, going around topless is not an option for me, I get terrible back pain and my nipples didn’t “air out” anyway, they just pulled themselves back in to be reopened next feed, excruciatingly. I also developed vasospasms, so cold was horribly painful and the nipple shells were okay but hard to fit in a bra with the Lcup girls so I gave up on those too. Changing from clutch/rugby hold to cross-cradle helped mysteriously (large breasts = clutch hold!!!! Why isn’t it working for you???) as did accepting I was never ever going to do cradle hold and I was always going to need both hands (and I dunno about the carpal tunnelly wrist pain resolution, one problem at a time). Anyway, knowing others have pain, knowing lots of different treatment ideas, and being able to call BS on some suggestions is the gift this blog gave me.
June 22, 2013 at 8:51 am
Thanks for your comment – it’s great to hear things are getting better.