Nipple nightmares 2: fissures

mother holding babyHaving been told that my initial breastfeeding difficulties – cracked, bleeding, excruciatingly painful nipples – were quite normal (despite what the official literature said), I was looking forward to the three week deadline after which everything would be functioning as it should. I was, however, slightly perturbed by the fact that as he deadline approached, no improvement was evident. In fact, my nipples were getting much, much worse. My husband expressed genuine concern that C was going to chew one of them off! By this stage, the bleeding had stopped, but it had been replaced by deep, ulcerated gashes on the outside edge of each nipple. I dreaded feeding, and as C wanted to do so 10-12 times a day, I spent all 24 hours either in pain, or anticipating its imminent start.

‘A mother’s guide to breastfeeding’, provided by my health visitor, wasn’t particularly reassuring. The only place it mentioned what I had finally come to recognize as fissures was in the ‘problem solving chart’ on the back cover. Apparently, this meant that C had tongue tie! I thought this was unlikely, as we’d seen her sticking her tongue right out of her mouth. Nevertheless, the information sent me into another panicked state, and I was on the phone yet again to the maternity unit.

On the next visit, the midwife assured me that C didn’t have tongue-tie. In fact, she seemed remarkably unperturbed by what I felt was the pretty horrifying sight of my nipples. Although she didn’t know quite what the problem was, she acknowledged that some mothers have these difficulties, and that many of them give up as a result. She was confident that things would improve, and said that I should consider getting a nipple shield to make things more bearable in the short term. She also suggested I call a breastfeeding helpline. I was sceptical they would be able to tell me anything I didn’t already know, but by this point anything was worth a try.

Nipple nightmares 1: bleeding

mother breastfeedingThe first couple of days at home were pretty breezy. Before I left hospital I was assured by two midwives that C was latching on properly – cheeks puffed out, chin pumping, ears wiggling – so I was confident we had the technique sorted. Family visited and I assured them everything was going well, demonstrating our successful feeding on several occasions. By the time I got to day four, however, things weren’t quite so easy. Accompanying the hormone-induced plunge into despair inadequately named ‘the baby blues’ (that coincides with the start of proper milk production) was a serious deterioration of my nipples.

The ‘initial soreness’ quietly mentioned in some of the leaflets just didn’t cover it. Not only did feeding result in agony extending minutes beyond the approved first 10-15 seconds, but I was starting to display serious war wounds. The first time that C vomited blood I was frantic with worry, and straight on the phone to the maternity unit. But, as the midwife reassured me (!), the blood was my own, swallowed by C while she fed. Bleeding!? No one had told me about this. Well, no one except for my friend Zara… Surely it couldn’t be normal? It certainly wasn’t according to the copious NHS breastfeeding resources.

And this was a major part of the problem. Everywhere I looked I was told that nipple soreness, cracks and bleeding were caused by the baby failing to latch on correctly: these problems were my own fault, caused by a poor technique. The thing is, when I talked to the health professionals, I was told I was doing it right, and fortunately, C seemed to be getting plenty of milk.

When the midwife next visited, I voiced my concerns. She checked my attachment – again, it seemed fine – and then admitted that she had had the same problem. Apparently, people with fair skin have a much harder time of it when it comes to breastfeeding. My nipples hadn’t darkened at all during pregnancy, so I could be particularly susceptible to problems. Hearing this was a massive relief. Ironically, being told that I might find it more difficult because of my inferior nipples made it easier to carry on (see the post on skin colour and nipple pain for more info on this). The midwife suggested I grit my teeth, and within two to three weeks it would be ‘a piece of cake’.

Does pale skin mean problem nipples?

test tubes and tape measureOne of the anecdotes you may have heard (particularly if you are pale) is that women with fair skin are more likely to experience sore or damaged nipples. If you have very light skin and painful nipples (as I did), it may be strangely reassuring to be able to attribute at least some of the difficulties you’re experiencing to your colouring. On the other hand, if you have dark skin and sore nipples, you may simply view this kind of statement as irritating nonsense.

Is there any evidence that skin colour is associated with nipple problems when breastfeeding? There don’t seem to be any studies looking solely at the relationship between the two, but there are some studies that have included it as a factor, and the results they report are mixed. Whilst one study looking at breastfeeding in the first few days after birth found an association between nipple damage and skin colour1, another found that there was no link between the two2.

To confuse matters further, some research looking at the effect of ‘conditioning’ nipples prior to breastfeeding (by rubbing them with a rough towel – ouch!) found that women with fair skin reported significantly more pain when feeding on the unconditioned nipple, and olive skinned women reported significantly more pain when feeding on the conditioned nipple3. (I should mention that this research was carried out in 1979 – actively damaging you nipples whilst pregnant to ‘toughen them up’ for breastfeeding is no longer recommended.)

So, it seems the jury’s still out on this one. I suppose the most important thing to remember is that whilst there may be some link between fair skin and nipple pain or damage when breastfeeding, there certainly isn’t conclusive evidence for this, and there definitely are reports from women of all skin types that breastfeeding can be very painful!

  1. Rev Bras Enferm. 2005 Sep-Oct;58(5):529-34
  2. Birth. 1987 Mar;14(1):41-5.
  3. Nurs Res. 1979 Sep-Oct;28(5):267-71

Early days

drawing of baby crying

Before giving birth, I heard somewhere that babies should start to suckle in the four hours after birth, and ideally straight away. When I was handed my tiny, startled daughter, I was pretty zonked, but I seemed to recall her little mouth seeking out my nipple. Or me putting my nipple near to her little mouth. Or something like that. Anyway, within a few minutes of ‘skin on skin’ she seemed to have something breast-like in her mouth and was happily sucking away.

The midwives were all suitably impressed. ‘Ooo, look she’s latched on already! That’s great. I’m sure you’ll be a natural.’ Well, of course – surely breastfeeding was the most natural thing in the world? If you were happy to let your intuition govern your actions, and you responded to your baby instinctively, then it seemed pretty straightforward. I should point out at this stage that I’d just had a calm water birth, without major trauma or pain relief, and was therefore feeling pretty earth mother about everything. Breastfeeding was the next obvious step, and I was going to be great at it.

Over the remaining hours spent in hospital, my daughter C and I slept, interspersed with periods of the suckling we were both so fantastic at. If I was honest, it was starting to sting a bit, but nothing I couldn’t handle. The next morning, I overheard a conversation between a midwife and the woman in the bed opposite me on the ward. ‘Are you breast or bottle feeding?’ the nurse asked. ‘Bottle’ she replied without hesitation. ‘He’s had loads – two lots of 30 mils just last night’. God, you had to make up that formula from scratch each time, I thought. What a pain! How can you have dismissed breastfeeding so quickly?

Before the birth

drawing of stork carrying baby

As a responsible mother-to-be, I went along to the last ‘parent craft’ class at my local health centre as a matter of course. The main theme of the class was feeding your baby. Or, more precisely, breastfeeding your baby.

Breastfeeding, as anyone who has recently had a baby will know, is STRONGLY ENCOURAGED by the National Health Service, World Health Organization, National Childbirth Trust, Unicef … in fact, pretty much any health/baby-related organization you can think of. As the midwife taking the class pointed out, she officially isn’t allowed to say anything that might encourage you to start on the formula instead.

I wasn’t worried. For me, there was no question about it: my mother and mother-in-law had both breastfed, and obviously, I would do the same. As the other conscientious first-time mothers and I sat in the class and discussed the copious advantages of breastfeeding, and disadvantages of formula, we all smugly agreed that it was the obvious option. So cheap and convenient, not to mention fantastically healthy for both you and your baby. This was all provided you got your baby to ‘latch on’ properly, but really, how hard could it be?

‘I did actually find breastfeeding quite difficult,’ said my mother. Well, I can understand that, I thought. In those days, women were actually discouraged from breastfeeding, and as Mum had frequently reminded me, she was the only woman on the whole ward who did it. Given this complete lack of support, it isn’t surprising she had a bit of trouble. I had NHS leaflets and helplines coming out of my ears, so I was obviously well equipped to deal with any of the minor difficulties that might arise. My friend Zara had mentioned a few problems too, with bleeding nipples etc. Well, that sounded pretty extreme – hardly likely to be an issue for many people!

And so I naïvely began my journey into the world of pain and paranoia that constitutes the early days (or should that be weeks?) of breastfeeding. Ultimately, with incessant, dedicated research into what was going wrong, and stubbornly gritted teeth, I made it through to the happy point where feeding no longer hurt, and was a genuinely convenient alternative to the bottle. What I discovered along the way however, was a society ill-equipped to support breastfeeding mothers, and a patronizing health service unwilling to be honest with them.