Although I’ve criticized the health service for their, ‘breastfeeding is easy as long as you do it right’ line (a criticism that I stand by), the health visitors and midwives I have spoken to have generally been sympathetic. They have also been willing to deviate from the official advice when it’s obvious that it isn’t working.
Faced with my mutilated nipples, two midwives suggested nipple shields. A shield is a silicon or rubber teat that you hold over the nipple to protect it during a feed. It is shaped like a large nipple, with holes in the end for the milk to come through. Apparently, they can affect milk supply, so do not have NHS approval, although I have since discovered that this recommendation may be rather out of date (see the nipple shields research post). I didn’t have any luck with shields (C looked at me as if I were mad – she was going to put one of those in her mouth?!) but I have spoken to many women who found them useful.
Breast shells, on the other hand, did prove to be a hit. In contrast to shields, you use shells in between feeds, to protect sore nipples or draw flat ones out (they apply a small amount of suction). They consist of a silicon disk with a hole in the middle for your nipple, topped off with a half a clear plastic tennis ball that acts as a protective bubble around your nipple and stops the fabric of your clothes coming into contact with it. The plastic bit also has holes in, to allow air to circulate. The instructions said to always make sure these were facing upwards, an instruction that I initially failed to heed. What difference would the direction of the holes make? I discovered the answer to this when I noticed a substantial wet patch on my t-shirt. A significant amount of milk can collect in them if you have them on for any period of time, and this milk will naturally leak out of any holes it finds. If you can motivate yourself to sterilize the shells regularly, you can store this milk for later use, but it wasn’t really a priority for me at that point. In the end, I put a breast pad in each shell to soak up any rogue milk (making sure the holes pointed upwards, of course.) Although this will have hindered the air flow a little, the shells still proved very effective in preventing discomfort, and seemed to allow my nipples to heal more easily. I say ‘seemed’ because the effect may have been psychological – when using the shell, my nipple looked less mangled, and I thus assumed it was improving.
I should probably mention, however, that I didn’t exactly use the shells as specified on the box. The instructions state that you shouldn’t use them for more than a couple of hours at a time, as they can cause blocked ducts. I weighed up the potential for blocked ducts against the possibility of my nipples healing a bit faster, and decided the chance of the latter made it reasonable to risk the former. This meant, in practice, that I ended up using them all the time, including at night. Fortunately I didn’t suffer any blocked ducts, although I did end up stretching a rather expensive Elle McPherson nursing bra (and looking like Madonna during her pointy cone bra period unless I dressed very carefully). To date, there has been very little clinical research investigating the effectiveness (or not) of breast shells (see breast shells: preserving your modesty), but they seemed to help me get through a difficult time. If you want to take the pressure off your nipples – and are willing to risk increasing it on your milk ducts – they may be worth a try.
My nipple fissures weren’t showing any signs of improving, so after a day of deliberation, I phoned the National Childbirth Trust. I was starting to realise that the fact that there were helplines (and whole charities, in the case of La Leche League) dedicated to solving breastfeeding problems should probably have served as a warning that it might not be that easy. The counsellor who answered the phone was helpful, if a little abrupt. She asked me which direction my nipples pointed (!) and when I said it was slightly outwards, rather than directly forwards, she said that they were probably getting bent backwards in C’s mouth when I was holding her in the cradle feeding position. She suggested using a different position to feed her (such as the rugby/football hold, where C’s mouth would approach the nipple from the opposite direction) while I waited for them to heal. This seemed sensible advice, and after a few goes, C and I managed to perfect some new feeding positions. Although I can’t say it was definitely less painful, the knowledge that C’s mouth probably wasn’t putting pressure on my nipples in the same way seemed to help at least psychologically.
Having 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.
The 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 Truth About Breastfeeding 