Some general rules of thumb and best practices to prevent nipple irritation while breast feeding:
Use no soap on your nipples. Wash only with warm water as needed in the shower/bath.
Avoid routine use of breast creams. If your nipples become tender or sensitive, hand express a few drops of colostrum/breast milk after each breast feeding and rub gently into your nipple/areola. Air dry for a few minutes. Colostrum and breast milk contain enzymes to soothe your nipples and heal. If needed, ask your staff nurse or the lactation consultant for help in learning the technique of hand expression. Lansinoh is a safe cream to use if a breast cream is needed. Squeeze a tiny amount from the tube onto your finger and gently dab the cream only on the spot where needed. Lansinoh is safe to use when breast feeding and does not need to be removed before feeding the baby. But, Lansinoh does have a taste and an odor which some babies do not like. Avoid using if your baby does not like the cream on your nipple.
Air dry your nipples for a few minutes after each nursing.
Use of a nursing bra is optional. You may leave your bra off until your breasts signal that they need the support. Support may be needed as your milk volume builds. Underwire bras can press on your breast tissue and prevent your breast from adequately draining, so it is important to wear a properly fitting nursing bra.
Use of nursing pads are optional. If needed, use only 100% cotton pads. Quality nursing pads may be purchased at the area breast pump depots and local maternity shops. You may also make your own nursing pads by cutting up old softened cotton tee shirts or by using men's 100% cotton hankerchieves folded up inside your bra. If your breast leak milk at night while you sleep, place folded towels on your bed to absorb the milk and keep your bed dry.
If your nipples are painful, reddened, blistered, or cracked ask your staff nurse and the lactation consultant to evaluate your latch and your baby's suckle. Or contact a lactation consultant after discharge for fedding and latch assessment.
Tenderness: Some tenderness can be normal as you become accustomed to breastfeeding and your nipples "toughen up". The first 2 weeks of breastfeeding are a learning period for you and your baby. If your nipples are tender, hand express (squeeze out) a few drops of your colostrum/breast milk after each nursing or as often as every hour and spread over your tender nipples. Allow your nipples to air dry. Some women find relief from nipple tenderness by placing a wet tea bag over their nipple for 5 minutes after each nursing. If you try the tea bag, rinse your nipple with clean warm water after each use and allow your nipple to air dry.
Blisters: Friction and rubbing on an area can cause blister formation -- like blisters on your heel caused by breaking in a new pair of shoes. If your nipple is not far enough back in the baby's mouth or the baby's suckle is very vigorous, the nipple can rub against the roof of the baby's mouth causing blisters to form from the friction of the rubbing motion. If your latch and/or you baby's suckle is not comfortable, ask the nursing staff for help. Arrange a lactation consult if your comfort level is not greatly improved.
If you notice blisters on your nipple, place a clean soft cloth (baby diaper, wash cloth, tea towel) soaked in very warm water on your nipple for a few minutes before each nursing. Experiment with the positon in which you feed your baby, find which is more comfortable for your nipples. Try the salt water solution and if soothing, follow the directions and use after each nursing until the blister is resolved. If your nipple is not greatly improved after 2 days of following these suggestions, call for a consult with a lactation consultant to evaluate your latch and your baby's suckle.
Cracked Nipples: Occasionally, nipples can become cracked. You may notice a fine lne across the face of your nipple that may or may not bleed. The blood from the crack will dry between breastfeedings and you may notice a crust forming along the cracked area. Sometimes you may see blood in your baby's mouth or in spit up. Rarely will your baby be upset form swallowing blood but call you baby's physician if you are concerned. Ask the nursing staff to help with your latch and to observe your baby's suckling technique.
Begin using salt water soaks to soothe your nipples. If you are in the hospital, ask the nursing staff for a bottle of 0.9% sterile normal saline and small disposable paper cups (similar to bathroom size Dixie cups). After each nursing, pour some of the solution into a cup, lean over and soak your nipple for 5 minutes. After the 5 mnutes, discard the cup and solution used and rinse your nipple in a small amount of warm tap water. Air your nipples dry. Squeeze out some of your colostrum/breast milk or use a ultra-purified lanolin breast cream gently massaged into the affected area. Repeat after every breastfeeding until the crack is healed.
At home, make the salt water solution by dissolving 1/2 teaspoon of table salt in 8 oz. of boiled water. Cool the solution before using. Make a large amount of the salt water solution and store in a clean covered container away from young children's reach. Do not substitute contact lens solution for the recipe due to the additon of preservatives in the lens solution. If your nipple is not greatly improved after 2 days of using the salt water solution, contact a lactation consultant to evaluate your nipples and your baby's suckle.
ComfortGel hydrogel pads are available to relieve nipple soreness by creating a moist healing environment. These pads may be helpful if your nipples are sore, blistered or cracked. Contact Hollister/Ameda/Egnell at 1-800-323-4060 or www.hollister.com for locations near you where they can be purchased.
"White Bleb"/"Milk Blister": Occasionally you may notices a white "blister" on the tip of your nipple that is extremely painful. You may feel that the milk ducts behind this blister are plugging and not draining well. To help relieve this, make the salt water solution described above for cracked nipples. Before each breastfeeding, make the solution fresh and warm and gently rub the "white bleb" a few times with a clean soft cloth soaked in the solution. Then breastfeed as usual, beignning on the affected breast first. After the breastfeeding, soak the affected nipple in the warm fresh salt water solution for 5 minutes. Use the same soaking technique as suggested for cracked nipples. If this milk blister is still present after 2 days of follwing the suggestions above, please call your physician to discuss the need for an office visit to evaluate your nipple and help your milk duct to drain. Also, contact a lactation consultant and arrange for a home consult to evaluate your breastfeeding technique and your baby's suckle.
Yeast (Candida Albicans): We carry yeast normally in our bodies. Many women have a history of yeast infections. Pregnancy makes women prone to occurrences of yeast infections. Intact nipple skin is protection agains yeast. Nipple damage from a latch or suckle problem results in a breakdown of the skin barrier against yeast. The use of antibiotics can result in an overgrowth of yeast. During times of stress, yeast infections are more common. Women who are treated with steroids or have a history of diabetes mellitus are more prone to develop a yeast infection. The signs of yeast on your nipples and in your breast are varied. Your nipples may suddenly become very sore (exquisite pain), the nipples may feel itchy or look reddened or "burned", the areola may look shiny. You may feel "shooting or stabbing" pains in your breast.
You may notice thrush in your baby's mouth. Thrush resembles patches of white on your baby's tongue, roof of mouth or gums. These patches are fimly attached and will not wipe off with a soft cloth. You may notice a yeasty diaper rash. This yeasty rash looks like a burn around baby's anus which spreads into separate lesions. Baby may make a clicking sound while suckling, pull off repeatedly during a feeding or refuse to latch. Baby may be very gassy.
If you suspect a yeast infection, call a lactation consultant and arrange a home visit. If you have signs of a yeast infection, both you and your baby will need to be treated. You will need to contact your physician and baby's physician for treatment. Treatment may consist of one or more creams applied to your nipples, a liquid suspension painted inside baby's mouth, and/or an anti-fungal pill that mother takes for about 2 weeks. Deleting dairy products, yeasty breads and sugars from your diet can be helpful while being treated for yeast. Adding acidolphilus tablets (available in the vitamin section of food stores -- follow manufacturers suggestions for dosage) and taking your required calcium in other forms is suggested.
Breast Warning Signs
Regular self breast exam is recommended during lactation. You will become familiar with the shape and feel of your lactating breasts if you exam your breasts on a regular basis. Call your physicians and a lactation consultant if you notice a change in the contour or shape of your breast or any area in your breast which seems puffy or looks indented. Also, call your physician immediately if the skin on your breast resembles the peel of an orange.
For more information, call 1.866.CALL.MLH.