Getting Through Severely Cracked Nipples (not for the fainthearted)

"Cracked Nipples" sounds pretty bad, but considering it describes nipples that look and feel like they've been pressed against a belt sander, the term is actually a euphemism. I feel a strong sisterhood with anyone cursed to pass through this dark, dark place on the path to established breastfeeding and a strong jealousy toward the lucky majority who never had to deal with this. This is not a post about pain, which is common; it's about raw, abraded, and even broken skin.  I've been through it twice, and still can't decide which time I was less prepared for.

With my first, I knew I might have sore nipples, but had no clue what horrors were in store.  After a natural birth, I thought I'd conquered a pretty tough experience, but that was nothing compared to the first weeks of breastfeeding. I tried everything - changing my latch, using lanolin, applying breastmilk, leaving my boobs clean and dry - all of it.  Nothing worked, and soon my beautiful baby began to resemble a savage pirana and my supply began to fade.

Now I have read (and you may have, too, if what brought you to this post is your own pain) that cracked nipples are only caused by caused by poor technique and latching problems. To be sure, a number of things I learned from working with a certified lactation consultant, including better technique, helped me get back on track with my first son.  Then, 3 1/2 years later and with almost 3 years of breasfeeding experience under my belt, I was again looking down at my beautiful newborn baby past two horribly cracked, insanely painful nipples. 

Though I fully agree that poor latch can be the culprit, I have also observed that some women just have really delicate skin or an extra rough-nursing baby (or both).  Expert latching or no, these women will have an extra hurdle getting started breastfeeding (and not just with kid #1).  If you're the girl on the ski trip whose cheeks and lips get chapped the first day, this is a bad omen.

Unfortunately, study after study shows that ointments, creams, gels, breastmilk, and warm compresses don't help much with cracked nipples (breatmilk can help reduce pain). What does work? Preparing beforehand and doing what you can for the pain and damage to get through it and keep on nursing.
First consider the basics of lactation. Note that Lactation II, the milk production phase that begins at birth and ends 3-5 days later, does not depend on suckling the way later milk production does.  This means your milk will not come in faster if you nurse constantly in the first 48 hours (plus, the colostrum you produce at this time is perfect nutrition for your baby - no need to rush it!). 

You won't feel sore until the second or third day, and it's better if this doesn't hit you like a ton of bricks.  Certainly, feeding on demand is best, but don't initiate extra frequent or long sessions in a race to bring your milk in.  It won't help, anyway, and instead of a first place trophy you may end up with sore, damaged nipples.

Once you're home, keep your boobs in a breathable accessible place, like the open air.  An open nursing bra will let you add nursing pad quickly as needed.  This "boobs out" state is a great reason that anyone not in your innermost circle will be more comfortable waiting a few weeks for when all this "early breastfeeding stuff" is done before they intrude, I mean visit.  Although it truly saddens me that so many people are scandalized and offended by breastfeeding, use it to your advantage when you can.  You'll catch the downside of it enough once you're ready to take your baby out in public

Besides seeing a lactation consultant, pacing yourself, and keeping your boobs out/dry/clean, you can try to deal with the pain.  Remember this is not advice for everyone who has a twinge of pain or general soreness, it's advice for people whose skin is worn off and scabbing over. 

Here are some options:

1. Nipple Shields:  These can be hard to use properly so get help choosing and fitting one at a breastfeeding class or with a consultant.  They can also complicate and already tough process for both you and your newborn.  That said, a good nipple shield can really save your skin.  You may hear that nipple shields can cause the dreaded "nipple confusion" (more thoughts on this later). Unfortunately, when your nipples started bleeding, you officially left the realm of "ideal scenario" and entered the realm of "make it work" (this applies to #5, A Pump, too). 

2. Ice Water: Sound awful? It is for a minute, but when your nipples are wrecked, numbing them can get you through the first extra painful moments after latch-on.  

3. Drugs: Motrin (ibuprofen) and Tylenol (acetaminophen) are cleared for breastfeeding mothers (look them up here, but still talk to your pediatrician about her recommendation).  Like many biochemists (the very people who make them), I am sketched out by almost all drugs, especially while pregnant or nursing a newborn.  I don't take cold medicines, skip the lidocaine at the dentist, and did two natural births.  That said, I took Motrin and was happy to have it when my nipples were a warzone.

4. Lamaze Breathing: Another technique that keeps your focus off the pain and on the goal (one feeeding at a time until you start to heal).  The bonus is, you probably have this technique fresh in your mind.

5. A Pump: This is never a first resort for an early breastfeeding problem, but it's often the last. If you have major damage, alternating between your baby and a pump (which will still hurt) can spare some areas that have gotten especially worn down.  Also, pumping can help you get out of a vicious cycle of pain/damage -> incomplete emptying of the breast through nursing -> reduced supply -> increased, frustrated suckling -> pain/damage, etc..

6. A Stout Heart: I think I've been pretty candid about how bad this can be, but there is one more thing that no one likes to mention. If your nipples are cracked, they will bleed.  Your baby will injest some blood.  Sounds like something out of a nightmare, but it does happen. It's not going to hurt your baby.  It may cause your baby to have reddsih brownish spit-up.  Don't lose it, and don't quit brestfeeding over it.  Being a mom is tough stuff.  Being a breastfeeding mom is even tougher.  Talk to your IBCLC and your pediatrician about what you are going through and get through it - you will! 

The biggest thing that will get you through this phase is knowing that it will end.  It can take up to a month or more for your boobs to improve.  Once they get adjusted to nursing and your newborn becomes less of a savage, the damage will completely heal, the pain will fade, and you will still be nursing your lovely bundle of snugglefection. You'll be on your way to sucessful mothering and able to use the most reliable rule of parenting - "When the baby cries, stick a boob in her mouth." It really is a magical balm - for you and your baby.  Until you get there, do what you can to make it though - and remember you are not alone. 

Note: This post does not address two other problems that cause nipple pain, mastitis and thrush.

Also see:

A great and thorough discussion of nursing pain from from PhD in parenting

More information about cracked nipples from kellymom

Please post any other references you know in the comments!