Breastfeeding is certainly a natural act, but it is not always easy to implement. Among the concerns encountered by breastfeeding mothers, pain is one of the leading causes of early cessation of breastfeeding. Some tips to prevent them.

The more efficiently the baby sucks, the more receptors located on the areola of the breast will be stimulated and the higher the production of lactation hormones will be. A baby who is breastfeeding well is also a guarantee of pain-free breastfeeding. If it does not take the breast correctly, the baby risks stretching the nipple with each feeding and weakening it.  

The criteria for effective suction 

For effective suction, a few criteria must be met:

• the baby’s head should be slightly bent back
• her chin touches the breast
• the baby should have her mouth wide open in order to take a large part of the areola of the breast, and not just the nipple. In his mouth, the areola should be slightly shifted towards the palate.
• during the feed, her nose should be slightly open and her lips curved outwards.

The position of the baby during the feeding is very important to respect these different criteria. There is no single position for breastfeeding, but different positions from which the mother will choose the one that suits her best, depending on her preferences and circumstances.  

The Madonna: the classic position

This is the classic breastfeeding position, usually the one shown to mothers in the maternity ward. Manual :

• sit comfortably with your back slightly back, supported by a pillow. The feet are ideally placed on a small stool, so that the knees are higher than the hips.
• place the baby lying on his side, tummy against his mother’s, as if he was wrapped around it. Support her buttocks with one hand and let her head rest on the forearm, in the crook of the elbow. The mother should not carry her baby (at the risk of being strained and hurting her back), but simply supporting her.
• the baby’s head must be at the level of the breast, so that it can take it well in the mouth, without the mother having to bend down or stand up.

The nursing pillow, supposed to make breastfeeding easier and more comfortable, is very popular with mothers. But beware, badly used, it can serve breastfeeding more than it facilitates. Lying the baby down on the pillow sometimes requires it to be pulled away from the breast, which can make it difficult to latch on and increase the risk of nipple pain. Not to mention that the pillow can slip during the feeding. A breastfeeding accessory to be used with great care …

The lying position: for maximum relaxation

The lying position allows you to breastfeed your baby while relaxing. This is often the position adopted for mothers who co-sleep (ideally with a side-bed, for more security). Because it does not exert any pressure on the stomach, lying down is also recommended after a cesarean section, to limit pain. In practice : 

• lie on your side with a pillow under your head and one behind your back if necessary. Bend and raise his upper leg to be quite stable.
• lay the baby on his side, tucked in, tummy to tummy. His head should be slightly lower than the breast, so that he has to flex it slightly to take it.

Biological nurturing: for “instinctive” breastfeeding

Much more than a breastfeeding position, biological nurturing is an instinctive approach to breastfeeding. According to its designer Suzanne Colson, an American lactation consultant, biological nurturing aims to promote the innate behaviors of mother and baby, for serene and effective breastfeeding.

Thus, in biological nurturing, the mother gives the breast to her baby in a reclined position rather than sitting down, which is more comfortable. Naturally, she will make a nest with her arms to guide her baby who, for her part, will be able to use all her reflexes to find her mother’s breast and suck effectively. 

In practice : 

• sit comfortably, sitting with your torso tilted back or in a semi-reclining position, open. The head, neck, shoulders and arms should be well supported with pillows for example.
• place the baby against you, face down on your chest, with her feet resting on yourself or on a cushion.
• let the baby “crawl” towards the breast, and guide him if necessary with the gestures that seem the most natural.

Feeding should take place in a quiet place, so that the baby and its mother are relaxed. For an effective and painless breastfeeding, here is the procedure to follow:

Offer the breast to your baby at the first signs of awakening

Reflex movements while drowsy or open mouth, moans, searching mouth. It is not necessary (or even not recommended) to wait until he cries to offer him the breast

Offer the baby a first breast

And that until he lets go.

If baby falls asleep at the breast or stops sucking too early

Compress the breast to eject a little milk. This will stimulate him to resume sucking.

Offer the other breast to the baby

On the condition that he still seems to want to suck. 

To remove baby’s breast if he is not doing it alone

Make sure to “break the suction” by inserting a finger at the corner of her mouth, between her gums. This prevents it from pinching and stretching the nipple, which can eventually cause cracks.

How do you know if your baby is nursing well?

A little clue to make sure that baby is sucking well: his temples move, he swallows with each suck at the beginning of the feed, then every two to three sucks at the end. He pauses in the middle of the sucking, mouth wide open, to take a sip of milk.

On the mother’s side, the breast softens as the feed progresses, small tingling appear and she feels great relaxation (effect of oxytocin).  

Breastfeeding doesn’t have to be uncomfortable, let alone painful. Pain is a warning sign that breastfeeding conditions are not optimal.  

The number one cause of breastfeeding pain is crevice, most often due to poor sucking. If breastfeeding hurts, it is therefore first necessary to check the correct position of the baby on the breast and its sucking. Do not hesitate to call on a midwife specialized in breastfeeding (IUD Lactation and Breastfeeding) or an IBCLB lactation consultant (International Board Certified Lactation Consultant) for good advice and to find an optimal position for breastfeeding.  

How to relieve a crevice?

To promote the healing process of the crevice, different means exist:

Breast milk:

Thanks to its anti-inflammatory substances, epidermal growth factors (EGF) and anti-infectious factors (leukocytes, lysozyme, lactoferrin, etc.), breast milk promotes healing. The mother can either apply a few drops to the nipple after feeding or use it as a bandage. To do this, simply soak a sterile compress with breast milk and keep it on the nipple (using cling film) between each feeding. Change it every 2 hours.

Lanolin:

this natural substance extracted from the sebaceous glands of sheep has emollient, soothing and moisturizing properties. Applied to the nipple at the rate of a hazelnut previously heated between the fingers, lanolin is safe for the baby and does not need to be wiped off before feeding. Choose it purified and 100% lanolin. Note that there is a very low risk of an allergen present in the free alcohol portion of lanolin.  

Other possible causes of a crevice

If, despite correcting the breastfeeding position and these treatments, the cracks persist or even worsen, it is necessary to see other possible causes, such as:

• congenital torticollis that prevents the baby from turning his head well,
• a too tight tongue frenulum that interferes with sucking,
• flat or retracted nipples that make it difficult to grip the nipple

Another recurring cause of breastfeeding pain is engorgement. It is common at the time of the flow of milk, but can also occur later. The best way to manage engorgement but also to prevent it is to practice breastfeeding on demand, with frequent breastfeeding. It is also necessary to check the correct position of the baby on the breast to ensure that his sucking is effective. If it does not suck well, the breast cannot be emptied properly, increasing the risk of engorgement. 

Breast engorgement: when to consult?

Certain situations require you to consult your doctor or midwife:

• a flu-like condition: fever, body aches, great fatigue;
• a superinfected crevice;
• a hard, red, hot lump in the breast.