Breast pain and breastfeeding

There are a number of reasons why you may experience breast pain while you're breastfeeding.

Always ask for help from your midwife, health visitor or breastfeeding specialist if you're having problems breastfeeding.

Here's how to deal with some of the most common causes.

Breast engorgement

Breast engorgement is when, for whatever reason, your breasts become overly full. They may feel hard, tight and painful.

In the early days, engorgement can be due to your milk coming in. Newborns need feeding little and often. It can take a few days for your milk supply to match your baby's needs.

If your baby is not well attached to the breast, it may be hard for them to take your milk when your breast is engorged.

The nipple can become a little overstretched and flattened, and possibly painful.

Ask your midwife, health visitor or a breastfeeding specialist for advice immediately to help your baby relieve the engorgement and prevent it happening again.

Find out more about positioning and attachment

Engorgement can still happen once you have learnt the skill of positioning and attachment, usually when your baby has not fed for a while.

Your baby usually knows when they need a feed, for how long and from which breast.

Early signs (cues) that your baby is ready to feed can include:

• moving their eyes rapidly
• putting their fingers into their mouth
• rooting (turning to 1 side with their mouth open as if seeking the breast)
• becoming restless

Crying is the very last sign that your baby needs feeding. Feeding them before they cry often leads to a much calmer feed.

Keeping your baby close so you can watch and learn their early feeding cues will help.

How to ease breast engorgement

To ease the discomfort of engorgement, apart from your baby feeding, you could try expressing a little breast milk by hand. Only express enough to relieve the discomfort because expressing more will make you produce more milk.

Ask your midwife, health visitor or breastfeeding specialist to show you how.

Find out more about expressing breast milk

You may also find it helps to:

• wear a well-fitting breastfeeding bra that does not restrict your breasts
• apply a cloth soaked in warm water to the breast (or a warm shower or bath) just before hand expressing to encourage the flow – do not apply a lot of heat as this may increase inflammation
• take some paracetamol or ibuprofen at the recommended dose to ease the pain (these are safe to take while you're breastfeeding)

Too much breast milk

Occasionally women make too much breast milk and their babies struggle to cope.

It's best to get your midwife, health visitor or breastfeeding specialist to watch a feed to see if they can spot why this is happening.

They can also suggest ways to decrease your supply.

Blocked breast milk ducts

The milk-making glands in your breasts are divided up into segments, rather like an orange.

Narrow tubes called ducts carry the milk from each segment to your nipple.

If one of the segments is not drained properly during a feed (perhaps because your baby is not attached properly), this can lead to a blocked duct.

You may feel a small, tender lump in your breast.

Avoid wearing tight clothes or bras so your milk can flow freely from every part of your breast.

Other things that may help include:

• continuing to use the affected breast and breastfeeding your baby when they want and for as long as they want
• applying a cloth soaked in warm water to the breast (or a warm shower or bath) to encourage the flow – do not apply a lot of heat as this may increase inflammation
• gently massaging the lump towards your nipple while your baby feeds
• applying a cloth soaked in cold water between feeding – this may reduce pain

It's important to deal with a blocked duct quickly as, if left, it could lead to mastitis.

Mastitis

Mastitis (inflammation in the breast) happens when a blocked duct is not relieved.

It makes the breast feel painful and inflamed, and can make you feel very unwell with flu-like symptoms.

If you do not deal with the early signs of mastitis, it can turn into an infection and you'll need to take antibiotics.

Symptoms of mastitis include:

• a breast that feels hot and tender
• a red patch of skin that's painful to touch
• a general feeling of illness, as if you have flu
• feeling achy, tired and tearful
• a high temperature

If you think you're developing a blocked duct or mastitis, try the following:

• Carry on breastfeeding.
• Check your baby's positioning and attachment. Ask your midwife, health visitor or a breastfeeding specialist to watch a feed.
• Let your baby feed on the tender breast first.
• If the affected breast still feels full after a feed, or your baby cannot feed for some reason, express your milk by hand. Only express as much as your baby would usually need.
• Warmth can help the milk flow. Try applying a cloth soaked in warm water to the breast or having a warm shower or bath – do not apply a lot of heat as this may increase inflammation.
• Try applying a cloth soaked in cold water between feeding – this may reduce pain
• Get as much rest as you can. Go to bed if you can.
• Take paracetamol or ibuprofen to relieve the pain.

Contact your GP or NHS 111 if you feel worse at any time, or if you're no better within 12 to 24 hours.

You may need antibiotics, which will be fine to take while breastfeeding.

Stopping breastfeeding will make your symptoms worse, and may lead to a breast abscess.

Breast abscess

If a mastitis infection is not treated, it can lead to a breast abscess, which may need an operation to drain it.

This can also develop if the mastitis does not respond to frequent feeding plus a course of antibiotics.

You can carry on breastfeeding while you're having treatment for a breast abscess.

Find out more about breast abscesses

Thrush

If you experience pain in both breasts, often after a period of pain-free breastfeeding, and the pain lasts for up to an hour after a feed, you may have developed thrush.

Find out more about thrush and breastfeeding

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