Breastfeeding Pain and using Nipple Shields

By Juliet Honey, Ardo Australia

Sometimes, no matter our best intentions, breastfeeding gets off to a rocky start. After giving birth (no small feat, no matter which way baby arrives!) You’re probably pretty exhausted and it might take some time to get to know your body and your baby. For most of us the first time we see a baby breastfeed is when we breastfeed our own baby, so it’s not a surprise that sometimes it can be challenging.  If you are experiencing ongoing breastfeeding pain or discomfort, it is advisable to get some help from someone qualified in assisting with breastfeeding difficulties.

What might make breastfeeding hurt?

Attachment problems

Most nipple pain is caused by your baby not latching on to your breast properly and effectively. It takes time to get the hang of how to position baby to help them attach well, especially if you have had a difficult birth. Ideally your baby is close against your body, head tipped back a little with chin tucked into your breast. Inside their mouth, your nipple should be back at their soft palate so it isn’t being squashed by their hard palate.

Cracked or Sore Nipples

Damage to the nipple may cause cracks (fissures) to appear which will be painful. These cracks may bleed a little, which can be distressing for you. While it’s difficult not to panic, it’s okay for your baby to ingest a little blood, it won’t hurt them. Getting help from the Australian Breastfeeding Association (they have a 24 hour counselling service) or a Lactation Consultant can help you get on top of the attachment problems that may be causing your pain.

Bleps or White Spot

Many of us think of nipples as the tap where the breastmilk comes out, but actually there are lot of tiny openings on the nipple, so it’s more like a shower rose. It’s occasionally possible that some of those opening are closed over with a thin layer of skin. Until you commence breastfeeding there probably isn’t a way to tell. But if it hurts to breastfeed and when you take your baby off you notice some tiny blisters or white spots on your nipple, it could be a blocked opening or blep. Sometimes these can be removed with some gentle rubbing with a warm facewasher in the shower, other times you may need assistance from a Lactation Consultant or Health Professional.

Nipple Infections

You probably know about (and perhaps suffered) vaginal thrush, but did you know that babies can get oral thrush as well, plus, you can get nipple thrush? Nipple thrush can feel like lots of needle-like stabbing pain when feeding. Your baby may or may not have a thick white coating on their tongue or white spots. Similar to thrush, staph infection is another bacteria that can make your nipples feel sore and breastfeeding painful. Staph bacteria is a common bacteria on our skin, but it can cause problems in areas where there is damaged tissue, like a sore or cracked nipple. If you suspect a nipple infection it’s best to get a medical professional to check it out.


Vasospasm is a fairly rare condition associated with diagnosed poor circulation like Renaud’s syndrome. Instead of the milk ducts staying open to deliver milk to your baby, they constrict when exposed to the cold (like when you take your shirt off to feed your baby) and breastfeeding becomes painful.

Breast Pain


For some women, when their milk ‘comes in’ after the initial colostrum production, it comes it with a bang. Full, hard breasts full of milk can be uncomfortable and can make it difficult for a baby to feed if the breast is so full that it stops the baby from attaching to the breast properly.

Blocked Ducts

Around each breast there are a series of ducts that take the breast milk that has been produced in the body to the nipple for your baby. A duct can become blocked if there is something pressing on an area of the breast (eg a tight bra) or if your baby’s not attaching properly. Your breast may feel sore in a particular spot and may look red. You may also feel ‘flu-like’ symptoms as your body tries to deal with the blockage.


Mastitis is a blocked duct that has become infected. It’s very painful and you often feel quite unwell. Having a headache is often one of the first signs . Sometimes mothers want to wean because of the pain, but your baby breastfeeding is probably one of the best treatments in this situation. If you suspect mastitis see a medical professional as you may need medication as well as getting the blockage sorted.

How a Nipple Shield Might Help

Nipple shields are a super-thin silicon membrane that can be placed over your nipple to reduce some of the discomfort and pain you may be experiencing. They look like a little sombrero, and many have a cut out in the ‘brim’ for your baby’s nose to still be on your skin.

They help by literally acting as a shield between you and your baby’s mouth. If your nipples are cracked and/or sore, then keeping them protected can help them feel better during a breastfeed.

Nipple shields are generally a temporary measure while you sort out what is causing your pain. It’s a good idea to get help from a Lactation Consultant if you are using/planning to use nipple shields.

Nipple shields come in multiple sizes, because nipples come in different sizes. Unfortunately you cannot really judge which size you need until you try one. Your nipple should have some space clear at the tip. If your nipple touches the tip of the nipple shield, then it’s too small.

How expressing might help

Another option that you can try when breastfeeding is painful is to express. While expressing isn’t as effective as a baby breastfeeding for removing milk from your breast, if you are at the point where you are dreading putting your baby to the breast, then expressing may help in overcoming your challenges.

You can hand express directly into a container, use a manual breastpump or an electric breastpump. Using a manual or electric breastpump won’t involve direct contact with your nipples as they use suction to remove the milk. This can give your nipples a break if they are sore or cracked. Some mothers use a combination of breastfeeding and expressing while they address positioning or attachment problems.

Other tips to help overcome painful breastfeeding

  1. Seek help! The Australian Breastfeeding Association has a 24 hour Breastfeeding Helpline where you can chat to a qualified breastfeeding counsellor about your situation. Even if it’s 3am and you’re sobbing in your hospital bed, you can give them a call.
  2. Find a Lactation Consultant. Your hospital may have some on staff or you can meet one privately. Look for a Consultant who has International Board of Certified Lactation Consultant’s (IBCLC) registration.
  3. Try Baby Led Attachment. Rather than bringing your baby into a particular position for breastfeeding, Baby led Attachment starts with you and bub skin to skin (so no shirt or bra for you mumma, and strip bub down to a nappy). Your baby actually has the skills to wriggle down to a breast and with you just supporting their weight, can find your breast and attach. This often happens immediately post birth, but it can still be useful with babies right up to several months of age.
  4. Take it one breastfeed at a time. It’s easy to become overwhelmed if breastfeeding is painful, but with time and support you can overcome most challenges.

Juliet Honey

Ardo Australia

Note: The views and advice expressed on this blog post are those of the author and are not representative of the Pregnancy Babies & Children's Expo.

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