Ask the midwife: I’m breastfeeding well, why do I have sore nipples?

In our ‘Ask the midwife’ series, Natasha Cullen from Beloved Bumps answers all the big questions! This week, we’re talking about sore nipples and when it could be thrush...

Who knew there was such a thing as nipple thrush? Any breastfeeding mum who’s experienced the excruciatingly sore nipples of this condition will wince at the mere mention of it. Add the frustration of not knowing why you’re in so much pain when you and your bub have nailed the latch, and the embarrassment of telling your mothers’ group what’s going on, it’s an unpleasant experience all ‘round. And you thought the morning sickness was bad (granted, it probably was). So, in this edition of ‘Ask the midwife’, Natasha Cullen from Beloved Bumps answers the question:

I have really sore nipples but I’m sure my baby is latched correctly. What’s going on?

Natasha says:
This week I did a breastfeeding visit with a lady who needed some help latching her baby to the breast without the use of nipple shields. By the end of my visit, it was clear that she was really confident with her position and the baby’s latch was great. But, two days later, I heard from her again – her nipples had become very red and sore, and she was on the verge of giving up breastfeeding.

I visited her again at home and noticed that her nipples were pink and that the baby had a white coating on his tongue that didn’t go away when I wiped it. When the baby was feeding on the breast, the position and latch were perfect. Both of these were a clear sign to me that that mum and baby had thrush – something that is common in pregnancy (in the vagina) and also postnatally, when it can present on the nipples and the baby’s mouth.

The classic symptoms of nipple thrush are: pain with feeding that can last for a while after the feed, sharp or burning pains in the breast, pink/shiny nipples, or itchiness/tenderness of the nipple. It will only be diagnosed if any of these are present on both breasts. If you have never had pain-free breastfeeding then the pain may still be due to position and attachment – but if you have been feeding well with no pain and it suddenly develops, then thrush could be the cause.

The baby will have a white coating on the tongue, cheeks, roof of the mouth or on the gums. There may be a white film on the lips too. This does not go away with wiping – sometimes milk can leave the same look, but this will be easily removed. The baby may be irritable when feeding, and sometimes thrush can also cause nappy rash.

The treatment is to have an antifungal cream for your nipples that you apply after each feed, and a doctor can prescribe drops for your baby’s mouth – both of you need to be treated so you don’t pass the infection between each other. If the pain in your breasts is bad, then you can take paracetamol until the worst is over, and ‘air’ your nipples. Cutting down on the amount of sugar you are eating can also help, as well as taking probiotics and eating natural live yoghurt.

Stay tuned for the next instalment of ‘Ask the midwife’, coming soon!

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