When I was a health visitor back in 2008 it seemed to me that nearly every other lady in the breastfeeding clinic had a case of thrush. I couldn’t quite believe it even then, and I believe it even less now! It is one of those diagnoses that feels quite neat and tidy: fussy baby, sore nipples, white tongue = thrush! Solution: take this cream or use these drops and your worries will all be gone! Was it really that simple? No, of course not. If you’re sore, and you can’t figure out why – read on…
What is thrush? Ok, so the basics to start with. Thrush is a fungal infection caused by an overgrowth of candida. Some people seem prone to it. For instance, I know of many women who report symptoms of vaginal thrush every time they are prescribed antibiotics. But that is by no means common to everyone.
The problems are at least two-fold:
- The symptoms of thrush are vague, and easily confused with other types of breast and nipple pain
- Many health professionals do not have the skill to unpick the symptoms and history of breastfeeding to gain a better understanding of why you are in pain
This is very frustrating for lactation consultants like me who hear of many miserable women who have been back and forth to their GP or health visitor for anti-fungal medication which has had no real impact on their pain. It is wrong to prescribe anti-fungals when it is not a very certain case of thrush because this denies a woman the chance to have her pain resolved at the root of the problem. It prolongs her pain and undermines her confidence. She is more likely to give up breastfeeding if she is in chronic pain and it is just plain NOT FUN!
It is extremely unlikely to be thrush if:
- You have NEVER been pain free during a feed
- Your nipples are squashed looking, flattened, have a white line or stripe running across them or are a strange shape after feeds
- Your baby is under 1 month old
Babies often have a white tongue in the first few weeks – they feed frequently, are sometimes sick, and sometimes regurgitate small amounts of thick milk (urgh – lovely!!!) and this is an unreliable sign of thrush. Check the insides of their cheeks and the undersides of their lips instead. There is excellent information about thrush available here: https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/thrush-and-breastfeeding/
Women use the following words to describe their nipple pain –
All of these words give us clues as to the cause of the pain. But do you see how complicated it can get?! Many of the conditions that cause nipple pain have pain that is hard to describe, or have different types of pain at the same time.
Add to that normal hormonal sensitivity in the first few days and it’s a minefield! You’ve probably heard that you’ll ‘toughen up’. Utter rubbish. You wont. But your hormones will settle down I promise. Do you remember when you first got pregnant and your nipples were super-sensitive? Or maybe your breasts ached or tingled? Nothing to do with breastfeeding trauma – just hormones! The same thing happens to some extent in the early days of breastfeeding. If you need to concentrate hard, clench your buttocks and count to ten – that’s probably normal, as long as the pain goes away. If you want to swear, wrench your baby off your breast and curl your toes – that’s almost never normal.
If you’re not sure – check the shape of your nipple after feeds. If it looks the same at the end as it did at the beginning – it’s likely that you’re experiencing normal sensitivity. If it looks a funny shape, or is cracked, bleeding or blistered – read on!
Here are some other maternal causes of nipple pain:
- Poor positioning (most likely problem!)
- Raynauds phenomenon
- Bacterial infection
- Flare up of existing skin condition such as eczema or psoriasis
- Psychological distress – including previous abuse and post-traumatic stress disorder
- Generalised body pain (heightened pain response)
- Paget’s disease (rare form of breast cancer) – I have to mention this to be thorough, but it’s even less likely than thrush!!
- Milk bleb (blocked nipple opening)
But the root cause of your pain may be more to do with your baby:
- Shallow attachment
- Biting down due to fast let down (see my earlier post on older babies here: http://www.dreamfeeds.co.uk/blog/breastfeeding-a-baby-with-teeth
- Tongue tie
- Torticollis (shortening of the muscle on one side of the neck which leads to a marked head tilt and often a preference for only one breast)
- Plagiocephaly (flat head syndrome – sometimes caused by torticollis)
- Frustration with slow flow
Of course I can’t do justice to any of these problems in a simple blog! I haven’t met you, and I can’t fully assess you right now! If you’re unsure of why you’re in pain I cannot stress enough to seek out professional help as soon as you can to get to the bottom of it. But here are a few quick fixes which may help temporarily:
- Lean back – gravity is working against you if you are upright. Take the pressure off the end of your nipple and you may take your pain down a notch
- Allow your baby to self-attach in a reclined position. Look at this video on Youtube by Nancy Mohrbacher.
- Feed your baby lying down in your bed
- Feed your baby before they’re over-hungry – they are more fractious and difficult to feed the more frustrated they get
- Use breast shells and lanolin (sparingly!!) in between feeds to promote moist wound healing
- Use dry heat after feeds if you suspect Raynauds phenomenon (more likely if you are prone to poor circulation)
- If you’re feeling very full, your baby won’t be able to get a big mouthful of breast tissue – so try hand expressing a little first
- Try some gentle breast massage before and after feeds
- Try to deepen the attachment of your baby at your breast – go right back to basics:
- Align your baby so that their nose is opposite your nipple
- Wait for that head to tip right back – your baby may bob about beforehand – be patient!
- They come to the breast chin first
- Hug in quickly and deeply when the nipple is in line with your baby’s top lip
- Take painkillers if you’re really sore
- See your GP if you have a wound that is not healing or is oozing
- If you are at your wits end and about to throw in the towel altogether, express for 24-48 hours with an effective pumping technique while you cup or bottle feed the baby (using ‘paced bottle feeding’) and then try again.