“So, how does the latch look?”
I get this question a lot. Many new moms tell me that the hospital nurse or lactation consultant talked with them about what to look for when baby is latching: baby’s wide-open mouth and smooth cheeks (no dimpling), upper and lower lips flanged out, a generous amount of the areola in baby’s mouth, no clicking noises or loss of suction, a round and elongated nipple after breastfeeding, and no pain. Often, moms are tripped up by the last item on the list. If the latch looks good, why is it still painful?
Because in breastfeeding, looks aren't everything.
Pain is a signal that something needs adjustment, whether it’s the baby’s position or the breastfeeding pair’s emotional state or the way the baby is sucking. Sometimes the adjustment is as simple as manually flipping a baby’s bottom lip out, which can be hard to see when that little chin is deeply buried in the breast. Flipping out the upper lip may help, too, but there is evidence that this is not as critical for a deep, comfortable latch as was once believed.
If a baby’s mouth is not wide open when latched, I find that pushing down on a baby’s chin typically doesn’t help. Instead, I recommend moving the whole baby! Often I see babies being brought to breast with their chins tucked into their chests, so pushing on the chin is futile if baby is curled up in this way. The snuggle and slide move is very useful in these cases.
When breastfeeding has been stressful, I find that moms and babies are often holding tension in their bodies as they attempt positioning and latching. Relaxed babies tend to open wider, and relaxed mothers tend to feel less pain. I like to look for ways to help the pair relax together, particularly the mom since her baby will take cues from her. Often a few deep breaths and some measures to soothe the baby, such as skin-to-skin holding, make for a much better experience initiating breastfeeding.
I also encourage moms to take a few moments to let baby relax into a latch. If baby came to the breast very hungry or fussy, her mouth is likely to be tighter, and she may need a minute or two to settle in. Rather than unlatching baby immediately to get a “correct” latch, I ask mom to see what happens if she waits a short time. Does baby open wider? How does the latch feel now? Often, the improvement comes quickly, and without the frustration of baby going on and off the breast several times until she gets it “right” (which can lead to more soreness for some moms).
It’s also possible that have a baby who is latching well and to have some lingering nipple soreness, especially if there were wounds in the early days. As those wounds heal, it’s normal to continue feeling some discomfort, particularly in the first 30-60 seconds of the latch. If the pain subsides, that is an encouraging sign that baby is not continuing to latch in a way that is causing further damage.
If, despite these adjustments, pain continues and breastfeeding feels unsustainable, there may be other factors at play. A full assessment with a lactation consult, who may loop in mom and baby’s doctors, can be useful to determine the cause of the pain and possible treatments.
One lactation consultant's musings about milk.