It is not uncommon for nursing mothers to develop nipple wounds (cracks, scabs) with or without bleeding, especially in the first days of nursing. See photos.
Most wounds occur because the baby does not latch on well and rubs the nipple tip with the tongue.
Latch:
- Ideally you want to get as much breast tissue in the baby’s mouth as possible.
- Aim the nipple at the baby’s nose so the baby opens wide.
- You then guide the baby on in a way that the nipple ends up closer to the roof of the baby’s mouth and more of the bottom part of the areole will be in the mouth.
- You want the tongue to compress the areolae and not the nipple.
- When open wide, the angle at the corner of the mouth should be 90º or more.
- Look at the nipple when the baby comes off the breast. If the nipple is round (without a crease or fold at the tip), the latch was probably good.
- If you need help latching your baby on comfortably, see a lactation consultant.
Many women can continue to nurse the baby as the wounds heal. However, if the the nipples are very painful or the wounds are very deep, you may need to take a break from nursing and pump for 24 to 48 hours so the nipples can heal more quickly.
How to heal wounds on the nipples:
- After feeding or pumping, soak nipples in warm salt water. Mix 1 teaspoon of salt in 1 cup warm water, put it in a shallow cup and dip your nipples in for 3 minutes.
- Let dry.
- You may need an antibacterial ointment. Speak with your doctor about Bactroban/ mupirocin ointment. Use ½ peasize of ointment on the crack after you have soaked the nipple.
- If the wound doesn’t start to heal in 2-3 days, you may try using breast shells. Breast shells are protective domes which are worn between feedings so the nipple tip will not touch anything. This allows the wound not to be touched by pads, bras in between feeds.
- If after a week you still do not see improvement, try not nursing on that side and pump at every feeding session for 24 to 48 hours.
***If there is still no healing, speak with your doctor again. Persistant wounds on the nipples are not normal and need to be evaluated by a physician.***
Nipple Compression:
Sometimes, even with a good, deep latch, the baby may compress the nipple and cause pain. In this case, you will see a compression line, crease or fold on the nipple tip. This may happen if a baby has a tight frenulum (tongue tie) and/or a high palate. Also, when the flow of milk is too fast, the baby may compress the nipple in order to slow down the flow.
Nipple compression during every feeding makes it very difficult for wounds to heal. If you have overproduction and / or an overactive letdown, take measures to slow the flow.If you think the baby may have a tight frenulum (tongue tie), have the baby evaluated by your lactation consultant and pediatrician.
ScabsA nipple scab may soften after each nursing and appear white. Small pieces of the scab may be swallowed by the baby during nursing. This is not dangerous for the baby. If you have pain with nursing, the scab needs to heal for the pain to improve.
A very small (1mm) yellow or white scab may also be an indication of an inflamed duct/bleb/milk blister.