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Thread: Bleeding Nipples WITH Nipple Shield

  1. #1
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    Default Bleeding Nipples WITH Nipple Shield

    I'm currently 32 weeks with #3 and am hoping to avoid the previous BFing problems I experienced with #1 and #2. With both babies, LC's at the hospital determined that I have flat nipples that created latching problems and recommended short-term use of nipple shields. With my last, about 2 weeks into BFing, my nipples cracked and bled even while using the shields. The first 2-3 minutes after LO latched on were so painful that I gripped the chair to get through them. I was also pumping after feedings. I developed a nasty case of mastitis, as well. I really don't want to go through any of that again and am trying to be proactive. I will again work with LC's after #3 is born and seek out help from my local LLLI group. But I guess my question is what could have caused nipple bleeding and mastitis? Both the nipple shields and the flanges for my electric pump felt very tight around my nipples -- is it possible/likely that I was using shields and flanges that were too small? If my flanges were too small, is it possible/likely that this was the problem and nursing just made my already inflamed nipples worse? Should I not have pumped so early after birth? I usually used the football hold or cradle hold, both of which didn't create pain on my c-section incision. Is it possible/likely that one or both positions created a latch problem? The LC's complimented my LO's latch before we left the hospital -- but maybe once I was sitting in a chair instead of lying in a bed, the latch changed? I'm so grateful in advance for whatever ideas anyone might share!

  2. #2
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    Default Re: Bleeding Nipples WITH Nipple Shield

    Welcome to the forum and congratulations on baby #3 to come!

    It's really hard to say exactly what caused the cracking and bleeding you experienced with your first babies. There are a lot of possibilities, including the following:
    - Poor latch related to flat nipples
    - Poor latch related to poor positioning- transitioning from the side-lying or reclined position to seated positions definitely could have made things worse
    - Poor latch related to anatomical issue with baby's mouth, e.g., tongue tie, lip tie, high palate, recessed chin, small mouth, etc.
    - Poor pump fit
    - Infection with bacteria or yeast

    It sounds like the help you got at the hospital was not all it could have been. Nipple shields are a good intervention when mom has a good milk supply but her baby has difficulty latching, but generally not for pain related to a difficult latch. Is it possible for you to see someone else, preferably an IBCLC from outside the hospital? I'd want to set up an appointment now, and discuss your last two nursing experiences and what went wrong there, and also set things up so that you can get the IBCLC's help with nursing and/or pumping after your baby is born (if help is necessary, that is).

    Another thing you could look into right now is breast shells, which help inverted or flat nipples to every more. They can be used even while you are pregnant. They aren't guaranteed to help, but they can't hurt.

    Can you go visit your local LLL now, before your baby is born? It's always easier to forge the connection with LLL now, before the baby is born and before trouble springs up. And the LLLmoms may have some really good suggestions for you, like the name of a good IBCLC, or a doctor who is good at recognizing and treating tongue ties, etc.

  3. #3
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    Default Re: Bleeding Nipples WITH Nipple Shield

    is it possible/likely that I was using shields and flanges that were too small? If my flanges were too small, is it possible/likely that this was the problem and nursing just made my already inflamed nipples worse?
    It absolutely can damage nipples if you use pump flanges that are too small. Damage is possible also from pump setting to high, pump motor not cycling correctly, flanges too large, pumping too long....etc. Pumps are machines that attempt to extract milk from the breast via a process that is not at all like nursing. In other words, pumping is not anatomically natural and never will be. Yes some moms do need to pump. But it makes me nuts that it is so often not recognized that pumps can and do cause injury in many moms.

    Nipple shields can also rub against the nipple (no matter what size) and cause injury. So injury from use of pumps or shields - This is absolutely possible. Whether this is the problem or not in your case, there is of course no way of knowing at this remove.

    Pumping also pulls fluid into the areola, causing edema. So yes, pumping can certainly cause swelling- that swelling makes it harder for baby to latch, and the cycle continues.

    Pumping too much can also cause/ exacerbate overproduction and engorgement - both of which also make it harder for baby to latch and exacerbate "flat" nipples.

    My first question is, ARE your nipples always really and truly flat? I do not mean when nursing, I mean, between babies or before babies- Did you never experience erect nipples in response to stimuli? (touch, cold, etc?) When a baby nurses, there is a hormonal connection that causes nipples to be erect.

    Lots of things can make 'normal' nipples to be temporarily flat - or at least, more flat than they would otherwise be- right after birth. Medications, edema, engorgement, sleep deprivation, pain.... so this is something to know. C-sections? Oh yeah, they are the perfect storm for temporary issues in all these areas, right? All those fluids in your IV can cause post surgery edema- in the breasts just like anywhere else, meds, pain etc...see what I mean?

    What I am curious is what was going latch wise on in the 2 weeks before you started having cracks and bleeding. How often was baby nursing, how often were you pumping, and was the pain getting any better, worse, etc BEFORE injury occurred? I guess I am wondering why it took two week before there was injury, if something changed??

    Also, Did you ever attempt to latch your babies without shields in the early hours? At what point were they able to latch without shields if they ever were?

    I will again work with LC's after #3 is born and seek out help from my local LLLI group
    Don't wait until baby is born. It sounds to me as if you had issues really early on and you want to make sure you get helpful help immediately if you have issues again.- if you have not already, go to LLL meeting before baby and/or connect with IBCLC or LLL Leaders before baby.

    There is much more to latch and positioning even for C-section moms...Are you planning VBAC or C-Section this time?

    TO facilitate baby latching early on, it helps if baby is 1) On mom as quickly after birth as possible. On her chest, snuggled between the breasts. Avoid unnecessary separations, there are places that will put baby on mom even while the surgery is completed, but even if they won't do this, if there are no complications you should be able to have baby on you within an hour or so after birth. Your baby does not need a bath, exams. shots etc. can be done while baby is ON MOM.

    In the hospital bed, lay at a reclined position and have baby on you, babies front against you, either snuggled between your breasts or positioned just under or to the side of one breast (so nose is close to nipple.) You are an experienced breastfeeding mom and know how to help a baby find the nipple and latch, right? It is totally ok to help as much as needed, but do not think you have to do it all for baby. A brand newborn in this position can very often self attach quite well. Even my daughter born at 37 weeks after C-section did this no problem- pushed herself up and popped right on the nipple. If it hurts, try repositioning baby but not necessarily taking baby off to "re-latch" - it is possible (not all the time but often) to get the latch comfortable just by shifting baby around while they are attached. if you want more info on laid back positioning let me know.

    Get the book the womanly art of breastfeeding 8th edition I suggest

    Also, hand expression not pumping is the recommendation these days for early hours/days if baby cannot latch or milk expression is needed.

  4. #4
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    Default Re: Bleeding Nipples WITH Nipple Shield

    Quote Originally Posted by @llli*mommal View Post
    Welcome to the forum and congratulations on baby #3 to come!

    It's really hard to say exactly what caused the cracking and bleeding you experienced with your first babies. There are a lot of possibilities, including the following:
    - Poor latch related to flat nipples
    - Poor latch related to poor positioning- transitioning from the side-lying or reclined position to seated positions definitely could have made things worse
    - Poor latch related to anatomical issue with baby's mouth, e.g., tongue tie, lip tie, high palate, recessed chin, small mouth, etc.
    - Poor pump fit
    - Infection with bacteria or yeast

    It sounds like the help you got at the hospital was not all it could have been. Nipple shields are a good intervention when mom has a good milk supply but her baby has difficulty latching, but generally not for pain related to a difficult latch. Is it possible for you to see someone else, preferably an IBCLC from outside the hospital? I'd want to set up an appointment now, and discuss your last two nursing experiences and what went wrong there, and also set things up so that you can get the IBCLC's help with nursing and/or pumping after your baby is born (if help is necessary, that is).

    Another thing you could look into right now is breast shells, which help inverted or flat nipples to every more. They can be used even while you are pregnant. They aren't guaranteed to help, but they can't hurt.

    Can you go visit your local LLL now, before your baby is born? It's always easier to forge the connection with LLL now, before the baby is born and before trouble springs up. And the LLLmoms may have some really good suggestions for you, like the name of a good IBCLC, or a doctor who is good at recognizing and treating tongue ties, etc.
    Thanks so much for the welcome and the response!

    My LO didn't have tongue tie and my supply was great right from the start -- just flat nipples and large breasts that made it impossible for her to get a mouthful. And yes! I've just entered the 8th month and I'm going to dig up my breast shells. Excellent suggestion! I just contacted my local LLL today and am awaiting a response. Hopefully creating that relationship now will help me later down the road.

    I'm really grateful for your response and suggestions! All worth following up on.

  5. #5
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    Default Re: Bleeding Nipples WITH Nipple Shield

    Quote Originally Posted by @llli*maddieb View Post
    It absolutely can damage nipples if you use pump flanges that are too small. Damage is possible also from pump setting to high, pump motor not cycling correctly, flanges too large, pumping too long....etc. Pumps are machines that attempt to extract milk from the breast via a process that is not at all like nursing. In other words, pumping is not anatomically natural and never will be. Yes some moms do need to pump. But it makes me nuts that it is so often not recognized that pumps can and do cause injury in many moms.

    Nipple shields can also rub against the nipple (no matter what size) and cause injury. So injury from use of pumps or shields - This is absolutely possible. Whether this is the problem or not in your case, there is of course no way of knowing at this remove.

    Pumping also pulls fluid into the areola, causing edema. So yes, pumping can certainly cause swelling- that swelling makes it harder for baby to latch, and the cycle continues.

    Pumping too much can also cause/ exacerbate overproduction and engorgement - both of which also make it harder for baby to latch and exacerbate "flat" nipples.

    My first question is, ARE your nipples always really and truly flat? I do not mean when nursing, I mean, between babies or before babies- Did you never experience erect nipples in response to stimuli? (touch, cold, etc?) When a baby nurses, there is a hormonal connection that causes nipples to be erect.

    Lots of things can make 'normal' nipples to be temporarily flat - or at least, more flat than they would otherwise be- right after birth. Medications, edema, engorgement, sleep deprivation, pain.... so this is something to know. C-sections? Oh yeah, they are the perfect storm for temporary issues in all these areas, right? All those fluids in your IV can cause post surgery edema- in the breasts just like anywhere else, meds, pain etc...see what I mean?

    What I am curious is what was going latch wise on in the 2 weeks before you started having cracks and bleeding. How often was baby nursing, how often were you pumping, and was the pain getting any better, worse, etc BEFORE injury occurred? I guess I am wondering why it took two week before there was injury, if something changed??

    Also, Did you ever attempt to latch your babies without shields in the early hours? At what point were they able to latch without shields if they ever were?

    Don't wait until baby is born. It sounds to me as if you had issues really early on and you want to make sure you get helpful help immediately if you have issues again.- if you have not already, go to LLL meeting before baby and/or connect with IBCLC or LLL Leaders before baby.

    There is much more to latch and positioning even for C-section moms...Are you planning VBAC or C-Section this time?

    TO facilitate baby latching early on, it helps if baby is 1) On mom as quickly after birth as possible. On her chest, snuggled between the breasts. Avoid unnecessary separations, there are places that will put baby on mom even while the surgery is completed, but even if they won't do this, if there are no complications you should be able to have baby on you within an hour or so after birth. Your baby does not need a bath, exams. shots etc. can be done while baby is ON MOM.

    In the hospital bed, lay at a reclined position and have baby on you, babies front against you, either snuggled between your breasts or positioned just under or to the side of one breast (so nose is close to nipple.) You are an experienced breastfeeding mom and know how to help a baby find the nipple and latch, right? It is totally ok to help as much as needed, but do not think you have to do it all for baby. A brand newborn in this position can very often self attach quite well. Even my daughter born at 37 weeks after C-section did this no problem- pushed herself up and popped right on the nipple. If it hurts, try repositioning baby but not necessarily taking baby off to "re-latch" - it is possible (not all the time but often) to get the latch comfortable just by shifting baby around while they are attached. if you want more info on laid back positioning let me know.

    Get the book the womanly art of breastfeeding 8th edition I suggest

    Also, hand expression not pumping is the recommendation these days for early hours/days if baby cannot latch or milk expression is needed.
    Thanks for your response! It's very possible that the c-section added to the problems I experienced with flat nipples. They're typically no more than less than 1/4 inch when erect -- nothing like post-nipple shield feeding or post-pumping. I'm going to need to experiment with different positions this time around, that's for sure. When I was in the hospital last time, I loved the My Brest Friend nursing pillow -- baby was pulled up close and there was little pressure from her pulling on my nipple while nursing. I'm going to purchase one this time around. Have you known others to have success with these?

    In the first two weeks, I was laying back more often when nursing to allow my incision to heal. Nursing A LOT -- sometimes once every hour or two for maybe 20-30 minutes. LO usually fell asleep at the breast, which I tried desperately to discourage but with no luck. After about 1 1/2-2 weeks, I guess one thing that changed was my positioning when nursing (from reclining in bed to sitting upright in a rocker). I also wasn't pumping until that point. I then pumped maybe 2-3 times a day, at first to build up my supply (which in hindsight I don't think I needed to do -- I always have plenty of milk) and then to alleviate the pain I was experiencing while nursing (but, again in hindsight, it might have made the pain worse). I HATED pumping. I was an exclusive pumper with baby #1 and I felt so totally detached and automated.

    Latching was an issue without the shield (as I just mentioned in a response to another poster) but LO was a champ once the shield was on. I had some bad encounters with LC's and nurses in hospital but there was one LC who was awesome. She was really experienced and was positive about the latch (with shield) and my positioning of my LO. Honestly, everything in the hospital felt great and we nursed on and off all day long with no problems -- the pain came later.

    I will definitely check out the book and put baby on me immediately.

  6. #6
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    Default Re: Bleeding Nipples WITH Nipple Shield

    I loved the My Brest Friend nursing pillow -- baby was pulled up close and there was little pressure from her pulling on my nipple while nursing. I'm going to purchase one this time around. Have you known others to have success with these?
    If you are going to use a breastfeeding pillow, the My Breast Friend is the only one I would recommend. But nursing pillows (even this one) can limit moms movement and keep mom and baby from easily adjusting as needed. They also limit the number of positions baby can be in. You can do the cradle holds, and foot ball, but if you want to align baby differently than that, they either do not help or actually hinder. And being able to align baby differently is often key. Also, they tend to place baby too high. I am not opposed to pillows, they have their purpose. Just know that pillows are not the magic key to latch success.

    Why were you concerned about baby falling asleep at the breast? It sounds like baby was nursing with good, normal frequency and length of time. Was weight gain in question?

    Like pillows, rockers and gliders limit positioning adjustments. After my first baby, I personally ditched both.

    It is very common for everything to feel great in the hospital and then to have problems later. When I expressed surprise that you had injury at 2 weeks, I did not realize nursing was painful prior. I thought you were given shields and latch was then fine- ie, not painful. The pain meant latch was off and you were on your way to injury, so it makes perfect sense now.

    There are a few reasons latch is so often "fine" in the hospital and then gets worse later.

    1) Milk has not yet "come in" or is not as abundant as it will get by the end of week one or so, and baby is able to latch better on the soft breast
    2) Pain from latch issues that are not corrected get progressively worse as injury increases.
    3)You are on strong pain meds in the hospital and may not realize how off the latch is.


    BTW I want to be clear I am not opposed to nipple shields. I used them with my oldest child and I am convinced I never would have been able to nurse without them. But this is largely because the thinking about positioning and latch at that time was very limited and those did not work for my baby and I.

    But they were given to me several days after birth by an IBCLC I had been working with for over an hour. She was very careful about fit. She explained the pros and cons. Most importantly, I was given lots of latch help and we had follow up appointments to keep working on our issues, and that made all the difference.

    Here are some articles and videos you can check out if you like:

    http://www.llli.org/docs/00000000000...astfeeding.pdf

    http://globalhealthmedia.org/portfol...rtfolioID=5623

    http://feedthebabyllc.com/latch-and-positioning/

    https://www.youtube.com/playlist?lis...Nggkqw0aWCfRD3

  7. #7
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    Default Re: Bleeding Nipples WITH Nipple Shield

    Quote Originally Posted by @llli*maddieb View Post
    If you are going to use a breastfeeding pillow, the My Breast Friend is the only one I would recommend. But nursing pillows (even this one) can limit moms movement and keep mom and baby from easily adjusting as needed. They also limit the number of positions baby can be in. You can do the cradle holds, and foot ball, but if you want to align baby differently than that, they either do not help or actually hinder. And being able to align baby differently is often key. Also, they tend to place baby too high. I am not opposed to pillows, they have their purpose. Just know that pillows are not the magic key to latch success.

    Why were you concerned about baby falling asleep at the breast? It sounds like baby was nursing with good, normal frequency and length of time. Was weight gain in question?

    Like pillows, rockers and gliders limit positioning adjustments. After my first baby, I personally ditched both.

    It is very common for everything to feel great in the hospital and then to have problems later. When I expressed surprise that you had injury at 2 weeks, I did not realize nursing was painful prior. I thought you were given shields and latch was then fine- ie, not painful. The pain meant latch was off and you were on your way to injury, so it makes perfect sense now.

    There are a few reasons latch is so often "fine" in the hospital and then gets worse later.

    1) Milk has not yet "come in" or is not as abundant as it will get by the end of week one or so, and baby is able to latch better on the soft breast
    2) Pain from latch issues that are not corrected get progressively worse as injury increases.
    3)You are on strong pain meds in the hospital and may not realize how off the latch is.


    BTW I want to be clear I am not opposed to nipple shields. I used them with my oldest child and I am convinced I never would have been able to nurse without them. But this is largely because the thinking about positioning and latch at that time was very limited and those did not work for my baby and I.

    But they were given to me several days after birth by an IBCLC I had been working with for over an hour. She was very careful about fit. She explained the pros and cons. Most importantly, I was given lots of latch help and we had follow up appointments to keep working on our issues, and that made all the difference.

    Here are some articles and videos you can check out if you like:

    http://www.llli.org/docs/00000000000...astfeeding.pdf

    http://globalhealthmedia.org/portfol...rtfolioID=5623

    http://feedthebabyllc.com/latch-and-positioning/

    https://www.youtube.com/playlist?lis...Nggkqw0aWCfRD3
    Thanks for the links! I was concerned about baby falling asleep at the breast because I was concerned about fully draining my breasts. Ironically, I was worried about mastitis -- and then I came down with it anyway. Again, maybe due to too much milk production as a result of nursing and pumping. The latch was good with no pain at first with the shields -- and then the pain came. Glad to hear you're not opposed to shields -- I've heard from several women who made me feel awful for using shields and frankly, they really weren't knowledgeable about the benefits and problems associated with them. I'd rather not use them -- why would I want the additional hassle if I could do without them, right? But if they make breastfeeding possible when it otherwise wouldn't be, I'm all for them.

    I just made contact with my local LLL group and will be going to a meeting next week -- yay! I'm really excited to meet folks that I can reach out to once baby arrives. Thanks, too, for your advice!

  8. #8
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    Default Re: Bleeding Nipples WITH Nipple Shield

    OK sounds good keep us posted!

    Yes typically no need to make sure baby "drains" or "empties" the breast. These are actually meaningless terms as the normally lactating breast is never really empty or drained, or would be for long. As long as baby is nursing very often, pooping "enough" and mom is comfortable when nursing and also not getting engorged, you can be pretty sure early days nursing is going well. Once you can start measuring gain that tells you baby is getting enough. Baby nursing often and efficiently and avoiding injury to the nipples is what helps mom avoid mastitis, not breast draining. Efficient means, baby gets out enough milk for mom to feel comfortable and baby to gain normally, not that the breast is emptied.

  9. #9
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    Default Re: Bleeding Nipples WITH Nipple Shield

    Quote Originally Posted by @llli*maddieb View Post
    OK sounds good keep us posted!

    Yes typically no need to make sure baby "drains" or "empties" the breast. These are actually meaningless terms as the normally lactating breast is never really empty or drained, or would be for long. As long as baby is nursing very often, pooping "enough" and mom is comfortable when nursing and also not getting engorged, you can be pretty sure early days nursing is going well. Once you can start measuring gain that tells you baby is getting enough. Baby nursing often and efficiently and avoiding injury to the nipples is what helps mom avoid mastitis, not breast draining. Efficient means, baby gets out enough milk for mom to feel comfortable and baby to gain normally, not that the breast is emptied.
    I'm really enjoying your informative responses. I didn't learn about the falseness of "draining" breasts until after I was done with my last. In some ways (and I hope this doesn't sound offensive to anyone -- really), I think we've made breastfeeding into a Rubik's Cube of sorts. A new mom encounters ridiculous amounts of information and advice: a dozen possible positions, hindmilk and foremilk, latching, let-down, expressing, pumping, engorgement... It's no wonder so many moms give up. Sometimes it seems that we (culturally, not LLLI) aren't teaching them that breastfeeding is natural or how to listen to their instincts. We're teaching them that an advanced degree is necessary to feed one's child. In the midst of massive hormonal changes and healing, it can become so overwhelming. I'm really, REALLY glad that I'm reaching out for help this time around. Which includes you!

    Someone just shared this with me, which I also found interesting in terms of finding a nursing position that helps with latching: http://www.mothering.com/articles/na...breastfeeding/

  10. #10
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    Default Re: Bleeding Nipples WITH Nipple Shield

    Quote Originally Posted by @llli*gracepoole View Post
    I think we've made breastfeeding into a Rubik's Cube of sorts.
    Totally! The best thing about Rubik's cubes is that they are solvable if you have the right algorithm, which in the case of breastfeeding is "Don't overthink it, just nurse nurse nurse and listen to your instincts and everything will be fine 99% of the time"!

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