Why does breastfeeding hurt more in the afternoon?
March 25, 2011 3:17 AM   Subscribe

Why is breastfeeding excruciating in the afternoon/early evening, but tolerable/comfortable at other times of the day?

I have been exclusively breastfeeding our adorable newborn identical twin boys since they were born 3.5 weeks ago. They were a bit sleepy and slow to latch on in the beginning (they were born at 37 weeks), but they've been hungrily latching on ever since my milk came in.

I had a few grazes on my nipples in the beginning, but worked with the midwives to try to get a better latch. I don't think the three of us have fully mastered the whole process at any point, as I've always found the first few sucks to be toe curlingly painful, but as the pain usually subsides after the letdown I've been prepared to be patient and let things work themselves out.

The pain was getting a bit out of hand last week, so I went and spent the afternoon with the hospitals lactation consultant. She wasn't able to identify any problems, although the latches that she observed were pretty painless.

This week however, I've found that the afternoon/early evening feeds are becoming unbearable. My nipples burn so bad I want to vomit, and my left breast is much more painful that the right. After the feed I also get lots of burning/tingling and pain which seems to be as my breasts are filling up with milk again (just a theory). Weirdly, the night/morning feeds seem to be getting easier and sometimes border on pleasant. I have noticed that the boys do seem to flail about a bit more in the afternoons, which involves clamping down on my nipples, arching their back and pulling away. This really hurts. Is this a sign that they are getting frustrated? Do I not have enough supply? Are my nipples being bruised from this clamping down? Is that why I'm getting all the pain?

Other relevant info: Both boys are putting on weight nicely, and are pooing and weeing lots. I rub breast milk onto my nipples after every feed and air them as much as possible. I use Lansinoh ointment at night which seems to help. Although I my nipples aren't bleeding, they do have a bit of a whitish/yellow crust forming (moreso on the left). I've also just noticed a scrape/graze on the outer edge of my left areola that particularly burns during feeds. I'm taking an anti-inflammatory and applying heat and ice to my poor boobs. I'm not sure which is best? Both boys seem to take about 75 minutes to feed, which seems a bit long, but they will rarely settle unless we let them feed for about 3 lots of 15 minutes (with changes and burping in between). As a result I try to feed them together (football hold) so that I can get some rest between feeds. I have noticed that I enjoy feeding them separately much more, and often find it a lot more comfortable. But that could just be confounded by the time of day. I haven't been able to identify the trend yet. I briefly tried a nipple shield, but the pain didn't seem to be diminished in any way.

I've looked at Kellymom, other forums and called the Australian Breastfeeding help line, but haven't really been able to get any relief so am hoping the collective askme wisdom will help us all get through this crazy wonderful time.
posted by bingoes to Health & Fitness (17 answers total) 3 users marked this as a favorite
I'm not sure what to tell you about relief. Things are so new at this stage that, as long as you've ruled out mastitis, thrush and the other biggies, my tendency would be to soothe as best you can and try to ride it out. My experience (2 kids, 2.6 yrs total bf'ing) was that afternoons were often fussy periods. All the micro-movements of them clamping, arching, and your own micro-movements to maintain latch, to get/stay comfortable, or to alleviate end-of-day fatigue, might all be colliding in repeatedly painful nursing sessions. Also, your breasts do produce different quantities of milk at/for different times of day. Perhaps the kids are demanding more at that time, and, coupled with getting more efficient, more is being demanded your breasts and you play catch-up for a few sessions/days. So your sensation of your breasts refilling quickly and painfully might be what's happening. I wouldn't waste your time fretting about production unless you notice a change in their output (says someone who has spent a lot of time fretting about production!).

I had large chunks of skin come off of my nipples early in breastfeeding and used Soothies (refrigerated gel pads), some tylenol, self-massage and...time. Heat wouldn't be my first thought for treating painful breasts, but since the cause is so nebulous, if it helps, go for it. I wouldn't think a shield would do much for pain in general, especially since you're already a month into a good feeding relationship with the kids. And it might frustrate them in their effort for efficiency or familiar latch, so I'd watch out for that. If possible (given twins, their age, different holds and whether you even have a bath) you might try nursing in the bathtub. A wet or damp towel behind you can give you stability and the water takes a lot of weight off of your shoulder and mid-back muscles.

Sorry I don't have a silver bullet. Time is really the only thing I'd hang my hat on here. But if it continues more than another week or two, I'd definitely line up another call or appointment with the LC for a closer look.
posted by cocoagirl at 3:40 AM on March 25, 2011

First, congrats on the little ones!

*Have* you ruled out thrush? Not sure about the times of day but it's something I'd look into. Another thing-- during the in-between times when you feel pain, take a peek at your nipples to see if the very tips are turning white (vasoconstriction). I had that due to an occasional poor latch causing some damage, and it acted a lot like that. The vasoconstriction hurt a lot
more when I was chilly (ironic because I was airing my chest out more to deal with what I thought was thrush). Maybe you're more uncovered in he afternoon and getting chilly?

I think the pulling thing is either a "come on letdown hurry up!" thing or a "ack mom too much milk slow down!" thing. An LC would be able to say for sure. It could definitely hurt you enough for the feed after to be uncomfortable.

Since the other feeds during the day are all right, I'd also look at layout--are the uncomfortable feeds always happening when you're sitting in a particular chair, with a particular baby on a particular side, during a time of day that you feel hurried, something else? I had to be really careful with night feeds because I was so engorged that I just dealt with an imperfect latch out of impatience--when I got strict with myself about that things got way better.

Good luck!
posted by tchemgrrl at 5:07 AM on March 25, 2011 [1 favorite]

For me, the pain after feeding was a sign of thrush. It went away when both of us were treated for it.

With my first, the toe-curling pain at latch-on lasted 6 weeks due to cracked nipples. I was definitely not using enough lanolin. Use it after EVERY feeding. It allows wounds to heal in a moist environment. You'll need lots of nursing pads to prevent staining. Please use it after every feeding to speed up healing. Not using it every time was my biggest mistake, and caused me so much pain for six weeks! Even if you're not seeing active bleeding, your nipples are probably cracked, much like cracked skin doesn't exactly ooze blood. You don't need to wash it off before feeding, it's safe for babies to ingest.
posted by ellenaim at 5:44 AM on March 25, 2011

Just wanted to agree with ellanaim: Use the lanolin after *every* feeding.
posted by Andrhia at 6:05 AM on March 25, 2011

I experienced something similar to what you describe in terms of afternoon after-feed discomfort, although my afternoon feeder was a pump, not a baby.

My LC advised that I was getting dehydrated over the course of the day and so my milk production was lower in the afternoons. The simple act of drinking A LOT MORE water over the course of the morning helped quite a bit.

Have you tried using nipple shields? They were a godsend for us in terms of getting the latch straightened out without me wanting to vomit.
posted by anastasiav at 6:16 AM on March 25, 2011

It is possible that you are allergic to lanolin! I don't know what alternatives there are now, I weaned my youngest decades ago, I remember just using straight olive oil because of my reaction to lanolin.
posted by mareli at 6:27 AM on March 25, 2011

I should add that most wool makes me itch, if you have that problem then definitely stop using the lanolin.
posted by mareli at 6:31 AM on March 25, 2011

Following up on anastasiav, with my first I was having supply issues that made late afternoon/early evening feeds difficult. My LC suggested, in addition to drinking more water, trying to get a nap in the early afternoon- the rest helps your milk production. My LC suggested bringing my baby into bed with me, so that I could sleep and the baby could nurse. I know that would be impossible to do with two, but since you mentioned that you enjoy feeding one on one, maybe you could alternate somehow?
posted by ambrosia at 7:34 AM on March 25, 2011

congratulations on the babies! You are right in the middle of baby boot camp so I hope you're not trying to do too much, especially with two.

nthing the "if you've ruled out thrush" and following with: it might be a flukey thing that will resolve itself soon. I think for the first 6 weeks, every day can be totally different but also it gets better ever single day as the babies get older and can do a little more themselves.

Also - do you have inverted nipples? That's what caused the toe-curling for me with my first and it was just a matter of time (weeks, not months) before it worked itself out.
posted by dawkins_7 at 7:47 AM on March 25, 2011

My solution for all breastfeeding problems:

You topless, babies, bed, remote/smartphone/book, huge bottle of water, tons of snacks. Stay this way for 24 hours.
posted by k8t at 8:55 AM on March 25, 2011 [2 favorites]

Another factor to consider - the body naturally produces more milk in the mornings, from the early hours all the way through to late mornings. By the afternoon/evenings, production is lower, which explains why many babies like to "cluster feed" (lots of short nursing sessions) at that time of day. As you suggest, it may simply be that them nursing more in the PM is just worsening the pain you already feel, as your nipples adjust and heal, and your babies work on their technique! Definitely try drinking more water during the day to see if that helps, and yes, apply the lanolin after every feed.

If you need to rest, I found the side-lying position in bed (can be tricky at first, google it for a diagram) was awesome for getting a snooze and helping with back and shoulder pain.
posted by Joh at 9:16 AM on March 25, 2011 [2 favorites]

Are you more sensitive to pain in general during that time of day?
posted by Knowyournuts at 9:17 AM on March 25, 2011

Looks like a supply consensus. I'd pump for the afternoon feedings, just to get a nipple break, and let dad give the milk (i like Dr. Brown bottles even though they don't screw onto my pump). Also, one formula feed (with twins!!!) shouldn't hurt production if you're pumpung - freeze for later...during your massage....that you'll schedule right after you read this.
My nip pain peaked about 3-4 weeks, so relief is just around the corner.
posted by kristymcj at 9:31 AM on March 25, 2011

Ask your lactation people/midwife/doc for a prescription for APNO (all purpose nipple ointment). It's made at a compounding pharmacy. It's a mixture of emollients, anti bacterials, anti inflammatories, anti fungal, and pain relief. You can nurse without wiping it off. It'll help with pain and preventing infections in those little abrasions.
posted by xo at 10:58 AM on March 25, 2011 [1 favorite]

I came in here to suggest supply too. Not a problem, necessarily, just that milk production tends to be lower that time of day, so babies may be nursing more frequently and vigorously. I don't have any genius suggestions, unfortunately. If you're showing any sign of damage to your nipples, I would put a little lanolin on them after every feeding just so your bra or breast pads aren't sticking to your nipples and making problems worse. The clamping down and pulling away is really common - my hospital has a nursing group, and I asked about it there at that age and everyone was like "Oh, yeah, ouch. I was glad when they stopped that." I also had a lot of pain when baby latched on for the first few weeks, and we breastfed easily and for over a year, so I don't think the toe curling pain is necessarily a sign of a problem, particularly if it's only at the very beginning of the feeding.
posted by robinpME at 11:42 AM on March 25, 2011

If supply is a problem, I recommend Mother's Milk tea (if it's available where you are). YMMV; it works for some women and doesn't work for others, but it works for me. I notice an increased supply if I have 3 or more cups a day.
posted by ellenaim at 1:14 PM on March 25, 2011

My twins were born at 37.5 weeks. I remember thinking that it wasn't until they were 3-4 weeks old that the nursing them became similar to nursing my first as a newborn. Being born 3 weeks 'early' seemed to me to make a difference (I know it's considered 'full-term' and it's obviously not preemie, but . . . they just took a little longer to really master the skill).

I'm just going to nth all the others -- assuming it's not thrush, your experience sounds pretty normal for 3-4 weeks. Supply is lower in the afternoon, but also I think babies get fussier in the afternoon, some groups refer to this time of day as 'the witching hour'. Supply will continue to work itself out, sadly the witching hour stays until they move out. I had pain and odd sensations during let down until about 4-5 weeks.

Mother's Milk tea, fenugreek capsules -- I don't know if they did anything but both kids kept growing and it made me feel like I'd done *everything*, so . . .

Just a side note, I recall reading once that post-pardum depression was originally diagnosed in mothers of twins -- so keep an eye out and please get treatment. Kellymom will tell you which meds are safe. It's hard enough to enjoy twins when they keep you so busy, I'd hate for you to get PPD and suffer without help.

posted by MeiraV at 3:43 PM on March 26, 2011

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