So many times mothers come to us with this situation: “Breastfeeding hurts, but they say the latch is ok. They’ve checked everything and they tell me my baby is latching on well”.

And that’s when we dissimulate and realise how difficult it is to combat the persisting myth of normalizing pain. Breastfeeding has to be pleasurable and effective, breastfeeding does not hurt, sore nipples are not normal, and pain always indicates that something is wrong. We would not have gotten this far as a species if breastfeeding was in itself a painful process.

If you feel pain, you should know that the main causes are:

• Incorrect breastfeeding positions: the baby’s body has to be aligned in a straight line: the ear, shoulder, and hip must remain aligned in whatever position is chosen for breastfeeding.
• Incorrect positioning and attachment: each breast is different, so you should try to trace an imaginary line from the centre of your nipple towards the baby’s head. If there are imaginary angles, your nipple is twisted inside the baby’s mouth and this can cause pain. And very importantly, the baby’s chin and nose should be close to the breast.
• Incorrect latch: when the baby latches onto the breast, we should observe how the nipple is directed towards the palate, the baby’s lips wide open, achieving* an angle of more than 90 degrees, both lips are curled outwards, and the cheeks are rounded.
• Tongue-tie (short lingual frenulum): the presence of a short frenulum can cause the baby to have a compensated suction, which means it counteracts the restrictions of her tongue, and she will use more force or suckle with more force to get breastmilk.
• Sucking difficulties: some babies have immature sucking or chewing sucking patterns that cause trauma to the nipple and a lot of pain.

Mothers are increasingly aware that breastfeeding should not hurt, but we still have a long way to go to get women to internalise this concept. If you feel pain while breastfeeding, it always means something is wrong. If this is your case, make sure you find a breastfeeding support group or a healthcare professional expert in the field, such as an IBCLC, who can help you assess a feed and find the causes of your pain.

*These observations regarding the latch and positioning only refer to the first few months of life of the baby; from three months onwards, babies suckle in any position as they choose, and this does not usually cause their mothers any pain.

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