Between 80-85% of new mums use a breast pump within the first 4 months of their baby’s life[1], and whether it’s sore breasts or nipple pain, pain while pumping is a common issue many new mothers and people who lactate experience. But pain when pumping isn’t inevitable, and it certainly isn’t something you should have to suffer through.
To avoid pain while pumping, it’s important to make sure you’re using your pump in the most comfortable way. In this post, Lactation Consultant Stacey Zimmels shares some of the reasons why painful pumping may occur and some tips for preventing or relieving pain during and after pumping.
Is breast pumping painful?
Pumping shouldn’t hurt. When you first put on a breast pump, you may feel a gentle pulling or tugging sensation as the nipple first enters the pump shield (or flange); however, any sensation of discomfort you feel should pass within the first minute of pumping.
If you feel uncomfortable for longer than this, or you experience something stronger and more painful than a gentle tug, then something isn’t right. At this stage, you should stop pumping and consider any adjustments you can make to prevent or alleviate pain.
What causes breast pain when pumping?
We can break down pain when pumping into two categories: there’s the pain caused by pumping itself, and pain experienced as a result of breastfeeding and lactation.
The two most common causes of pain when using a breast pump are the pump shield not fitting correctly or the pump itself being used incorrectly. There are also a number of common lactation-related conditions which can cause pain, such as engorgement, plugged ducts, or mastitis.
Common reasons for experiencing pain while breast pumping include:
Incorrect pump shield size and fit
The pump shield (the part which fits over your nipple to form a seal around the areola) needs to fit correctly to be comfortable during pumping, as well as to optimise milk output. A shield that’s too large can pull in the areola and cause it to swell and feel painful, while shields that are too small can cause the nipple to rub against the sides of the shield and create friction blisters.
Most pumps offer shields in various size options — you can use the Elvie nipple sizing guide to help you select the right size shield for your nipple — but remember that each of your breasts and nipples may not be the same shape and size, so it’s possible you may need different size shields for each breast. You should also regularly check how pumping feels, as throughout your lactation your breasts can change size — which can impact on the shield size you need.
In addition to ensuring that you have the right size shield, you also need to align the breast shield to the direction of the nipple when you are putting the pump on. Ensure that it is placed symmetrically with the nipple centred within the shield to avoid pain or damage.
If our shield sizes are too big, our soft silicone nipple cushions can help eliminate the pain and chafing you might experience. Choose from three sizes to ensure your nipple fits snugly, and pump without the pain of a bad fit.
Incorrect use of the pump
Many people believe that the stronger the suction, the more milk that you will stimulate and produce during pumping. This is incorrect. In reality, increasing suction strength beyond what feels comfortable will cause pain and possible damage to the nipples.
You should aim for a light suction at the start of pumping, with faster pumping cycles. Once the milk begins to flow, switch to a slower pumping cycle and then increase suction to the highest level which feels comfortable for you.
Before using a new pump for the first time, make sure you thoroughly read the instruction manual to ensure you know how to use it correctly. You might also want to read Elvie’s guide on How to properly use a breast pump.
Engorgement
Engorgement is a condition which typically occurs 2 to 4 days after your baby is born, when your milk “comes in” and you move from colostrum to mature milk. It can also occur if you skip a nursing session; for example, if your baby sleeps longer than expected or you miss a typical pumping time in your schedule.
Engorgement occurs due to a build-up of milk in the breasts. If you try to pump on an engorged breast, you may find it painful and may struggle to draw in the nipple from the swollen areola and breast.
If you are able to begin pumping, it may hurt and you may struggle to get a ‘let down’. The following tips may help:
Use the reverse pressure softening technique prior to pumping.
After using reverse pressure softening, hand express to remove some milk. This will make it easier to put the pump in place and more likely that you will get a let down.
Put cold compresses on the breasts between pumping sessions.
Just before pumping, place a warm compress on the breast for a very short period. This can help you feel more comfortable and also help to trigger the milk ejection reflex (the ‘let down’).
You can avoid engorgement while exclusively pumping by keeping to your pumping schedule and ensuring that you continue to pump for long enough during each pumping session.
Plugged ducts and mastitis
Plugged ducts and mastitis can occur during lactation, both of which can increase pain during pumping. A plugged duct is a local area of the breast where there is a blockage which can slow milk flow, while mastitis is an inflammatory breast condition which has varying different causes.
Until recently, it was suggested that the frequency in which you pump should be increased if you have plugged ducts or mastitis, but it is now thought that this could increase associated engorgement and inflammation and is therefore no longer recommended.
Instead, the following management tips can be used to help ease pain caused by plugged ducts or mastitis:
Continue to pump according to your usual pumping schedule.
Apply a cold compress on the breast between feeds to soothe and reduce inflammation.
Lightly touch the skin of the breast in a sweeping fashion — moving away from the nipple towards the armpit — to reduce the inflammation and encourage milk flow[2] (vigorous massage and use of vibration on the blockages is no longer recommended, as evidence suggests it can worsen inflammation & engorgement).
Take paracetamol and ibuprofen (both are safe for breastfeeding women) to relieve pain and reduce inflammation.
Not sure whether you’re suffering from engorgement, a plugged duct, or mastitis? Read our guide to understanding the differences.
Nipple damage
Nipples can become painful if there has been trauma either from a poor latch or damage during pumping. Using the moist wound healing technique can help the nipple heal, while pumping using more gentle suction than usual will reduce pain as it heals.
If nipple pain and damage persist, consult with your physician as a bacterial infection such as staphylococcus aureus may be present. Other, less common causes of persistent nipple pain may include thrush, which would require diagnosis and treatment by your doctor.
If you your nipple is tingly or discoloured (white or blue), then check your shield fit as you may be experiencing vasospasm due to compression of the nipple while pumping. This can occur as a result of incorrect shield size or placement.
How to prevent breast pain while pumping
Whatever the likely cause of your pain while using a breast pump, there are a number of adjustments you can make to prevent pain and ensure you can pump comfortably and confidently. For example:
Make sure your breast pump shield is the right size: An International Board Certified Lactation Consultant can work with you to help ensure you have the right size and fit of pump shield for your body, which can prevent pain during pumping and help to increase milk production.
Use your breast pump correctly: Read the instructions thoroughly before using a breast pump for the first time, and use a suction cycle that feels comfortable for you. Aim for a light suction at the start, then switch to a slower pumping cycle and with increased suction when milk begins to flow.
Keep your breast pump clean: Cleaning your pump daily and practising good hygiene will reduce your risk of contracting a bacterial infection, which can cause nipple pain and inflammation.
If you are pumping engorged breasts, you could also:
Use the reverse pressure softening technique: Reverse pressure softening involves using the hands to move the fluid in your breasts backward, helping to relieve the pressure from engorgement and make pumping less painful.
Apply a warm compress before pumping: Just before you pump, apply a warm compress to the breast for a few seconds. This can help trigger the milk ejection reflex and make you feel more comfortable while pumping.
How to relieve breast pain after pumping
Feeling pain in the breasts after pumping? If you experience breast pain, nipple pain, discomfort or inflammation following a pumping session, there are several measures you can use to soothe the area and reduce any swelling. These include:
Breast milk: Not only is breast milk full of incredible nutrients for your baby, but it can also help ease the pain of sore and cracked nipples. The American Pregnancy Association advises hand expressing a little breast milk and gently rubbing it into the nipples after feeding or pumping.
Cold compress: Applying a cold compress or a glycerin gel pad to the breasts for a short time following each pumping session can help soothe pain and reduce inflammation.
Moist wound healing: If your nipples are painful because they’ve become damaged during pumping, using the moist wound healing technique can help them to heal faster.
Coconut oil: Pumping with dry skin can cause the nipples to become cracked. You may find pumping more comfortable if you lubricate the nipples. Try using coconut oil as it contains natural moisturising properties.
Painkillers: Over-the-counter painkillers such as paracetamol and ibuprofen can be used safely while breastfeeding, and they can provide temporary relief from pain caused by pumping.
When to seek medical care for breast pain
If you have followed the above guidance and you’re still experiencing persistent pain or discomfort during or following pumping, you should speak to your doctor. If your pain is caused by a bacterial infection such as staphylococcus aureus, you will be prescribed a course of antibiotics to treat it.
Similarly, you will need to see your doctor if you have symptoms of mastitis — a red, swollen area on the breast, a hard or wedge-shaped area on the breast, a burning pain that intensifies when you breastfeed or pump — for more than 24 hours, as antibiotics will be required. You should also see a medic if you have nipple trauma or pain that isn’t resolving after first line treatments.
About Stacey Zimmels
Bsc (Hons) MRSCSLT, MHCPC, MASLTIP, IBCLC
Paediatric Feeding and Swallowing Specialist Speech Therapist and Lactation Consultant
Stacey Zimmels is a feeding and swallowing specialist speech therapist (SLT) and International Board-Certified Lactation Consultant (IBCLC). Stacey has worked for over 20 years supporting infants and children with a wide range of feeding and swallowing difficulties.
Stacey spends her time providing 1:1 support to babies and families with breastfeeding, bottle feeding, weaning and eating difficulties. She also educates parents via her feedeatspeak Instagram account, blog and through her online feeding courses.
Her breadth of knowledge and experience runs across the spectrum; including but not exclusive to feeding difficulties associated with preterm infants and medical/developmental conditions, breast and bottle feeding, weaning difficulties, feeding challenges secondary to food allergies and reflux, swallowing difficulties and fussy eating.
References
[1] Labiner-Wolfe J, Fein SB, Shealy KR, Wang C. Prevalence of breast milk expression and associated factors. Pediatrics. 2008;122 Suppl 2:S63–8.
[2] Mitchell, K.B., Johnson, H.M., Rodríguez, J.M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., Cash, K.W., Berens, P. and Miller, B. (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17(5), pp.360–376. doi:10.1089/bfm.2022.29207.kbm.