WHEN BREASTFEEDING OR PUMPING HURTS

What's Normal and What's Not

Breastfeeding and pumping are often described as “hard in the beginning.”

What they are not meant to be is painful.

In our Pregnant and Popped VILLAGE community, breastfeeding and pumping consistently sit in the top three concerns new parents ask about. Pain is common. But common does not mean normal.

In this masterclass, International Board Certified Lactation Consultant (IBCLC) Eliza Koo, founder of Tender Loving Milk, breaks down why breastfeeding and pumping hurt, what is normal in the first few days, and what needs attention.

Because pushing through pain is not a feeding strategy.

WATCH THE REPLAY NOW

(or scroll below for our handy written summary of all of Eliza's main takeaways)

IS BREASTFEEDING PAIN EVER NORMAL?

Some nipple tenderness in the first 24 to 48 hours after birth can be common.

Ongoing pain is not.

Pain is a clinical sign. It tells us something in the mechanics of feeding needs attention.

When pain is ignored:

• Stress hormones rise

• Oxytocin can be affected

• Milk flow may be impacted

• Parents begin to dread feeds

• Confidence drops

And very often, parents stop earlier than they had hoped.

This is not about guilt. It is about understanding what your body is trying to tell you.

The "latch looks fine” but it still hurts

One of the most common things Eliza hears is: “But they said the latch looks fine.”

Feeding is not just visual. It is functional.

A latch can look textbook from the outside and still cause pain if:

• Baby is using more jaw than tongue

• There is tension in the neck or shoulders

• The mouth gape is restricted

• Baby slides lower on the breast during the feed

• There is shallow attachment over time

This is why an IBCLC looks beyond what it “looks like” and assesses what is happening mechanically.

What nipple damage can tell you

Nipple injuries are not random. They are often diagnostic clues.

Common patterns include:

• Cracked or bleeding nipples, often linked to shallow latch

• Lipstick-shaped or flattened nipples, indicating compression

• Blisters from friction or poor seal

• Bruising from jaw tension

• Blanching, where the nipple turns white due to reduced blood flow

After a feed, your nipple should look round. Not pinched. Not flattened. Not raw.

If it does not, something needs adjusting.

Positioning matters more than you think

Exhausted parents often slouch while feeding, it's understandable, but when you curl forward:

• Baby slides lower on the breast

• The latch can become shallower

• Neck tension increases

• Your shoulders and back start to ache

Positioning is not just about baby’s mouth, it is about your body too.

Eliza’s favourite positions to teach are laid-back and side-lying. When your body is supported and rested, feeding often improves dramatically.

Sometimes the smallest shift, like ensuring baby’s tummy is fully facing your body or allowing the neck to extend rather than tuck, makes a significant difference.

Baby tension and oral function

Feeding is a full-body activity.

The tongue, jaw, neck, and shoulders are interconnected.

Some subtle signs that may indicate tension or restricted oral function include:

• Tight mouth gape

• Chin tucked down during latch

• Neck twisted away from the body

• Clicking sounds during feeds

• Lower jaw quivering

• Lip blisters

• Red tension lines on the neck or feet

None of these signs alone mean something is “wrong.”

But when paired with pain or poor milk transfer, they help guide a deeper assessment.

If you are struggling, working with an IBCLC trained in infant oral function can be transformative.

Tongue tie and oral restrictions

Tongue function affects how deeply baby can latch and how effectively milk is transferred.

When the tongue cannot lift adequately:

• The nipple may sit too far forward in the mouth

• Milk flow may be less efficient

• Baby may overuse jaw muscles

• Pain may increase

If you suspect a restriction, seek an experienced IBCLC first. They can assess feeding holistically and guide you on next steps.

Intervention is a decision, it should be informed, not pressured.

PUMPING SHOULD NOT HURT EITHER

Many parents assume pumping discomfort means it is “working.”

It does not.

Common pumping-related injuries include:

• Red, sore nipples

• Swollen, overstretched nipples from oversized flanges

• Areola abrasions

• Broken skin

• Strawberry milk from capillary damage

• Blocked ducts from poor milk removal

The most common culprit? Flange size.

The old method of simply adding several millimetres to nipple measurement is outdated. Newer research suggests most mothers should use smaller flange sizes than traditionally recommended.

Flange fitting should include:

• Measuring the nipple

• Trialling multiple sizes

• Watching how the nipple moves during pumping

• Ensuring contact and glide without abrasion

Pumping should feel comfortable.

Supporting letdown and oxytocin while pumping

Milk flow is hormonal as much as mechanicall if stress is high, letdown can be affected.

Some ways to support oxytocin while pumping include:

• Slow breathing techniques

• Skin-to-skin time

• Watching or smelling baby

• Gentle movement

• Meditation

• Humming

• Creating a calm environment

There is no one perfect method, it is about finding what relaxes your nervous system.

Blocked ducts, engorgement and healing nipples

If you are dealing with soreness or cracks:

• Address the root cause first

• Use expressed breast milk on the nipple

• Consider pure lanolin or hydrogel pads

• Air dry where possible

For inflammation and engorgement:

• Use cold compress

• Avoid aggressive massage

• Reassess latch and pump settings

Blocked ducts are often linked to incomplete milk removal or mechanical issues.

Treat the cause, not just the symptom.

FREQUENTLY ASKED QUESTIONS FROM THE MASTERCLASS

Does anaemia affect milk supply?

Severely low iron levels can affect energy, and potentially supply. Address underlying health factors alongside feeding mechanics.

Can pumping alone increase supply?

Yes, but only if flange size, suction, frequency, and maternal health are optimised.

Are herbal supplements helpful?

They are not regulated in the same way as medications. Some parents find them helpful. Some do not. Individual assessment is key.

When should I measure flange size?

Late third trimester can be a guide. Reassess after birth if needed.

Can left and right nipples be different sizes?

Absolutely. It is common.

How do I maintain supply while healing sore nipples?

Hand expression is often the gentlest method. Seek support early.

WHEN TO SEEK HELP

If:

• Pain lasts beyond the first few days

• Nipples look damaged after feeds

• Feeding causes dread

• Baby seems tense or inefficient

• Pumping is uncomfortable

Do not wait.

Pain is information.

An IBCLC can assess latch, oral function, positioning, pump fit, and milk transfer in a way that goes far beyond quick visual checks.

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ABOUT THE SPEAKER

Eliza Koo is an International Board Certified Lactation Consultant and founder of Tender Loving Milk. She supports families with evidence-based, compassionate care rooted in both clinical training and lived experience.

She also supports families inside the Pregnant and Popped VILLAGE WhatsApp community, which runs 24 hours a day, 365 days a year.

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Please note: Certain visual materials were removed from the public replay of this masterclass. For full access to referenced resources, please contact Eliza at eliza@tenderlovingmilk.com.