Pumping milk uses suction to draw milk from the breast, allowing parents to provide breast milk when direct feeding is not possible. While many worry about pain, pumping should not cause lasting or severe discomfort. True pain indicates that an adjustment is needed, either to the equipment or to address an underlying physical condition. Understanding the difference between expected sensations and actual pain is key to a comfortable and effective pumping journey.
Expected Sensations and Discomfort
An effective pumping session involves sensations of tugging and pulling, which should not escalate into sharp or burning pain. This pressure is required to initiate the milk ejection reflex, often called the letdown. The letdown can feel like tingling, a pins-and-needles sensation, or a sudden feeling of warmth as milk begins to flow.
It is normal to experience brief discomfort, lasting only 10 to 15 seconds, when the pump first engages and the nipple tissue stretches. This initial feeling should quickly fade as milk flow begins. If discomfort persists beyond the first minute or feels sharp, stabbing, or burning, it signals an issue. Discomfort is temporary and tolerable, but true pain is persistent and requires immediate attention to prevent injury.
Ensuring Proper Equipment Fit and Technique
The most frequent cause of pain is an incorrect fit of the breast shield, also known as the flange. The flange is the funnel-shaped piece that creates a vacuum seal over the nipple and areola. Its size is determined by the diameter of the nipple itself. If the flange is too small, the nipple rubs painfully against the sides of the tunnel, causing friction, soreness, and potential trauma.
If the flange is too large, excessive areola tissue is pulled into the tunnel. This can lead to swelling, bruising, and inefficient milk removal. To determine the correct fit, measure the diameter of your nipple at the base in millimeters when it is at rest, excluding the areola. Lactation consultants recommend choosing a flange size a few millimeters larger than this measurement to allow for natural movement during pumping.
Vacuum Settings
Misuse of the pump’s vacuum settings is another common issue. The suction level should be set to the highest possible vacuum that remains comfortable, not the maximum setting available. Suction that is too high causes significant pain and damage to the nipple tissue. Most pumps feature a “stimulation” or “massage” mode with a faster cycle speed to trigger the letdown, followed by an “expression” mode with slower, stronger suction to remove milk.
Alignment
Proper technique also requires careful alignment, ensuring the nipple is centered precisely in the flange tunnel before turning the pump on. If the nipple is off-center, it rubs against the tunnel wall, creating painful friction and potential skin breakdown. Checking the alignment at the start of every session is necessary to maintain comfort and prevent injury.
Physical Conditions That Cause Pain
If equipment fit and technique are correct, pain may stem from an underlying physical condition within the breast tissue.
Clogged Ducts
A common ailment is a clogged milk duct, which occurs when milk flow is obstructed. This leads to a painful, tender lump in the breast, often feeling like a hard knot. This blockage causes localized pain and tenderness, which is exacerbated by ineffective milk removal.
Nipple Trauma
Nipple friction injury or trauma presents as painful skin breakdown, cracking, or blistering, usually resulting from an incorrect flange size. Continuous rubbing or excessive suction damages the skin, making subsequent pumping sessions intensely painful until the tissue heals. Applying a small amount of lubricant, such as nipple cream or vegetable oil, before pumping can help reduce friction during the healing process.
Mastitis
A more serious cause of pain is mastitis, an infection of the breast tissue often developing from unrelieved milk stasis. Symptoms include redness, swelling, and heat on the breast, accompanied by flu-like symptoms. These include a fever of 101 degrees Fahrenheit or higher, chills, and body aches. Mastitis requires prompt medical attention and is typically treated with antibiotics.
Vasospasm (Raynaud’s Phenomenon)
Vasospasm involves the blood vessels in the nipple constricting. This can cause the nipple to turn white or blue, followed by a sharp, burning, or throbbing pain immediately after pumping. The sudden change in color and intense pain is caused by blood rushing back into the tissue after the pump is removed.
Thrush (Fungal Infection)
A fungal infection like thrush can cause shooting pain inside the breast during or after pumping. External signs of thrush may include nipples that are visibly bright pink or red, itchy, flaky, or burning. Since thrush can be passed between the parent and the baby, a healthcare provider must treat both simultaneously to prevent reinfection.
Recognizing Serious Warning Signs
Certain symptoms indicate that pain requires immediate consultation with a healthcare provider or lactation consultant.
- Pain that is sharp, stabbing, or persists continuously throughout the pumping session suggests an injury or infection needing professional diagnosis.
- The sudden onset of flu-like symptoms, including a high fever, severe body aches, or chills, are definitive signs of a possible infection like mastitis.
- Visible signs of severe nipple trauma, such as deep cracking or blistering that does not heal, must be addressed urgently.
- Any discharge of pus or blood in the milk requires immediate attention.
Ignoring these warning signs can lead to worsening infection, greater tissue damage, and a reduction in milk supply.