When using a breast pump, discomfort or pain is common, but it is not a necessary part of the process. Pain during pumping is often a clear signal that something in the technique or equipment needs adjustment. Addressing this discomfort is important not only for physical well-being but also for maintaining a consistent milk supply, as pain can inhibit the milk-ejection reflex.
Ensuring Proper Equipment Fit
The most frequent source of pain during pumping stems from using an incorrectly sized breast shield, commonly called a flange. A proper fit ensures the nipple is gently drawn into the tunnel without excessive friction or pulling in too much of the surrounding tissue.
To determine the correct size, measure the diameter of the nipple base, across the widest part, before a pumping session and without including the areola. This measurement should be taken in millimeters. Experts recommend selecting a flange size that is 2 to 4 millimeters larger than the nipple diameter to allow for natural expansion during pumping.
Once pumping, the nipple should be centered and move freely within the flange tunnel without rubbing against the sides. If the flange is too small, the nipple will rub painfully against the walls, leading to friction and trauma. If the flange is too large, it will draw in excessive areola tissue, causing swelling and potentially compressing the milk ducts. Using soft silicone inserts can improve comfort and create a more precise fit.
Optimizing Pumping Technique and Settings
Beyond the correct physical fit, pump settings must be optimized to mimic the natural suckling pattern of a baby. Most modern electric pumps utilize a two-phase system: stimulation and expression. The stimulation mode uses a fast cycling speed with lower suction to initiate the milk-ejection reflex, similar to a baby’s rapid, flutter sucking.
Once milk flows consistently, switch to the slower, deeper expression mode. Gradually increase the suction strength to the Maximum Comfort Vacuum (MCV). The MCV is the highest vacuum level that can be used while remaining completely comfortable, never reaching a point of pain. If the suction begins to feel uncomfortable, immediately decrease the setting by one level.
Using a vacuum level that is too high does not necessarily result in more milk and can cause trauma to the breast tissue, potentially leading to pain and reduced output. Pumping sessions should last around 15 to 20 minutes, or until the breast is softened. Pumping for durations over 30 minutes can cause unnecessary irritation.
Addressing Physical Sources of Pain
When pain persists despite optimizing equipment and settings, the cause is often a physiological condition requiring specific management. One common issue is nipple trauma, presenting as cracking, blistering, or bleeding, usually caused by friction from an ill-fitting flange or overly high suction. Temporarily resting the affected breast or using a lower suction setting allows the skin to heal, often aided by applying a lanolin or hydrogel pad.
Pain accompanied by a hard, tender, or warm lump may indicate a clogged milk duct or mastitis. A clogged duct can be managed by applying gentle heat before pumping and massaging the area toward the nipple during the session. Mastitis is a severe inflammation that presents with flu-like symptoms, including fever, chills, and body aches. If signs of infection like fever above 101°F or significant malaise are present, immediate medical attention is necessary, as mastitis may require antibiotics.
Another specific cause of pain is vasospasm, sometimes known as Raynaud’s phenomenon of the nipple, which involves the tightening of blood vessels. This condition causes intense, burning, or throbbing pain, often after pumping, and the nipple may visibly blanch, turning white, blue, or purple, especially when exposed to cold. Management involves avoiding cold exposure and applying immediate warmth to the nipple after pumping to encourage blood flow.
Preparation and Comfort Strategies
Incorporating simple preparation and comfort strategies into the pumping routine can reduce overall discomfort and improve the milk-ejection reflex. Applying warmth to the breasts just prior to or during the pumping session helps stimulate milk flow and makes the experience more comfortable. This can be achieved using a warm compress or taking a warm shower before connecting the pump.
Gentle massage of the breast before and during pumping aids in moving milk through the ducts, which relieves pressure and prevents clogs. To reduce friction inside the flange tunnel, a small amount of specialized pumping spray or a food-grade oil, like coconut oil, can be applied to the nipple and areola.
Creating a relaxed environment is beneficial because the milk-ejection reflex is strongly influenced by hormones, particularly oxytocin, which is inhibited by stress. Finding a quiet, comfortable location and utilizing relaxation techniques, such as deep breathing or looking at pictures of the baby, can help trigger a more effective let-down. Consistent use of these comfort measures helps transform pumping from a source of dread into a manageable and productive routine.