Do not use soap on your breasts while breastfeeding as this can dry out your nipples.  Rinsing with clear water is sufficient.  If your nipples are very dry, you may use a samll amount of pure lanolin on them.  Lotions are generally not necessary as your nipples are already producing all they need for their protection.

Always wash hands thoroughly before breast feeding or touching your breasts.  Make sure nipples are dry after nursing.  Leaving your bra flaps down for a few minutes to let them "air dry" is often helpful.

Sore nipples - Some mild tenderness is to be expected as you and your baby get used to breastfeeding, but should improve within three to five days.  Breastfeeding should not be painful.  If it is, you need to find out what the problem is and correct it.  Very sore nipples are usually caused by poor positioning or a baby that is latyching onto the nipple improperly.

Improper positioning - Make sure you are positioned comfortably, with pillows supporting your arms and in your lap (to bring baby up to the position of your breast).  The baby should be face to nipple and tummy to tummy with you so that he does not have to turn his head to latch on to your nipple.  Baby's chin should be just below the nipple so that it presses into your breast while nursing.  If you do not feel comfortable, detach and reposition baby.  Don't get frustrated.  Some babies seem to take to breastfeeding more naturally and easier than others.  It's a learning process.  As you and baby become more experienced, you will find that there are a number of other comfortable positions for breastfeeding.  Experiement and see what works - as long as your are comfortable and baby is nursing well.

Latching onto the nipple improperly - When latching on to the nipple, the baby needs to open wide to take in a good mouthful.  You may need to brush the tip of the nipple along the center of the baby's lips to stimulate the baby to "root" for the nipple.  If baby doesn't get enough of the nipple into the back of the mouth during sucking, the baby's tongue may be rubbing against the tip of the nipple or the baby may be gumming the base of the areola (over the mild sinuses).  This kind of nursing is very inefficient (baby will not get enough milk and will want to nurse more frequently, making nipples even more sore) and will lead to sore nipples.  If baby is making a smacking sound while sucking, he is not latched on properly.  If you are having problems, try the following:

• Make sure baby's mouth is opened very wide before pulling baby into the breast.  Baby should latch on far back on the areola - approximately one inch beyond the nipple.
• Make a "V" with your first and second fingers around the edge or slightly beyone the margins of the areola or by supporting your breast with your fingers underneath and thumb on top, pressing in to flatten the breast while pushing back toward your chest.  This makes the areola more taut, longer, and narrower and easier for baby to take into the mouth.
• Use the index finger on the hand supporting the breast to push down on baby's chin while baby is latching on.  This will help keep baby's mouth open wide.
• Always break the suction before taking baby off the breast by slipping a clean finger into the corner of baby's mouth or pressing down gently on the breast near baby's mouth.

Other causes for sore nipples include:

Flat or inverted nipples - Mothers with flat or inverted nipples can successfully breastfeed their babies without pain, but it may take a little more work and patience.  Waring breast shells during pregnancy may help to draw out your nipples.  Once your baby is born, it may be helpful to use a berast pump immediately before nursing your baby to help pull out your nipple before baby latches on to the breast.

Engorgement - When your milk first comes in and during the early days of nursing, engorgement is not uncommon.  some babies have a difficult time latching on to an engorged breast.  To avoid this, be sure your breasts are being emptied frequently.  If your newborn is not breastfeeding every two to three hours, hand-expressing, or using a breast pump may help you avoid engorgement.  The first breast that baby nurses on will be emptied more completely, so alternate breasts with each feeding to avoid having one breast that is overly enforged.  Your mailk supply will adjust according to baby's demands and the engorgement should resolve within a few days.

Removing baby from your breast - Most mothers find that once full, baby will release the breast on their own.  If baby must be removed from the breast before this happens, break the suction by inserting a finger into the corner of your baby's mouth, pulling down on baby's chin, or pressing down on your breast near baby's mouth.  "popping" your baby off the breast can cause sore nipples.

Thrush or Candida - If your baby is no longer a newborn and you suddenly find yourself with sore nipples that are red, blistery, itching, or burning or with deep breast pain, you may have thrush - especially if your baby has oral thrush (white patches on the tongue or sides of the mouth) or if you have just finished taking a course of antibiotics.  Call your doctor if you suspect you have thrush.

Mastitis - Occasionally you might experience blocked milk ducts.  Signs of a blocked duct include areas of the breast that are reddened and/or tender and engorged.  It is important to continue breastfeeding when you notice this so that baby will drain the breast.  This will not hurt the baby.  Offer the affected breast first and, if possible, position baby so that affected area is alighned with baby's nose and chin.  The symptoms should subside once the breast is adequately drained.  If the breast becomes hot and painful, if you run fever, or if the skin appears tight and shiny, you should notify your doctor.  DO NOT stop breastfeeding on the affected breast.

Lactation suppression - To limit milk production in the first few days, bind the breasts with an ACE wrap.  Remove the wrap daily to shower.  Uncomfortable engorgement usually gets better within three to four days.  DO NOT pump the breasts to relieve discomfort, as this will only stimulate more milk production.  Cold compresses or ice packs can be applied to the breasts for short periods of time and you may also take ibuprofen to provide relief.  for further information consult your doctor or childbirth/breastfeeding educator.

Cool Cabbage Compresses

Cabbage has properties that are anti-inflammatory, anti-edematous (reduce swelling) and anti infectious.  Cabbage is an inexpensive, effective homeopathic treatment for lactation suppression or engorgement.  There have been no known cases of adverse reactions.

Materials needed:

• One large head of green cabbage
• Cutting knife
• Water to wash cabbage leaves
• Colander
• One dish towel

Preparation of the cabbage:

Cut the cabbage in half.  Remove the leaves by layers and wash them thoroughly.  Drain the leaves in a colander, cover with a dish towel and store in the refrigerator.  Cabbage leaves should be crumbled or crushed by rolling them out with a rolling pin or soda can.

Before you begin:

Place one bath towel in the refrigerator to get cold.  Heat a large pot of water (enough to soak your second bath towel).  This will be your second compress.

Treatment:

This treatment needs to be done in bed or in a reclining chair so you can be completely relaxed.  Crumple the leaves before you layer them onto the breast.  Cover the entire breast and armpits; excluding the nipple.  Place the cool towel over the cabbage compresses and rest for 10-60 minutes.  Remove the cabbage compresses and begin teh application of the warm compresses.  Cover the entire breast and armpits with the warm compress.  Rest for at least 10 minutes.  Massage the breast in the same fashion as you would to do a breast self examination.  Treat the breast like the face of a clock:  begin at twelve o'clock and work from the chest wall down to the nipple, using circular motions while massaging; then move to the one o'clock position, and so on.  Next, nurse the baby, hand express, or pump the milk.

Note: This procedure may be repeated twice on the day you initiate treatment.  If you feel it is necessary, you may repeat the treatment once in the morning on the following day.  DO NOT overuse the cabbage, as it can suppress your milk production.  You should find the treatment very soothing, your swelling should be reduced, the redness will gradually subside, and your milk will flow easily on demand.  Nurse your baby or pump regularly at two-hour intervals and do not miss a feeding or pumping session.  Most mothers report lositive results after the second treatment.