One of the things I notice very quickly when supporting a new mother is the way her body responds when her baby latches.
Sometimes her shoulders rise. Her face changes. She holds her breath for a few seconds. When I ask, “Does that hurt?”, she might say, “A bit,” and look slightly unsure.
Because often she doesn’t know.
This may be her first baby. She has no reference point for what breastfeeding is supposed to feel like. She doesn’t know whether the pain she is experiencing is expected, whether it should disappear after a few seconds, or whether it is telling us that something needs adjusting.
So I make it more concrete.
I ask her to give me a number from zero to ten.
If the pain is a six or seven when the baby first attaches, I want to know what happens next. Does it quickly settle to a one or two? Or is she still sitting at a six several minutes into the feed?
Some women experience brief discomfort or sensitivity when a newborn first attaches, particularly in the early days. But significant pain that continues once the baby is feeding is not something I want a mother simply enduring.
My first step is to watch the feed.
If we improve the baby’s positioning and attachment and the pain changes immediately, that tells us something useful. If the attachment appears good and the pain remains significant, I want to know why.
Pain is information.
I want to see the feed, not just hear about the pain
When breastfeeding hurts, there is a temptation to focus immediately on the nipple.
I prefer to start further back.
How is the mother sitting? Is she comfortable, or has she gradually folded herself around the baby? Is the baby’s body close to hers? Are their head and body aligned? Can the baby tilt their head back and open their mouth widely?
Sometimes a small adjustment changes how deeply the baby takes the breast. When that happens, I ask for the number again.
If the pain was six and is now two, we have learned something.
That immediate feedback matters much more to me than whether the feed looks textbook-perfect from across the room.
A latch has a function. It isn’t a picture.
There isn’t one breastfeeding position for every body
Breasts are different, and that matters.
Some women have small breasts. Some have very large or heavy breasts. The shape and position of the breast, the mother’s height and torso, the size of the baby and even the chair or bed she is feeding on can change what works.
With a larger or heavier breast, we may need to think about supporting the breast as well as the baby. Another mother may find that a completely different position naturally brings her baby to the right height.
A good feeding pillow can sometimes change a feed enormously.
Not because every breastfeeding mother needs special equipment, but because holding a baby’s entire weight with the arms and shoulders feed after feed is difficult. Good support can allow the mother to relax and bring the baby towards the breast rather than gradually bringing herself down towards the baby.
Sometimes what looks like a latch problem is partly a support problem.
Nipples are different too
Nipples vary enormously in size, shape and how far they protrude. They may be prominent, very small, relatively flat or inverted.
None of those things automatically determines whether a woman will be able to breastfeed. Babies breastfeed from the breast, not simply from the nipple.
But anatomy can affect the mechanics.
A flatter or inverted nipple may be more difficult for some newborns to attach to and maintain in the mouth. A larger nipple can present a different challenge for a very small baby’s mouth, particularly in the early days.
I don’t see these things as something being wrong with a woman’s body.
They are information.
They help us work out how this particular mother and this particular baby can feed together most effectively.
Sometimes nipple shields are useful
Nipple shields are another tool, and I don’t think they need to be treated as either wonderful or terrible.
For some mother-and-baby combinations, a correctly fitted shield can be genuinely useful, including in situations where a baby is struggling to attach to a flat or inverted nipple.
But I want to know why we are using it. Fit and technique matter, and once a shield is introduced I still want to know whether the baby is transferring milk effectively and whether milk supply and weight gain are progressing as expected.
I also don’t want a mother to assume that because her baby needs a nipple shield now, this is necessarily how she will always breastfeed.
I have supported mothers who began breastfeeding with nipple shields and, eight or ten weeks later, had babies attaching happily without them.
A lot can change in those weeks.
The baby grows. Their mouth gets bigger. They become stronger and more coordinated. Something that was genuinely difficult for a tiny newborn may become much easier for the same baby several weeks later.
And the mother changes too.
She has had hundreds of feeds by then. She knows how to hold her baby, how her breast behaves, which positions work for them and what an effective feed feels like. What felt incredibly complicated during the first week can gradually become something she does almost without thinking.
Of course, time cannot correct every problem. If there is a mechanical or medical issue interfering with feeding, it needs to be recognised and appropriately assessed rather than simply waiting and hoping it disappears.
But when there isn’t an underlying problem that needs correcting, time can be a great equaliser.
Sometimes the mother and baby don’t need to become better at breastfeeding immediately.
They need support while they grow into it together.
Is the baby actually feeding?
Once the baby is attached comfortably, I watch what they do.
A baby can be on the breast without necessarily transferring much milk.
At the beginning of a feed, sucking may be quicker. Once milk begins flowing, I want to see deeper, more rhythmic sucking and begin to see or hear swallowing.
I watch the jaw and cheeks. I notice whether the baby maintains the attachment or repeatedly slips off.
This matters particularly with sleepy newborns. A baby can take a few sucks and then spend a considerable amount of time resting at the breast. From the outside it may look like a long feed.
But time at the breast and effective feeding are not the same thing.
I am looking at two things together: is Mum comfortable, and is the baby transferring milk?
We need both.
The nipple afterwards tells us something too
When the baby comes off, I look at the nipple.
Ideally, it should remain reasonably rounded. If it repeatedly comes out flattened, pinched, creased, blanched or noticeably misshapen, particularly alongside pain, I want to reassess what is happening during the feed.
The nipple may be getting compressed.
Nipple shape alone cannot diagnose a breastfeeding problem. But combined with the mother’s pain, the baby’s position and what we have observed during the feed, it gives us another piece of the picture.
This is also why nipple cream isn’t my first answer to painful breastfeeding.
It may soothe damaged skin, but if the same nipple is being compressed again at every feed, we need to understand why.
Breastfeeding is partly about mechanics
When breastfeeding is painful, we often ask whether the mother is doing something wrong with the latch.
I think that question is too narrow.
What we actually have are two individual bodies trying to perform a fairly complicated physical task together: the breast and nipple, the mother’s body and position, the size of the baby, and the baby’s jaw, tongue and mouth.
The baby needs to open widely, create and maintain a seal, coordinate sucking and swallowing and transfer milk effectively.
Sometimes the difficulty lies predominantly in one area. Often several small things are interacting.
That is why I look at the whole feed rather than deciding immediately that a mother simply needs to “improve her latch”.
What if the latch looks good and it still really hurts?
Then we need to stop assuming everything is about attachment.
I want to know more about the pain. Is it only during feeding or does it continue afterwards? Is it burning, shooting or throbbing? Does the nipple change colour? Is there itching, swelling, damaged skin or pain elsewhere in the breast?
Thrush is one possibility, although nipple pain alone does not establish that thrush is the cause and persistent pain deserves proper assessment rather than repeated treatment based on an assumption.
Nipple vasospasm, sometimes associated with Raynaud’s phenomenon, can also be extremely painful. The nipple may become white and sometimes change through other colours as circulation returns. Cold may make it worse, and a mother may describe burning, throbbing or shooting pain despite apparently good attachment.
Existing nipple trauma can remain painful while it heals. Dermatitis and other skin conditions can affect the nipple and areola. Engorgement and inflammation can cause pain too.
And mastitis usually involves more than nipple pain. An area of the breast may become painful, hot or swollen, and the mother may feel feverish, achy or generally unwell. Mastitis involves inflammation and doesn’t automatically mean a bacterial infection, but significant, worsening or persistent symptoms need appropriate medical assessment.
So “breastfeeding hurts” isn’t a diagnosis.
It’s the beginning of the assessment.
Sometimes the baby’s mouth is part of the difficulty
There are also times when I become more interested in the baby’s oral function.
Can the baby open their mouth widely? Can they move their tongue effectively? Can they create and maintain a seal? Do they repeatedly lose suction or click? Are they transferring milk?
Tongue-tie can affect breastfeeding for some babies, but I don’t assume tongue-tie simply because breastfeeding hurts or a baby clicks.
Again, function matters.
If a baby cannot maintain attachment, milk transfer appears poor, the mother remains in significant pain despite good positioning, or weight gain is a concern, I want the baby’s oral function properly assessed.
The useful question isn’t simply, “Does this baby have a tongue-tie?”
It is, “Is something about the way this baby’s mouth is functioning interfering with feeding?”
Small things matter when they happen together
A clicking sound doesn’t automatically mean something is wrong. Neither does an occasional long or sleepy feed, a baby coming off the breast or a nipple looking slightly different afterwards.
Newborn feeding is variable.
But persistent pain alongside repeated clicking, slipping off, very little swallowing, significant nipple compression or concerns about weight gain begins to tell us something.
This is why feeding support is so often about careful observation.
You watch. You change something. You see what happens. You ask the mother what she feels.
And gradually the picture becomes clearer.
I would rather know about pain early
Pain can quickly become a cycle.
A painful attachment causes nipple damage. The next feed hurts partly because of the attachment and partly because the nipple is already sore. The mother begins anticipating the pain before the baby even latches.
And newborns don’t leave much recovery time between feeds.
I would much rather know that breastfeeding is hurting early, before a mother reaches the point where her nipples are badly damaged and she is dreading the next feed.
Sometimes changing positioning and attachment makes an enormous difference.
Sometimes it doesn’t.
Knowing that it hasn’t improved is useful too, because it tells us to look further rather than continuing to give the same advice.
Knowing when a lactation consultant needs to be involved
As a maternity nurse, feeding is a significant part of my work. I have spent many years watching newborns feed, helping mothers with positioning and attachment, recognising effective milk transfer and noticing when something doesn’t look or feel quite right.
Because a maternity nurse may spend many hours with a mother and baby, observing feed after feed rather than one isolated moment, we are often in a very good position to notice a problem developing.
I may be the person who notices that pain isn’t improving, that the nipple is repeatedly compressed, that a baby is losing suction, that feeds are very long without much swallowing, or that something about the baby’s mouth, the mother’s nipple or the mechanics between the two is making feeding difficult.
There is a great deal I can recognise and help with within my role.
But I cannot call myself a lactation consultant, and sometimes specialist breastfeeding assessment is exactly what a mother and baby need.
If significant pain continues despite changes to positioning and attachment, milk transfer or supply is a concern, I suspect the baby’s oral function may be affecting feeding, or something simply isn’t making sense, I will recommend a qualified lactation professional.
Likewise, if I see symptoms that may need medical assessment, I will say so.
Breastfeeding pain is information
When a mother tells me breastfeeding hurts, I don’t want her to prove how much pain she can tolerate.
I want to understand what her body and her baby are telling us.
How much does it hurt? When does it hurt? Does the pain reduce once the baby begins feeding? What changes if we alter the position? What does the nipple look like afterwards? Can we see and hear swallowing? How is the baby growing?
Those answers help us understand what is happening.
And perhaps just as importantly, they help the mother begin to understand it too.
There is a big difference between sitting through a painful feed because you have no idea whether what you’re experiencing is normal, and being able to recognise what a comfortable, effective feed feels like in your own body.
That is what I want a mother to leave with.
Not simply a better latch for this feed.
More confidence in recognising what is happening at the next one.
Need support with feeding your newborn?
Feeding rarely exists in isolation during the early weeks. A sleepy baby may struggle to feed effectively. A baby who isn’t feeding well may wake very frequently. Feeding, weight gain, sleep and settling often need to be looked at together rather than as separate problems.
Through my Remote Newborn Support, I work with families to understand that wider picture. We can look at feeding alongside your baby’s sleep, settling, behaviour and development, and work out what may need adjusting and what is simply part of normal newborn life.
And when something needs specialist breastfeeding or medical assessment, I will tell you that too.
The aim isn’t to make you feed your baby according to somebody else’s philosophy.
It is to help you understand what is happening, make informed decisions and feel supported while you and your baby find what works for you.
About Solange
Solange Martins Stanger is the founder of SOL Coaching, a women’s coach, maternity nurse and mother of two, with over 15 years of experience supporting families. She understands how deeply motherhood can change a woman’s sense of herself. Her work offers space for women to feel heard, reconnect with their own needs and explore what they want for their lives—alongside caring for the people they love.