Cracked and Bleeding Nipples when Pumping Breast Milk

It can be alarming to look down and notice that the breast milk that you’re pumping is stained pink or red with blood. What causes bleeding nipples when pumping, and is it safe to give breast milk with blood in it to your baby? Here’s everything you need to know about what you should do if you pump bloody breast milk, and how to heal your damaged nipples.

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How to Fix the Underlying Issue / Cracked Nipple Causes

The first thing to do when you are breastfeeding and have nipples that are bleeding or cracked is to identify what’s causing the damage and fix it, so that no additional harm is done. Then, you can focus on healing.

Below are the mostly likely causes of cracked and bleeding nipples from pumping. (Note that if you’re nursing, there are a few different things that could be causing the problem – more info on this here.)

Breast Shield Size

The most common cause for nipple pain when you’re exclusively pumping is using flanges that are either too big or too small. When the flange is too small, your nipple rubs too much against the sides of the tunnel. When it’s too big, too much of your areola is pulled into the breast shield tunnel, leading to soreness.

Sometimes the friction from using the incorrect breast shield size can crack or damage the nipple.

What can be difficult about fixing this is that determining the correct size breast shield for you isn’t always easy. You can try measuring your nipple, as shown in this diagram. You can also just buy a bunch of different sizes of breast shields and see which is the most comfortable for you to use.

(If you buy Pumpin Pals, which many women find more comfortable anyway, they send you three sizes at once, which is a bonus. More information on alternative breast shields here.)

Lubrication

Some women find that the friction from pumping frequently can cause cracked nipples, even if their breast shields are properly sized.

One thing that can help with this is coconut oil – some women find that applying coconut oil to their breast shields before they pump makes pumping more comfortable and helps prevent nipple damage.

More information on using coconut oil while you pump here.

Nipple Positioning

If your nipple isn’t centered correctly in the breast shield, it will be pulled into the tunnel in the wrong way, which can injure it. Make sure that your nipple in centered in the breast shield.

A Lactalite might help you visualize your nipple positioning (especially in low lighting) and help prevent issues.

Pump Speed

Your pump should be set at the highest level that is comfortable for you. Be careful not to go above that, even if you’re struggling with low milk supply and are trying to get more milk when you pump. Pain while pumping can inhibit letdown, so it’s better to go with a slower, more comfortable speed.

Other Causes

Other issues that can exacerbate pain and damage from bleeding and cracked nipples are thrush, milk blisters, not changing breast pads frequently enough, and irritation from your bra. It’s a good idea to consider whether any of these might be an issue as well, and if so, seek treatment/adjust as necessary.

How to Heal Cracked and Bleeding Nipples

Once you’ve figured out the root cause of your cracked or bleeding nipples, you still might have some pain while the damage heals. (And unfortunately, you can’t take a break from pumping, or your milk supply will likely be affected.) Here are a few home remedies for cracked nipples that may be helpful to heal nipple pain faster while continuing to pump on your schedule.

Before Pumping

• If you’re in pain, don’t be afraid to take a pain reliever like Tylenol or Motrin (both of which are compatible with breastfeeding) to help with it.
• Use a warm compress, like a washcloth, to help relieve nipple pain.
• Consider applying a high quality coconut oil to your flanges.

While Pumping

• Nipple pain tends to be worse before you letdown. Hook yourself up to pump just on the side that is the least damaged, and then once your milk lets down, hook yourself up on the other side, too.

After Pumping

• Once you’re finished pumping, you can use a warm compress again for the pain
• A saline rinse might help heal your nipples more quickly (instructions for how to do this here)
• You should use a cloth to pat your nipples and aerola dry
• It might help speed the healing process to apply nipple cream after pumping as well.
• In addition to or instead of nipple cream, APNO (All Purpose Nipple Ointment) was created by Dr. Jack Newman to treat of range of issues related to breast pain. Many women have found it helpful for healing cracked nipples. It contains an antibiotic, a corticosteroid, and an antifungal agent; more info on what you need in a prescription here.
• Constant moisture against damaged nipples can prolong the healing process, so if you’re wearing breast pads, change them frequently.
• If the damage to your nipples makes wearing a bra (or doing anything besides going topless all the time) unbearable, Medela makes silicone SoftShells that can protect your nipples from your clothes. The SoftShells have holes that allow for air to get in to help heal your nipples.

Can you feed bloody pumped breast milk to your baby?

Experts say that yes, it is safe to feed breast milk with some blood in it to your baby. Per Dr. Jack Newman:

Sometimes when a baby swallows blood he may spit it up because it irritates his stomach, but it really does him no harm.

Additionally, Infant Risk says:

With blood, there’s not much you can do about its presence in milk except ignore it. Small amounts of human blood in milk is not a problem for a breastfeeding infant. Just the smallest drop of blood will noticeably stain your milk quite red. It’s not anything to worry about.

Therefore, in most cases it’s not an issue, and you can go ahead and feed it to your baby. However, if the idea of giving it your baby makes you uncomfortable, it’s obviously fine to dump it, too. (I pumped a bottle of bloody breast milk once that looked like it would have been perfect for a vampire baby, and I decided to dump it.)

Blood or Bacteria?

One other thing to consider before feeding is to be sure that the pinkness or redness is caused by blood. If you are not positive that the redness in your milk is caused by blood (for example, you don’t see any damage or feel any pain) you may want to take the milk to your pediatrician to clear it before feeding.

This is because a bacteria known as Serratia marsescens can also turn breast milk pink or red; this can happen if, for example, you were to leave your pump parts are out at room temperature overnight without washing and then use them to pump breast milk.

Large quantities of this bacteria can be dangerous for your baby. Therefore, if you pump breast milk is pink or red and you’re not sure this was caused by blood, you should either clear the milk with your pediatrician or dump it.

Have you pumped bloody breast milk? Let us know about your experience with bleeding nipple when pumping in the comments!

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