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 healing your damaged nipples and what you should do if you pump bloody breast milk when you’re exclusively pumping.

Image credit: Julia Wright. Used with permission.

First, Fix the Underlying Issue

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 when you are exclusively pumping. (Note that if you’re nursing, there are a few different things that could be causing the problem – more info 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.

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.)

Nipple Positioning

If your nipple isn’t centered correctly in the breast shield, it will be pulled into the tunnel in the wrong way, causing injury to 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 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.

Healing Bleeding Nipples when Pumping

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 you’ll lose milk supply.) Here are a few strategies 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.

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 Lanolin after pumping as well.
• 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 breast milk to your baby?

Image credit: Brittany Turner. Used with permission.

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 you think that there is too much blood and/or the idea of giving your baby a bottle of red breast milk gives you pause, 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.)

One other thing to consider is to be sure that the pinkness or redness is caused by blood. 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 positive this was caused by blood – maybe you don’t see the injury to your nipple or you don’t have any pain – 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!