Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat.When the baby is latched on correctly, the nipple is located against the soft palate in the back of the babys mouth. When the nipple is near the front of the mouth and being pinched against the hard palate, this will cause pain and development of cracked nipples. One cause of painful, cracked nipples is the incorrect positioning and incorrect latching on to the breast by the infant. The baby can create cracked nipples due to the strong sucking pressure, stretching and pulling the nipple, the friction and rubbing of skin to skin. The cause of sore, cracked nipples can also be from a yeast or Candida infection in the baby or the mother or both. Thrush can develop after the use of antibiotics. For first-time breastfeeding mothers, it normally takes a few tries before the latch is right, which can make the nipples tender and sore the first few days. If the nipples become cracked or bleed, the latch may need to be corrected. Women are advised to keep on breastfeeding, as it will actually help the nipples heal. A little breast milk or purified lanolin cream or ointment helps the healing process.If a feeding bottle is used in addition to breastfeeding, cracked nipples may result because the different sucking techniques required for the bottle and the breast vary.
Candida infection (thrush) of the nipple can also occur, resulting in deep-pink, cracked, and sore nipples. Contraindications for breastfeeding
Because cracked nipples can result in the infant being exposed to blood, women with certain blood-borne diseases may be advised to stop breastfeeding if they have a cracked nipple. It has been found safe for breastfeeding mothers with hepatitis B and cracked nipples to breastfeed. In the event that a nursing woman experiences cracked and bleeding nipples or breast inflammation within one to two weeks immediately following an acute Toxoplasmosis infection (when the organism is still circulating in her bloodstream), it is theoretically possible that she could transmit Toxoplasma gondii to the infant through her breast milk. Immune suppressed women could have circulating Toxoplasma for even longer periods of time. However, the likelihood of human milk transmission is very small. Transmission risk of HIV increases if the mother has cracked and bleeding nipples An uncommon infection in the mother, Chagas disease, can be transmitted to the nursing infant via cracked nipples. Women with hepatitis C are advised to abstain from breastfeeding if their nipples are cracked or bleeding. Cause
Some studies indicate that cracked nipples are caused by poor latch. Yet other causes could be poor positioning, use of a feeding bottle, breast engorgement, inexperience, semi-protruding nipples, use of breast pumps and light pigmentation of the nipples. Breast engorgement is also a main factor in altering the ability of the infant to latch-on.