A breastfeeding mother.
For many new mothers, the first few days of breastfeeding come with a shock they were never warned about. The nipples crack and sometimes bleed, making every feed a process to endure rather than to welcome.
And because the women around them say this is normal, they believe it.
"They are wrong," says Wanjiru Gichuri, a medical doctor and lactation consultant based in Nairobi.
"It is pretty common, but it is definitely not normal,” she says.
The first sign that something is wrong is pain. Not mild tenderness, but persistent, sharp discomfort that does not ease as the baby feeds. A mother who dreads every feed, or who winces any time the baby attaches, is being told something important by their bodies. Instead, they are told to persevere because ‘breastfeeding is simply supposed to hurt.’
"I know it has been passed on from generation to generation that breastfeeding is painful. It should not be," says Dr Gichuri.
When blood appears during breastfeeding, the first question is where it is coming from. Dr Gichuri says it is not always obvious. The blood could be coming from the nipple, from the baby's gums, or from another part of the breast entirely.
Mothers should check their nipples first, looking for cracks, soreness, or visible wounds. They should also check the baby's mouth. Finding the source matters before anything else can be done.
In most cases, when the blood is coming from the nipple, it traces back to one problem: the baby is not latching correctly. When a baby attaches to the nipple instead of the broader, darker skin around it, called the areola, the repeated friction cuts and cracks the skin over time.
Breastfeeding can reverse effects of breast lift surgery.
"Ideally, the baby is supposed to latch on the breast, not on the nipple," says Dr Gichuri. "If the baby does not latch on the areola, they end up latching on the nipple, and then they will be causing friction."
She says that a poorly fitted breast pump flange or the wrong size nipple shield can cause the same damage. But a bad latch is by far the most common reason mothers end up bleeding.
A baby who is not latching well will also not feed well. The baby works harder than they should, draws less milk than they need, and pulls away from the breast, still hungry. If a baby is unsettled after feeds, cries regularly and seems unsatisfied, it is worth examining how they are attaching to the breast rather than assuming the mother's milk supply is the problem.
That assumption, Dr Gichuri says, is one of the most persistent myths in infant feeding. A crying baby does not mean the mother does not have enough milk. Yet it is one of the main reasons mothers stop breastfeeding early, turning to formula before giving their bodies and their babies a real chance.
She also takes issue with the common advice to feed a baby every three hours. Breastfeeding, she says, works best when a mother follows her baby's cues rather than the clock.
"Babies signal when they are ready to feed. Waiting for those cues rather than feeding by schedule means the baby is more likely to be in the right state to latch well," says Dr Gichuri.
One mistake she sees often is a mother pushing the breast into the baby's mouth rather than offering it and waiting for the baby to open up and take it on their own. When the timing is forced, she says, the baby's mouth may not be open wide enough, and what follows is a shallow latch.
"If you're doing it yourself, feeding the baby right now is what I want right now; they are not ready, and their mouth will not be open well," she said.
She adds that new mothers are also dealing with something that nobody talks about openly – lack of confidence. Breastfeeding is a skill that both mother and baby are learning at the same time. Coming in with fixed ideas about how it should look, or trying to follow a method rather than responding to the baby in front of you, can make things harder.
"It is a journey that everything is going to develop," she says. "You need to do it with your baby."
When blood does appear in the milk, many mothers panic about what the baby has swallowed. Dr Gichuri says there is no cause for alarm. Blood that is swallowed goes into the stomach and passes through the digestive system. It does not enter the baby's bloodstream. It will not cause vomiting, and it will not show up as blood in the baby's stool.
A mother breastfeeding her child.
For mothers who are HIV positive, she says the risk of transmission through swallowed blood is very low, provided both mother and baby are already on the recommended medications. Those protocols exist precisely to reduce the risk of transmission through breastfeeding. Swallowing is not the same as direct blood-to-blood contact, and if the medications are in place, the situation does not change that risk significantly.
The greater danger is what happens when cracked nipples are left untreated. Broken skin creates an opening for bacteria to enter the breast, and that is how mastitis develops. Mastitis is a breast infection that causes swelling, heat, and intense pain. In severe cases, it can become an abscess. It can make breastfeeding impossible and sometimes requires urgent medical treatment.
“Treatment must address the cause, not just the wound. Healing the nipple without fixing the latch means the damage will return. Mothers dealing with persistent cracking or bleeding should see a lactation consultant who can assess the latch, identify what is going wrong, and advise on how to manage the injury, depending on how severe it is. There is no single approach that works for everyone,” she says. The level of damage determines what needs to happen next.
Her prevention advice is that if a latch is painful, a mother should detach the baby and try again. Pulling the baby off without breaking the suction first will cause more damage, so she advises slipping a clean finger into the corner of the baby's mouth to release the latch before repositioning.
After feeds, letting the nipples air dry helps the skin recover. A nipple cream can offer relief and protect the skin between feeds. And if the problems do not improve, getting help from a professional early prevents things from escalating.
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