Back pain is a common complaint of new nursing mothers. Most of the time, this is an avoidable problem. Back pain while breastfeeding generally comes from easily correctable posture problems. Combine poor posture with lack of sleep and round-clock-nursing and new mothers can suffer from some pretty serious discomfort.
The biggest factor in back pain from nursing is the tendency to bring the breast to the baby instead of bringing the baby to the breast. Cradle position (the baby's head nestled into the crook of the elbow) makes this easy, but new mothers often have more success in early nursing with the cross-cradle or football positions (see my related article, Choosing a Nursing Position, linked below). It's a common mistake in these positions to set the baby up and then lean over to bring the breast to the mouth.
A better strategy is to set up the mother and then position the baby to meet the breast. Put on any nursing pillows (Boppy, My Breast Friend, etc.) that you'll want to be wearing once you are positioned. Set the back against a straight surface (headboard, back of chair), using pillows if necessary for comfort or support. If sitting on a deep couch or chair, use pillows to bring the body forward so that the back can stay straight while allowing the knees to bend over the edge. Bring the knees up higher than the waist – a nursing stool is a great help in this regard (see my related article Medela Nursing Stool Product Review, in related links below).
Once the mother is positioned correctly, then position the baby. A second person may be helpful for this step (don't worry, you won't need a helper every time… just while you are figuring this out). In addition to any nursing pillows you might already be wearing, have a bunch of bed pillows or folded blankets or comforters available (even throw pillows can be helpful).
Without losing the back or leg position, add these cushions to create the level where the baby's head, when placed on these supports, will reach the breast (remember, soft cushions will compress a bit). Don't worry if it feels unnaturally high, especially with football hold. Place the arms in whatever nursing position is normally used and support the baby's weight with assistance of the new cushioning.
Placing the baby on top of all the cushioning will feel odd, and certainly it may feel impractical, or even absurd, as a long-term solution. But all the support isn't actually about the baby, it's about the mother getting a sense of how her body is supposed to feel when sitting properly. After doing this a few times, the mother's arms supporting the baby will begin to get used to their revised role, and the back will get some relief and some retraining of its own. Once the cushioning is scaled back, the arms and back will have some memory of the correct posture and the mother will feel more confident bringing the baby towards the body without compromising the baby's ability to nurse well. Once the bad habit of hunching over the baby is broken, it gets easier without the circus of helpers and pillows…really.
Nursing in the early days can be challenging. There are many issues that can arise and may require minor to major assistance or intervention. But back pain in nursing is completely correctable, can generally be handled with the help of a partner, and when corrected will go a long way towards reducing a weary mother's fatigue and frustration towards the nursing experience.
These items may help with positioning for proper posture while breastfeeding:
Medela NursingStool - Natural Oak
My Brest Friend Wearable Nursing Pillow - Green Sunburst