Common Breastfeeding Concerns

Sore Nipples

Temporary nipple soreness can occur during the first week. Most mothers feel tenderness with the initial latch and first few sucks. The soreness usually peaks between day 3 and 6 and then goes away. Breastfeeding less often or for not as long does not prevent this tenderness.

Nipple soreness that lasts beyond the first week indicates that something is wrong. Be sure to get a health care provider who is knowledgeable about breastfeeding to watch you breastfeed and offer assistance. There is always a reason for sore nipples!

Untreated nipple pain can result in cracks and skin breakdown. If you lessen your babys time at breast because of the pain your breasts and nipples can become more painful. Your breasts can become overly full and even engorged. Eventually this lessens your milk supply and you may find that you do not have enough milk for your baby. Untreated nipple pain can also lead to infection.

What you can do:

* Take action! Find a health care provider with knowledge and experience helping breastfeeding mothers. Have them watch you breastfeed. They can help you determine the reason for your sore nipples and offer assistance.
* Respond to your babys feeding cues promptly. Avoid letting your baby become overly eager at feeding time.
* Start the feed with the least sore breast first.
* Consider an alternate position keep babys chin away from the sore part.
* Soak your nipple in warm water to soften before nursing.
* Initiate the milk ejection reflex (letdown) before bringing baby to the breast. Try thinking about your baby, gentle massage, hand expression or pumping.
* Use alternate compression and massage during the feed to help keep your baby sucking and swallowing.
* Do not allow your baby to comfort suck at the breast.
* Promote nipple healing
o Bathe cracks with freshly expressed breast milk.
o Apply a thin coating of purified anhydrous lanolin such as Lansinoh or Pure Lan.
o Be sure to allow air circulation around your nipples eg. avoid plastic lined breast pads,
change breast pads whenever wet.
* Use medication as needed to help relieve pain.
o Apply a topical antibiotic/antifungal and possibly low strength topical steroid if there is
inflammation and severe nipple soreness. Check with your health care provider.
o Some oral analgesics such as acetaminophen are compatible with breastfeeding. Check
with your health care provider
* Resting the nipple by not breastfeeding is recommended only when the pain of breastfeeding is intolerable or when nipple bleeding and skin breakdown are worsening. Milk must be regularly removed from the breast by hand expression or pumping. Feed your baby the expressed breast milk.

Breast Fullness and Engorgement

It is normal for your breasts to become full within the first 4 days after giving birth. This fullness usually subsides on its own as long as you breastfeed or pump every 2 to 3 hours.

Breast fullness, if mishandled, can result in breast engorgement. Allowing your young baby to sleep for long periods and supplementing your baby rather than offering the breast can cause engorgement.

When you are engorged your breasts will be swollen, tight, warm, and painful. Your breast tissue can feel hard and look shiny. You may have a fever. Your baby will likely have difficulty latching. Under such conditions the breast will not even leak milk. Some mothers even find that they have numbness and tingling of their hands.

What you can do:

* If your milk will leak, apply warm moist compresses or soak your breasts in a warm bath, lean over a large bowl of warm water and submerge your breasts, or stand under a warm shower (back toward water source and water running over shoulders and breasts).
* If your milk will not leak, lie on your back and apply cold compresses or chilled, clean, raw cabbage leaves to your breasts.
o If using cold compresses place a clean cloth between your skin and the compress.
Remove the compress after 20 minutes.
o If using cabbage leaves be sure to cut a hole for your nipple. Remove the cabbage after it
wilts (about 20 minutes).
* Attempt milk removal.
* Offer your breast to your baby at least 8 times in 24 hours. Breastfeed at least every 3 hours, around the clock.
* If your baby is unable to latch and suckle, remove some of your milk with hand expression or a good quality breast pump. A fully automatic hospital grade electric breast pump is most effective. Pumping should be limited to 10 15 minutes. The breast should be massaged working toward the nipple while breastfeeding or pumping.
* Wear a well fitting, nursing bra 24 hours per day.
* Take pain relief medication compatible with breastfeeding eg. acetaminophen, acetaminophen with codeine, ibuprofen. Check with your health care provider regarding which medication you should try.

Letdown (Milk Ejection Reflex)

The success of breastfeeding depends on the ejection of milk. A mother may produce breast milk, but if the milk is not released or removed from the breast, further milk production stops.

A hormone called oxytocin stimulates the breast to eject milk. This ejection of milk is called a letdown. Letdowns are important because they provide for the free flow of milk. Your baby would receive only about one third of your milk if you had no letdowns. Furthermore, letdowns are necessary for your baby to receive the fat rich hind milk.

Some mothers feel a tingling or tightening sensation when letdown occurs. Uterine cramps can often be felt during letdown in the early postpartum period. Increased thirst or sleepiness/relaxation while breastfeeding are also signs that your letdown reflex is working.

Most mothers have several letdowns during a feeding. The first letdown is often the only one you will feel. Some mothers dont feel any of their letdowns.

Babies usually respond to the letdown of milk by drinking more quickly, gulping, or pulling away from the breast. If your baby pulls away from the breast you may see milk dripping or spraying from the nipple.

Many mothers find that when they think about breastfeeding they have a letdown. Please see the section re: milk leakage. Your letdown reflex can be inhibited by cold, pain, and emotional stress. It can also be reduced by large amounts of alcohol.

Leaking

Leaking is common during the early weeks of breastfeeding. Leaking usually lessens over time.

Leaking may occur during a feed from the breast not being nursed, just before a feed when the breasts are full, or if a feed is missed. Many stimuli can result in leaking - the sound of your baby stirring or crying, the scent of your babys clothing, thinking about your baby, listening to sound of a breast pump, listening to music that you listen to while breastfeeding, sitting in the chair that is used for breastfeeding and so on. Leaking can also occur in response to lovemaking.

Many mothers do not experience leaking. The absence of leaking does not mean that you have a low milk supply.

What you can do:

* Apply gentle pressure to the leaking breast. Some mothers press their arm or elbow against the breast. Other mothers cross both arms over their chest and press gently.
* Breast pads can provide some protection. Mothers generally want breast pads that are comfortable, absorbent, and affordable.
* Patterned clothes can help to camouflage leaking. Some mothers also carry a sweater to conceal milk leakage.
* Breastfeed before lovemaking, cover the bedding with towels, and remember that a sense of humour can help.

Plugged Ducts

A plug or blockage can occur in a duct of your breast. If the plug is located close to the skin you can feel a lump. The area can feel tender and there may be redness and heat at the site.

Plugged ducts are more common in mothers who have an abundant milk supply and inadequate milk removal during feedings. Pressure from a tight bra, underwire bra, seam in your bra, or the straps of your baby carrier digging into your breast can result in a plug. Sleeping in a position that puts pressure on one area of your breast or pressure from a breast pump that doesnt fit properly are other possible triggers.

Try to remove the plug quickly because plugged ducts can develop into larger blocked off areas of the breast and eventually lead to a breast infection.

What you can do:

* Take pain relief medication as needed. Check with your health care provider regarding which medication you should take (eg. acetaminophen, ibuprofen).
* Continue breastfeeding often. Ensure that your positioning and latching are correct. If the breast with the plug is especially tender, begin to breastfeed on the other breast to allow the affected breast to letdown without the pressure of suckling. When nursing on the affected breast try to position and latch baby so that the babys chin points to the area of blockage.
* Apply moist heat before feeding. Warmth can be soothing and promote milk flow.
* Manually massage the area to promote breast drainage. Work from behind the plug moving toward the nipple.
* If the plug fails to resolve after 48 hours talk to your health care provider about ultrasound treatments. Usually one treatment is all that is required. Sometimes a second treatment can be helpful.
* If you continue to have problems with plugged ducts be sure to talk to a health care provider who has knowledge and experience helping breastfeeding mothers.

Illness

If your breastfeeding problem seems to be getting worse be sure to call your health care provider right away.

Sometimes breastfeeding mothers feel sick, excessively tired, overly warm, shaky or achy. This could indicate that you have an infection. If this happens call your health care provider and explain how you are feeling. Be sure that your health care provider knows that you are breastfeeding. Often you can continue to breastfeed while having your problem treated. If it is necessary for you to stop breastfeeding for a short time, talk to a breastfeeding expert about ways to maintain your milk supply and how to continue breastfeeding.

When feeling unwell it is important for you to rest, try to eat nutritious meals, and drink plenty of fluids. Breastfeed often because you may have less milk. Try to get others to look after meals and household chores. Focus on yourself and your baby.

For more information call the Health Connection at the Middlesex-London Health Unit at 519-850-2280.