Breastfeeding Problems

Sometimes problems arise in connection with nursing, but you will be able to easily remedy them if you are properly prepared.

Nipple Soreness

Figure 11.2. The proper positioning of the baby's mouth on the breast.

Sore nipples are usually the result of improper positioning of the baby on your breast. It is crucial that he take the entire nipple into his mouth, along with a good portion of the areola—at least 1 inch of it—so that he does not “chew” on the end of your nipple. (See Figure 11.2.) In most cases, sore, cracked, or bleeding nipples can be remedied by adjusting the way the baby is positioned and latches onto the breast. A little tenderness is normal when you begin breastfeeding. Sore, cracked nipples are not. If you experience this, get help right away from a breastfeeding counselor or certified lactation consultant.

Frequent nursing can help reduce sore nipples. By nursing often, you will keep your baby from becoming so hungry that he latches on too strongly. Also, if you snuggle your baby up close to your breast, you will avoid unnecessary tugging.

Try not to let your breasts become engorged. The fullness may make it difficult for your baby to get hold of the breast, causing him to bite down on the nipple. If the breasts seem engorged, hand-express some of the milk before your baby nurses.

Even if your nipples become sore or cracked, continue nursing. Any blood swallowed by your baby will not hurt him. After feeding, express some of your milk and apply it to the nipples. Warm water compresses may also be soothing. Do not use soap or drying agents on your breasts because they wash away the natural protection. Expose your breasts to air and sunshine, or use a blow dryer on the warm setting, to help the nipples heal. Placing ice chips in a washcloth on your nipples prior to feeding may numb them.

Remember that nipple soreness is a temporary condition. With good care and perseverance, you can help your nipples heal in a very short time. However, if the pain becomes worse or lasts beyond the first week, it may be the result of other causes. Make sure your baby is well propped and remains at the level of the breast throughout the entire feeding. The weight of his head may cause your arm to drop and slide his jaw closer to the nipple during the feeding. Use a variety of nursing positions that will allow his jaws to apply pressure to different areas of the areola. Do not allow wet nursing pads to remain on your nipples for long periods. Never use plastic liners. If a pad is stuck, wet it with warm water to loosen it before removing.

Persistent sore nipples or nipples that become sore after weeks of comfortable nursing may be caused by thrush, a harmless yeast infection that the baby may have acquired as he traveled down the birth canal. This is then transmitted to the mother’s nipples during nursing. Thrush may appear as white patches on your nipples and in the baby’s mouth, or as a diaper rash. It is most important that both mother and baby be treated to eliminate this cause of nipple soreness.

Your sore nipples may be baby related. If the baby’s tongue is not extended over the bottom jaw, he will be unable to latch on effectively. A baby who is tongue-tied (has a short frenulum, the attachment under the tongue) may be unable to latch on effectively. Some doctors will clip a short frenulum if it interferes with nursing. Babies may become confused by sucking on a rubber nipple and may have difficulty switching back and forth between the breast and rubber nipple. If you are unable to identify and remedy the cause of painful nipples, do not hesitate to use the services of a certified lactation consultant.

Inadequate Milk Supply

An inadequate milk supply can result from a rigid or infrequent feeding schedule, the use of supplements, or stress. The early introduction of supplements can result in a vicious cycle—the more supplements you give, the less milk you produce, the more supplements you need to give, and the further your milk supply diminishes.

The signs in a baby of an inadequate milk supply include low weight gain, few wet diapers, dark concentrated urine when a diaper is wet, and unhappiness. If your baby develops these symptoms, call your pediatrician immediately. If the baby is severely dehydrated, he may require hospitalization, although most mild cases can be remedied at home. Use the services of a certified lactation consultant. She is trained to assess the nursing couple to determine the problem, provide a solution, and monitor progress.

If the problem is the result of any of the above reasons (rigid or infrequent feeding schedule, the use of supplements, or stress), you will probably be instructed to nurse frequently, every 1 1/2 to 2 hours during the day and every 3 hours at night. Make sure that you offer the baby both breasts at each feeding and nurse long enough for him to receive the high-calorie hindmilk. You may be instructed to use a breast pump to further stimulate milk production. If supplements are required, this milk can then be offered with a flexible cup or finger feeding. To finger feed, place your finger in the baby’s mouth to stimulate him to suck, then drip the milk into his mouth with a syringe or dropper. Your lactation consultant can give you more detailed instructions on how to perform this technique.

Infrequently, the problem is physical and requires professional help. A woman may be unable to produce sufficient milk if her thyroid is underactive, if she is severely anemic, or if she has untreated diabetes. These conditions can all be treated. Rarely, a woman’s breasts may have developed improperly and may not contain the necessary glandular tissue for nursing. With this situation, there is usually no change in the breasts during pregnancy or with continued nursing. In addition, if a piece of the placenta was retained after the birth, the woman’s body may think she is still pregnant and not produce enough hormones for lactation. Excessive or long-term bleeding should be reported to your caregiver.

If you are taking certain medications and are experiencing an inadequate milk supply, you may want to check with a lactation consultant. These medications include prescription drugs and over-the-counter preparations for allergies, asthma, depression, hypertension, migraines, insomnia, autoimmune diseases, and heart problems. Other factors that may decrease the mother’s milk supply are smoking, alcohol consumption, large amounts of caffeine, combined (estrogen and progestin) oral contraceptives, and high doses of vitamins.

You may think that your baby is not getting enough milk if he wants to nurse every 2 hours. This desire to nurse frequently is normal in a baby in the early weeks and during growth spurts, and is not a cause for alarm as long as he is not showing any of the symptoms mentioned above. Your baby may just need to suck a lot.

Normal Breast Fullness Versus Engorgement

Most new mothers experience a normal increase in the size and fullness of their breasts around the second to the sixth day after birth. This occurs as the milk “comes in” and is also the result of the extra blood and lymph fluids that assist in the production of milk. If the breasts become overfull and hardened, if pain or fever accompany the increase, or if the infant is unable to latch onto the severely swollen breast, the condition is known as engorgement. Engorgement is usually due to infrequent or insufficient feedings. It occurs most often in first-time mothers, but varies considerably among individuals. Engorgement is temporary and can be remedied by frequent nursing. The milk supply and excess swelling will readjust within a short time.

If you become engorged, you can relieve the discomfort by taking a hot shower or placing hot cloths on your breasts to encourage the milk to let down. If your baby has difficulty grasping the nipple, he may become frustrated and cry. Hand-express a little milk or use a pump before nursing to make the nipple soft and pliable. After the feeding, apply cool compresses to the breasts to reduce circulation and relieve pain.

Folklore has provided a technique for relieving engorgement that has been found to produce excellent results. Cover your breasts with cold cabbage leaves, leaving the nipples exposed, and use a bra to hold the cabbage in place. Apply the leaves for 20 minutes every 2 or 3 hours until the engorgement has improved. Cold cabbage leaves can also be used to help mothers who weaned abruptly, or who chose not to breastfeed and thus became engorged. In these cases, you should wear the leaves continuously and change them every 2 hours.

Milk Leaking

Milk leaking or spraying is usually a temporary condition. If you experience it, you can stop it by pushing the heel of your hand against the nipple. Wear nursing pads to protect your blouse against wet spots.

Mastitis and Plugged Ducts

Mastitis refers to any inflammation of the breast. A plugged duct is one type of mastitis. If you notice soreness and a lump in one area of your breast, you may have a plugged duct. This is caused by incomplete emptying of the duct by the baby, by missed feedings, or by wearing a tight bra. Avoid bras with underwires. You can clear a plugged duct within 24 hours by resting, drinking plenty of fluids, and nursing the baby frequently on the affected breast. Massage the breast with gentle pressure from the chest wall toward the nipple to help stimulate the flow of milk. Remove any dried milk secretions from your nipple. Also, apply warm compresses to the breast to promote milk flow.

Alter your baby’s position on the nipple while he is nursing to help him drain all the ducts. Make sure to offer him the affected breast first, when his sucking is the strongest.

Breast Infection

If a tender area, lump, or redness in the breast is accompanied by a fever and flulike symptoms, you may have a breast infection. In fact, all flu symptoms in a nursing mother should be considered a breast infection until proven otherwise.

If you have a breast infection, continue to nurse your baby frequently to empty all your ducts. Do not stop nursing. Stopping would be an emotional and physical shock to both you and the baby. It could actually make the problem worse because the ducts would become overfilled.

Drink plenty of fluids and get a lot of rest. Take your baby and go to bed. Apply heat to the infected area in the form of a heating pad or hot water bottle. Your caregiver may prescribe antibiotics that are safe to take while nursing.

Breast Abscess

Occasionally, a breast infection progresses to a breast abscess, a sore area filled with pus. Along with antibiotics, you may need to have the abscess incised and drained. This minor surgery is normally done in the doctor’s office and heals quickly. Until it is healed, hand-express the milk from the affected breast and discard it; nurse your baby on the other breast. Once the healing is complete, you can resume nursing on both sides.

Flat or Inverted Nipples

To determine if your nipples are inverted, place your thumb and index finger around the base of the nipple and press together. If the nipple shrinks inward, the nipple is inverted. Flat or inverted nipples frequently improve as the pregnancy progresses. If the inversion continues past your seventh month of pregnancy, see a breastfeeding counselor or certified lactation consultant.

You will still be able to breastfeed your baby because babies nurse by applying pressure on the areola, not the nipple. Also, the sucking will naturally draw out the nipple. Flat nipples can be made more erect by stimulation or by the application of ice prior to a feeding.

If your nipples are severely inverted, you might want to wear a special breast shell during your last trimester of pregnancy to encourage the nipple to protrude. Or, you can use a breast pump or a special syringe called Evert-It to draw out the nipple prior to a feeding. All of these products are available from breastfeeding counselors and lactation consultants.

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