Management of common breastfeeding problems
Although breastfeeding is thought to be ‘natural’, it is actually a skill that requires support and preparation to develop and maintain. Some breastfeeding mothers will experience minor problems at some time, however, there are plenty of people available who can advise and support you in overcoming these, including your midwife, health visitor, GP, breastfeeding counsellors and breastfeeding support groups. It is important that you enjoy your baby and if feeding times, or even the mere thought of them, starts to cause anxiety, it is important that you talk to someone who can give you the encouragement and confidence boost that you deserve. Reassurance, advice and information can all help to keep breastfeeding going while you resolve any problems. With the right support and guidance most problems can be avoided, especially if good positioning and attachment at the breast is achieved in the early days following your baby’s birth.
Powwow’s Tip: If you want to breastfeed, it isn’t a good idea to give any formula feeds for the first six weeks while your body is sorting out your milk supply.
It is common to initially experience tender or sore nipples during the first few days when the baby is feeding frequently and receiving ‘colostrum’, but breastfeeding doesn’t need to stop. However, continuing sore nipples are invariably caused by poor positioning and attachment of the baby at the breast; it is therefore important to make sure that you are comfortable at each feed. Your midwife will show you how to put the baby to the breast so that they are able to feed from you without causing any damage to the nipple. Although you may experience discomfort when the baby first latches on, breastfeeding should not be painful. If you do experience pain while your baby is sucking, remove them from the breast and reposition them until it feels more comfortable. The easiest way of removing your baby from the breast is to gently insert your little finger into the side of your baby’s mouth, to break the suction and then gently ease them off the nipple/areola. Your midwife, health visitor or local breastfeeding counsellor will be able to show you a range of different feeding positions that you can adopt which will help relieve sore nipples.
Where a baby continues to be incorrectly positioned at the breast and the nipples are being traumatised at each breastfeed, it is likely that the skin surface will become cracked. Research has looked into the management of skin trauma and findings suggest that skin heals more rapidly where a period of ‘moist healing’ is allowed to take place. There are a wide range of specialist creams and ointments for sore/cracked nipples, and your midwife or health visitor will be able to give you information and advice about these. Breastfeeding need not stop, although sometimes women find it too painful to continue feeding from the affected breast. If this is the case, your midwife can show you how to express your breast milk (either by hand or using a breast pump), so that your baby continues to benefit from the goodness of your breast milk while your nipple(s) heals.
When the milk ‘comes in’, which is usually around the third day following the baby’s birth, it is not uncommon for the breasts to become overfull and uncomfortable – this is called ‘engorgement’. Engorgement can be prevented where your baby is allowed to feed ‘on demand’ (also described as ‘baby-led’ feeding) and by ensuring correct positioning and attachment at the breast. Where breast engorgement develops, it usually resolves within a couple of days, however, in the interim, it is advisable to feed your baby frequently (as soon as they stir and start showing feeding cues) and to ensure your milk flow is not restricted by, for example, a poorly fitting bra. When the breasts are very full and hard, your baby may have difficulty attaching at the breast; in these circumstances it can be helpful to express some milk to soften the breast and draw out the nipple before feeding begins.
- Eye movements underneath closed lids/Opening their eyes
- Baby is more alert/moving their arms & legs
- Opening their mouth (often called ‘mouthing’)
- Licking their lips
- Sucking their fingers/fist
- Changes in their facial expressions
- Squeaking noises and/or light fussing
NB. Crying is a late sign of hunger.
Blocked milk duct
Where the breasts are very full and your milk flow becomes restricted, a milk duct (which transports milk to the nipple) can easily become blocked. Where this happens, the blocked duct can be felt as a hard tender lump just under the surface of the skin. You may also feel as if you have a flu-like illness. In these circumstances, it is important that you continue breastfeeding your baby to ensure that the affected breast is properly drained. You should also ensure that you do not wear any garments that restrict the breast. It can be helpful to apply warm flannels over the affected area, or to lie in a warm bath and massage the affected breast to help loosen the blockage in the milk duct. With sustained breastfeeding and attention to the correct positioning at the breast, it is possible to resolve the situation within one or two days. Antibiotics are not necessary, although taking an anti-inflammatory pain killer, such as Ibuprofen, can help to ease the symptoms. If you are feeling flu-like, it is advisable to rest in bed until you are feeling better. If you have any concerns, contact your midwife, health visitor or breastfeeding counsellor for advice.
‘Mastitis’ is inflammation of the breast which can be caused by overfull breasts or a blocked milk duct. The signs of mastitis are feeling flu-like, including having a high temperature and localised pain in the affected breast. On examination, a segment of the breast appears red, hot, hard or tender, and has the appearance of a ‘triangle-shape’ on the surface of the skin. Should you develop any of these symptoms, it is important to let your midwife, health visitor or GP know. Although painful, it is important to continue breastfeeding your baby to ensure the breast is being drained and to prevent a breast abscess from developing. You might need to consider increasing breastfeeds or expressing milk from the affected breast to ensure that the breast is being adequately drained. Pain killers and anti-inflammatory medication can help to relieve discomfort. Mastitis doesn’t necessarily mean that infection is present, however where symptoms persist for longer than 24 hours, inform your GP who may feel it is appropriate to prescribe a course of antibiotics. If this is the case, it is important that you complete the full course prescribed.
This is a commonly occurring infection of the nipple, which causes localised tenderness, ‘razor-like’ pain in the nipple, itching and burning sensations, discolouration of the nipple and areola (tender, shiny appearance, pink or red spots), and pain that continues before, during and after each breastfeed. Sore and cracked nipples are more prone to thrush infection; treatment with antibiotics for mastitis or a wound infection can also cause thrush, and the use of dummies and teats can increase your risk of developing the infection. Where thrush develops, it is important that you continue breastfeeding and change your breast pads at each feed. Both you and your baby should be treated simultaneously: For you (mum), Daktarin cream applied to your nipples/areola after each feed. For your baby, Daktarin gel applied gently, a small amount at a time, to coat the whole of the inside of their mouth after each feed, ensuring that neither your finger nor the gel touches the back of your baby’s throat. Daktarin gel is now regarded as being unsuitable for babies under four months old and should be used with care for babies between four and six months of age (BfN website). For further advice; speak to your midwife, health visitor or GP.
General treatment of thrush also includes sterilising all feeding equipment, maintaining good hand hygiene with thorough hand washing to reduce the risks of passing the infection from mother to baby and vice versa. Hot washing of all clothing (both your and your baby’s items) at 60OC, regular pain killers to ease discomfort, as well as eating natural yoghurts, which contain Acidophyllus and helps re-colonise the mother’s gut with healthy bacteria. Treatment should continue for one full week after the symptoms have disappeared, however, if there is no improvement, you should see your GP.