Bumps Along the Breastfeeding Road
These first couple of weeks nursing are by far the most difficult you’ll experience. While it’s always a good idea to have a lactation consultant’s number on hand, here are some problems you might encounter:
Sore, cracked, tender nipples are par for the breastfeeding course – though breastfeeding advocates would rather you not know. Breastfeeding does become a painless, convenient, bonding experience fairly quickly – but not quite yet. Some women’s nipples toughen up in a matter of days, yet all it takes is one time that the baby latches or unlatches incorrectly to cause painful cracks and scabs (only made worse by subsequent feeding sessions). Be sure to contact a local lactation consultant if you need help positioning the baby correctly, and, beyond that, just fight through it. Once the rocky beginning is over, you’ll be glad you stuck it out. In the meantime:
- Have medical-grade, natural lanolin (we recommend Lansinoh) on hand to prevent or heal cracked nipples. Dab a little on your nipples after a feeding for some much-needed relief.
- Use a little breast milk to help heal sore nipples. Use left-over milk or simply express a little to rub on yourself.
- Make sure your nipples are dry at all times – meaning changing your nursing pads as soon as they’re wet and letting them breathe (at home, of course.) Don’t immediately cover up when you’re done with a feeding – the air is good for you.
- Buy breast shells if even the touch of fabric on your nipples is irritating. The shells are designed to give your nipples some breathing room.
- Try switching your breastfeeding positions, so that different parts of your nipple are being used. This is also helpful in preventing clogged milk ducts.
One of the most important things to remember when dealing with sore nipples is to keep nursing on both sides, even if one is painful and the other isn’t. If you favor one side over the other, not only can you do damage to your milk production, but you’ll most likely wake up to find one breast two times the size of the other. It’s also important to know that most breastfeeding woes are temporary and most likely normal. Before you know it, your nipples will take to nursing as if they were designed for it.
Not producing enough milk:
Not being able to produce milk is a common fear, but the good news is that it’s only a reality for a very small percentage of women. If you’re having trouble:
- Watch for cues that your baby is, in fact, getting enough milk.Your body will produce as much as he or she needs, so as long as the baby is gaining weight and seems satisfied, don’t worry.
- Make sure problems like sore nipples or an improper latch aren’t inhibiting your baby from eating as much as needed. Call a lactation consultant for specific tips and advice, as most milk-production problems are fixable.
- Recognize that as your baby goes through a growth spurt and eats more frequently, your breasts may feel less full than normal, giving you the impression that you’re not making milk.
- Check to make sure you’re not taking any medications that diminish milk production, like birth control pills that contain estrogen. (We’ll cover safe birth control options when you’re feeling a little more up to the idea.)
- Continue to feed your baby to stimulate more milk production and, if necessary, try using a breast pump in between feedings.
- Let your baby feed as long as he or she wants. At this age, many babies will nurse for 45 minutes at a time.
- Drink a lot of water, because this can affect your supply.
- You might want to get your thyroid levels checked.
- Understand that if all options fail and you truly can’t produce milk, “primary lactation failure” is a real condition affecting about 4 percent of mothers, usually due to glandular tissue problem, prior breast surgery or Sheehan’s syndrome – in which a postpartum hemorrhage shocks the pituitary gland. It could also be because of blood pressure problems or even anemia.
Producing too much milk:
A less feared but still quite alarming problem is when you have an overabundance of milk, also known as hyperlactation. Yes, some people will give you the “Please, some of us have real problems!” reaction, but it’s unsettling to watch your baby choke, gasp and even spew milk from his or her nose. Plus there’s the embarrassment of constant leaking and spraying, and the fact that the baby might refuse to nurse.
Eventually (usually this month or next) your milk supply will start to stabilize and the gushing river of milk will trickle down to a more appropriate level. To help control the flow:
- Try nursing from only one breast per feeding, adequately draining one side while making your body think it should slow milk production in the other. But be careful to switch to the other side at the next feeding. If one breast per feeding isn’t diminishing your supply, try feeding from only one breast in a two-hour period while slightly pumping the other to prevent engorgement. Then switch to the other breast for the next two hours.
- Before a feeding, hand express or – for some women – just let the milk flow on its own before putting the baby to your breast. Often the let-down produces the most forceful flow, causing your baby to choke and sputter. But remember not to pump too much out, as the more milk you take out, the more you’ll produce to meet the demand.
- Gently apply pressure to the areola while nursing to help slow the flow.
- Reposition the baby so he or she is sitting up more, or even try nursing on your back to let gravity slow things down. Be careful not to always nurse this way though, as it could cause a clogged duct or breast infection.
- Call a lactation consultant for more tips.
One breast is twice the size of the other. Help!
If you suddenly wake up one day with lopsided breasts (and you didn’t have a previous breast surgery or injury on one side), it’s most likely because your baby has been feeding too frequently from the larger breast. This could be because:
- You simply lost track while recording the feedings and mistakenly fed too often from one side.
- The baby has an ear infection or another illness that makes it uncomfortable to eat in a certain position.
- You have a breast infection in the smaller breast, making your milk taste salty.
While the problem will probably even out with time, there are some measures you can take – as long as there isn’t a medical issue preventing nursing from one side:
- Start each feeding on the smaller side because babies often eat more vigorously in the beginning.
- If the problem is drastic, try nursing from only the small breast for two feedings in a row, then switch to the larger one. But be careful not to let the larger breast become engorged, which can lead to clogged ducts or a breast infection.
- Feed normally but pump the smaller side for five to ten extra minutes for a couple feedings.You should see results in a matter of days.
Mastitis is a painful breast infection caused by germs entering through cracked nipples. Even though it can happen at any time, mastitis is more likely to strike in the first six weeks when cracked nipples are more likely. Symptoms include:
- Breast warmth and/or extreme soreness
- Swelling and hardness
- Redness over the infected duct
- Flu-like feelings with chills, fatigue and a fever of 101 degrees or higher
Call your doctor as soon as you suspect an infection because it could easily turn into a breast abscess – an excruciatingly painful condition often requiring surgical drainage. If you develop an abscess, nurse only on the healthy side until it heals. However, you’ll have to pump the infected breast to maintain your milk supply.
Prevent mastitis by:
- Getting adequate advice and support on proper latching techniques to prevent cracked nipples.
- Vary your nursing positions to fully drain your breast.
- Wear a well-fitting bra, as one too tight can restrict milk flow.
- Your doctor will probably prescribe antibiotics and possibly bed rest and pain relievers.
- As painful as it is, continue to nurse from the infected breast and make sure it’s adequately drained (the breast will feel soft). If it’s not completely drained, you could develop milk stasis, causing more pressure on the ducts and milk leakage into the breast tissue. This can cause an abscess as well.
- Drink plenty of fluids and rest as much as possible to help fight the infection.
A baby with thrush (a yeast infection of the mouth) can infect a breastfeeding mother’s nipples – causing burning, itchy, flaky and/or extra pink nipples. If you’re experiencing this (especially after you or the baby has been on antibiotics), check your baby’s mouth for white patches that don’t easily wipe away. If you’re experiencing thrush:
- Don’t panic – thrush sounds and sometimes feels scarier than it is. The pain should stop within the week.
- Keep breastfeeding, if you currently are doing so. Apart from the discomfort, there’s no medical reason to disrupt your milk supply.
- Call your doctor for an antifungal ointment to help keep from passing the infection back and forth with your baby.
- Keep your nursing bras clean and dry because yeast is drawn to warm, moist areas.
Here are more tips on how to prevent and treat thrush.
Clogged milk ducts:
If you have a hard lump that’s tender to the touch or a streak of redness on your skin, you probably have a clogged milk duct. Untreated, this could easily develop into an infection (called mastitis, see above), which would cause you to feel feverish as well.
Prevent clogged milk ducts by:
- Adequately draining your breast at the end of a feeding. Unfortunately breasts aren’t equipped with measuring cups, but make sure your baby feeds for at least 10 minutes per side and each breast feels soft at the end of a nursing session.
- Wearing a well-fitting nursing bra.
- Not skipping feedings, which can lead to engorgement.
- Vary your nursing positions.
- Continuing to nurse and empty the breast, which will eventually reduce the inflammation. Try applying warm compresses before a nursing session to assist in drainage.
- Continuing to vary nursing positions. Some recommend pointing the baby’s chin at the infected duct, perhaps directing suction to the infection.
- Resting – which means enlisting extra help.