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Breastfeeding Problems

Alternate Names

  • breast care issues
  • plugged milk ducts
  • breast engorgement
  • milk supply problems when breastfeeding
  • let-down reflex
  • nipple soreness in breastfeeding

Definition

There are several problems with the breasts that can develop in a breastfeeding woman.

What is the information for this topic?

The breasts get ready to make milk during pregnancy. Milk production is controlled by hormones in the body. It is a complicated process. Anything that interrupts this system may interfere with proper breastfeeding.
Successful breastfeeding depends in large part on the mother's confidence in her ability to breastfeed. This involves having the proper environment in which to nurse and being prepared emotionally and physically for the experience.
If the mother is pain free, relaxed, and supported by family and others, she is more likely to be successful. Proper nipple care, positioning of the infant, and nursing frequency may help to prevent some common breastfeeding problems.
Symptoms of problems associated with breastfeeding include:
  • breast engorgement
  • inadequate milk supply
  • plugged milk ducts
  • nipple soreness
  • breast infection
  • thrush
  • painful let-down reflex
  • noninfectious inflammation
Breast engorgementBreast engorgement is a common problem for breastfeeding mothers, especially those who are breastfeeding for the first time. Sometimes within 2 days after giving birth, the mother's breasts may engorge with blood rather than milk. Nursing the baby or pumping the breasts does not help this type of breast fullness. In this case, ice packs may help with breast pain.
More commonly, engorgement of the breasts happens after the breasts begin to produce milk. This usually occurs 3 to 4 days after childbirth. Engorgement is the condition in which the milk glands fail to empty completely The symptoms include:
  • very tender and very swollen breasts
  • a more localized, tender, and firm area in the breast, called milk stasis
  • fever
  • increase in white blood cells
Treatment consists of
  • nursing the baby frequently
  • massaging the breasts
  • manually expressing a small amount of milk before the baby begins to nurse
  • applying warm compresses to the breasts
Nipple soreness/irritationThis is common for many nursing mothers, especially when nursing for the first time. At times it may be so painful that the mother will stop breastfeeding. Nipple soreness is usually the worst 3 days after delivery. It gradually gets better as the nipples get used to suckling. The most common causes of nipple soreness are not positioning the baby properly at the breast, not taking care of the nipples, and problems with the way the baby suckles.
Trouble signs to look for in the nursing infant include:
  • a tongue positioned above rather than below the nipple
  • the absence of noisy drawing of milk while feeding
  • excessive drawing of the infant's cheeks due to faulty suction
Nipple dryness may also create nipple soreness. The following should be avoided:
  • soap
  • alcohol
  • benzoin
  • other drying agents
Treatments that help sore or irritated nipples include:
  • lanolin creams or A&D ointment
  • leaving the nipple exposed to the air after each feeding
  • changing nursing pads often to prevent excessive moisture
  • using a heat or sunlamp for 1 to 2 minutes each day. Sunlamps should not be used if the mother is using medications or creams that increase sensitivity to the sun.
Positioning the baby correctly can prevent nipple soreness. The baby's whole body should face the mother rather than just the head. The baby's shoulders should be rounded forward to help the baby's head and tongue control. The mother may find that changing positions may help. Three common positions are:
  • lying on the side, with the mother's stomach facing the infant's stomach
  • sitting and cradling the infant, with pillow support for the infant to prevent the mother from having to bend
  • and a football hold, with the baby's legs and body underneath the mother's arm
Properly removing the infant's mouth from the breast will prevent little nicks or tears.
Thrush is a yeast infection that causes white patches that look like a milk coating inside the mouth of the infant. With thrush, this white coating cannot be washed off. Sometimes thrush may cause discomfort with nursing. A healthcare professional may prescribe a medicine to clear up the thrush.
Let-down reflex Some mothers feel deep, shooting pains during feedings. If the let-down reflex is inadequate or incomplete, this may cause breast pain. The mother should create a comfortable environment in which to breastfeed. Using warm compresses before feeding may decrease the discomfort.
Inadequate milk supply An inadequate milk supply is often caused by a mother's exhaustion. Other causes are stress, smoking, excessive caffeine intake, and using low-dose birth control pills. Rest and relaxation are crucial for a mother's adequate milk production. She should also drink a glass of water each time the baby breastfeeds to help increase her milk supply.
Milk production is directly related to nipple stimulation. Increasing the number of feedings and completely emptying the breast at each feeding increase the supply of milk. As long as the infant is gaining weight, it is important that the mother not use formula supplements. Using formula will decrease the infant's suckling strength and will reduce the number of times the infant empties the breasts. This will further decrease the supply of milk. The infant should nurse at the breast every 3 hours, or eight times over a 24-hour period.
Noninfectious inflammationNoninfectious inflammation, or swelling of the breasts, may occur before a full-blown infection, which is known as mastitis. Symptoms include long-lasting tenderness, swelling, redness, heat in the breast, and decreased milk production. White blood cells are usually found in the milk. Emptying the breasts regularly usually clears up these symptoms quickly. It also reduces the chances of developing mastitis.
A woman who desires to breastfeed but has difficulty getting the baby to latch on, getting the schedule "in sync" with the baby, or having enough milk for each feeding, should consult a professional with experience in lactation, or a support group for breastfeeding mothers, before giving up. Sometimes a few simple adjustments will make a positive difference.
However, if breastfeeding is not successful or possible, a mother should not feel guilty about bottle feeding. If there is a strong family history of allergies, a mother should consider using a formula which is less likely to cause allergies, such as a partially or fully hydrolyzed formula. If goat's milk is used, one should make sure that it has been pasteurized and supplemented with folic acid.
It is every woman's right to choose her feeding options, and should be encouraged to have a strong bonding relationship with her infant.

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