You may run into concerns or have questions from time to time. There is a lot you can do to help yourself. Usually, continuing to breastfeed will make the situation better.
Here are a few things you can do, no matter what your concern is:
If I am ill, can I continue to breastfeed my baby?
There are very few illnesses that would require you to stop breastfeeding. In most situations, you should continue to breastfeed your baby.
Leaking BreastsLeaking is caused by fullness in your breast or by the milk “letting down”. It is a normal part of breastfeeding. Leaking may happen if your baby sleeps a little longer than usual, if you hear a baby cry, or if you think about your baby. It is most common in the early weeks as your breasts adjust to breastfeeding. It is usually short-lived, but it can happen any time while you are breastfeeding your baby. Some women may also experience some leaking during sexual activity
Leaking BreastsLeaking is caused by fullness in your breast or by the milk “letting down”. It is a normal part of breastfeeding. Leaking may happen if your baby sleeps a little longer than usual, if you hear a baby cry, or if you think about your baby. It is most common in the early weeks as your breasts adjust to breastfeeding. It is usually short-lived, but it can happen any time while you are breastfeeding your baby. Some women may also experience some leaking during sexual activity
What can I do?
◆Apply gentle pressure by folding your arms across your breasts, or rest your chin in your hand and press your forearms against your breasts.
◆ Use cotton or disposable nursing pads in your bra to provide comfort, avoid embarrassment, and protect clothing.
◆ Do not use breast pads with plastic or waterproof liners.
◆ Change pads when moist to prevent sore nipples/ infection.
◆ Printed clothing may disguise leaking better than plain
colours. Breastmilk won’t stain washables.
Normal fullness
Early breast fullness is normal. It occurs in response to your
milk “coming in” and the extra blood and fluids in your
breasts. Most women have more milk than is needed during
the early time when a baby still has an irregular breastfeeding
pattern. This will settle down after the first week. You can
avoid having this normal fullness lead to engorgement by
making sure you breastfeed your baby early and often. Avoid
formula or water supplements and pacifiers as they reduce
baby’s sucking time at the breast. Make sure that your baby
is positioned and latched on well to the breast.
Engorgement
Engorgement is the painful overfilling of your breasts due to
the build-up of milk and fluids in the breast tissue. Engorged
breasts may be heavy, hard, warm and painful. The skin looks shiny. The nipple may appear flattened and may be sor. This may make it difficult for your baby to latch onto he breast. If engorgement is handled properly, the breasts will feel better in 24–48 hours. After the first two weeks, engorgement is usually caused by your breasts not being drained well enough at each feeding, or if you have missed a feeding.
How to avoid it!!
To avoid engorgement start breastfeeding as soon as possible after birth, nurse often, if you miss a feeding express milk from your breast and wear a firm supportive bra.
How can I treat it?
◆ Breastfeed more often, every 1½–2 hours day and night using your engorged breast first.
◆ Gently express some milk by hand, or pump after a feeding if the baby has not drained your breast well.
◆ Use ice packs or compresses (or a frozen bag of peas or crushed ice) on your breast after a feeding to relieve discomfort. This will reduce blood and fluid supply, and may make you more comfortable.
◆ Use an over-the-counter pain relief medication such as
ibuprofen to reduce pain or swelling.
◆ Place chilled, clean, raw green cabbage leaves on your breasts in between feedings for about 20 minutes. You should only have to follow this treatment 2–3 times. Some women have found that this helps to reduce the swelling.
◆ Wear a good supportive bra.
◆ Avoid restrictive clothing and underwire bras.
◆ Do not give bottles of water or formula to your baby.
◆ Avoid pacifiers.
◆ Rest, eat well and drink when thirsty.
◆ Talk to people who can help you: your public health nurse, doctor, members of a breastfeeding support groupor La Leche League, another mother who has breastfed, or a lactation consultant.
Sore nipples
A common reason for stopping breastfeeding is sore nipples.
Some women find the initial latching on a little uncomfortable
but it should not be painful. Nipple soreness usually peaks
on the third day after birth and clears by the end of the first
week. The main reason for sore nipples is poor positioning
and poor latching of your baby at your breast. A baby may
appear to be positioned well but may not be latched properly. If this is not corrected, it may lead to cracked nipples and a breast infection. Sore nipples can be prevented.
Other reasons for sore nipples can be:
◆ Baby not opening mouth wide enough when latching on.
◆ Baby sliding off nipple.
◆ Flat or inverted nipples.
◆ Using soap on your breasts and nipples.
◆ Wet nursing pads.
◆ Baby falling asleep during a feeding andclamping down on your breast.
◆ Pulling your nipple out of your baby’s mouth at the end of a feeding.
◆ Going too long between feedings.
◆ Engorgement
◆ Thrush (white mouth) in your baby. What can I do?
◆ Continue to breastfeed your baby.
◆ Check position and latch. Make sure your baby has a deep latch. This will usuallyhelp solve most problems. Hold your baby close so your nipple will not be pulled.
◆ Breastfeed often, every 2–3 hours. This will keep your breasts from getting too full, and may prevent your baby from sucking too vigorously.
◆ Use different positions to help relieve pressure on your nipples.
◆ Start a feeding on the less sore nipple.
◆ Express breastmilk to start the let-down at the beginning of a feeding. Your baby won’t need to suck so vigorously.
◆ Let your baby feed as long as she wants. Let her release your nipple after a feeding.
◆ If you wear nursing pads, change them when they get moist. Remember to use cloth or cotton breast pads. Do not use plastic-lined breast pads as they may cause soreness.
◆ Express breastmilk and spread on your nipples after each feeding and air-dry, if possible. Breastmilk helps with healing.
◆ Avoid using soap on your breasts.
◆ Rest, eat well and drink when thirsty.
◆ In very extreme cases, you may need to allow your nipple to heal for 24 hours. You may continue to nurse your baby from the unaffected nipple. During this time, express your milk from the sore nipple. When the nippleis healed, start breastfeeding again. Be sure your baby is properly positioned, latched on and removed from your breast.
◆ Avoid using nipple shields.
◆ If your baby has thrush or white mouth, see your health care provider for treatment of both you and your baby.
◆ See your health care provider if you have sore nipples that are not improving, even with good latch and positioning techniques. You may need a medicated ointment for your nipples
Blocked milk ducts
A milk duct that does not drain properly at a feeding may become blocked. Pressure builds up behind the block. A blocked milk duct makes a swollen, tender, warm spot or lump in the breast. You will generally feel well, and may or may not have a temperature. A blocked milk duct happens gradually and usually in only one breast. If the block is close to the nipple, there may be a white spot on the nipple. A blocked duct usually improves within 24–48 hours with continued nursing.
Some reasons for a blocked milk duct:
◆ Waiting too long between feedings.
◆ Too short a feeding time or “feeding on the run” so the breast is not drained well.
◆ Wearing too tight clothing, bra or a bra with underwires.
◆ Wearing a baby carrier for long periods of time.
◆ Nursing at the same breast at every feeding.
◆ Sleeping on your stomach.
◆ Giving your baby a bottle of water or formula instead of breastfeeding.
◆ Mother being tired.
◆ Pressing your finger on your breast during a feeding as a way of keeping your breast away from your baby’s nose.
What can I do?
◆ Continue to breastfeed your baby.
◆ Feed your baby or express milk often, every 2-3 hours.
◆ Be sure your baby is positioned and latched on correctly.
◆ Before a feeding, place warm, moist cloths on the affected area or take a warm shower to help promote drainage of the breast.
◆ Express some milk first to relieve fullness.
◆ Gently massage the lump before and during a feeding.
◆ Feed on the affected breast first when the baby’s suckling is more vigorous. Stroke the lump towards the nipple as the baby feeds.
◆ Use different breastfeeding positions. Use a position that points your baby’s chin and nose towards the sore spot for the strongest suckling action.
◆ Nurse until your baby stops feeding. Encourage longer feedings on the affected breast.
◆ If your baby doesn’t drain your breast well enough, you may try to express the milk.
◆ Feed your baby at both breasts during each feeding.
◆ Avoid giving your baby water or formula instead of nursing.
◆ Avoid pacifiers.
◆ Wear loose clothing. Avoid wearing underwire bras.
◆ Avoid sleeping on your stomach.
◆ Avoid wearing a baby carrier on your front for long periods of time.
◆ Rest, eat well and drink when thirsty.
◆ Watch for signs of infection.
◆ Talk to people who can help you: your public health nurse, lactation consultant, doctor, members of a breastfeeding support group or La Leche League, or another mother who has breastfed.
◆ See your health care provider if a lump persists.
Mastitis
Mastitis is a breast infection. It comes on quickly, usually only in one breast. The infected breast is red, hot and swollen, and may be painful. You will have a fever and flu-like symptoms (aches, nausea, vomiting and chills). If mastitis is not corrected, it can lead to an abscess which needs prompt medical care. Mastitis can develop when the breast is not being drained properly as in engorgement or blocked milk ducts. It can also develop from cracked nipples or leaving wet breast pads on for too long. Usually mastitis occurs in the first six weeks of breastfeeding.
What can I do?
◆ Continue to breastfeed your baby at least every two hours.
◆ Rest and do nothing but feed your baby.
◆ Get help with your other children and chores.
◆ If symptoms last more than 24 hours, go to your health care provider. Usually, an antibiotic is prescribed. Remind your health care provider that you are still breastfeeding. You do not need to stop breastfeeding. You can continue to breastfeed even when you are on an antibiotic. Remember to finish the medication even if you feel better. Sometimes, antibiotics can cause loose bowel movements in both you and your baby.
Low milk production
Concern over milk production is the most common reason
worldwide why women give up breastfeeding early. Most mothers make enough milk to satisfy their baby. You may notice that your milk production seems lower if you are tired, under stress, or at the end of the day. Don’t be discouraged if you cannot express milk after a feeding. The amount of milk you can express is not the same as the amount of milk in your breast. You have milk in your breast even if you cannot express it.
What causes it?
There could be several reasons why your milk production is low. Sometimes it is caused by problems in breastfeeding management; for example, the baby not latched on well to the breast; weak suckle; not breastfeeding often and long enough (baby not effectively removing milk); missed feedings; giving bottles of formula; overuse of pacifiers; and switching breasts before baby has had time to get to the hindmilk. There are also medical reasons for a low milk production: excessive bleeding during or after birth, or retained afterbirth; thyroid problems; infections and breast reduction surgery.
What can I do?
◆ Continue to breastfeed your baby.
◆ Have a calm environment for you and your baby when feeding. Work on any stresses that may be in your life.
◆ Rest, eat well and drink when thirsty. Limit tea, coffee and cola drinks to a total of three servings a day.
◆ Check that your baby is positioned and latched on properly.
◆ Encourage your baby to nurse by expressing some milk
into his mouth.
◆ Breastfeed often, at least every 1½–2 hours. Draining the breast is important in promoting an increased milk production
◆ Correct other problems such asengorgement or blocked ducts.
◆ Do not give bottles of formula or water to your baby. This will decrease your milk production.
◆ Avoid pacifiers as they decrease suckling time at the breast.
◆ Expression of breastmilk using a double, electric breast pump after a feeding may also increase stimulation and removal of breastmilk.
◆ Your health care provider may suggest herbal preparations such as fenugreek weight slowly, see your health care provider.
◆ Talk to people who can help you: your public health nurse, a lactation consultant, doctor, members of a breastfeeding support group or La Leche League, or another mother who has breast fed
◆ Have a relaxing bath.
◆ Go for a walk.
◆ Cuddle or rock your baby. You may also be soothed
by rocking!
Thrush (“white mouth”)
Thrush is a yeast (fungus) infection that can affect mother,
baby and her partner. If you develop thrush, it is more likely
to happen several weeks after your baby is born, but can
develop as early as two weeks after birth. Yeast is always
present in our bodies, but too much can cause infection, and
treatment may be needed.
What causes it?
The germ that causes thrush grows well in warm, moist,
dark places, such as in your baby’s mouth or diaper area,
in your milk ducts, on your nipples or in your vagina. The
infection can pass back and forth between you and your
baby. Thrush is more likely to happen when you or your baby have been on an antibiotic, and when you have sore
or cracked nipples.
What are the signs?
Mother’s nipples may look normal but still feel sore.
Mothers may have:
◆ Sudden onset of breast or nipple soreness when breastfeeding had been going well (pain-free).
◆ Nipple pain that does not improve even with better position and latching-on techniques.
◆ Cracked nipples that do not heal; fine cracks (like paper cuts) at the base of the nipple.
◆ Itchy or burning nipples and areolae that may look pink, red, shiny or flaky.
◆ Sharp, shooting pain in the breasts during feedings and possibly between feedings.
◆ Achy breasts and a painful let-down of milk.
◆ Thick, white vaginal discharge with redness, itchiness and burning in the vagina.
Some babies with thrush have no signs or symptoms at all.
Your baby may have:
◆ White patches on the inside of his mouth, cheeks, or tongue that do not wipe off.
◆ A change in temperament, (e.g., has more gassy or cranky periods).
◆ Periods where he refuses the breast or pulls off the breast during feeding.
◆ A clicking noise during sucking.
◆ A bright red diaper rash with a well-marked border, that does not improve with regular diaper cream.
What can I do?
◆ Talk with your health care provider if you think you or your baby has thrush. Once you start the prescribed treatment, you may see improvement in a day or two. However, you both need to be treated for at least two weeks. A good rule of thumb is to have seven days of pain-free nursing before you stop the treatment. Your partner also needs to be treated with a prescribed medication if you have a vaginal yeast infection.
◆ Continue to breastfeed your baby. Always check to make sure your baby has a deep latch.
◆ Try breastfeeding more often but for shorter periods. Start with the least sore breast.
◆ Keep your medication and your baby’s medication separate.
◆ Using a clean swab each time, paint the inside of baby’s mouth (cheek, gums, tongue and roof), with the medicine your doctor prescribed after each breastfeeding. The germ that causes thrush grows very quickly, about every 2–3 hours, so you need to treat both you and your baby after each feeding.
◆ Pay special attention to personal cleanliness, because the
infection may also be present in your vagina. Remember to wash your hands well, especially after changing your baby’s diaper, after using the washroom, before feeding your baby and before meals.
◆ Change your nursing pads at each feeding. Throw away disposable ones. Wash cloth ones in hot, soapy water and dry in a dryer at a hot setting before using again.
◆ Rinse your nipples and areolae with a vinegar and water solution (one tablespoon of vinegar to one cup of water) after each feeding. Air dry. Mix up a new solution every day.
◆ Put the cream prescribed by your health care provider on your nipple and areola of both breasts after each feeding. Gently massage the cream into your nipples. Do not remove the cream before breastfeeding.
◆ The milk that you express during a thrush infection can be used but not frozen.
◆ Each day, boil for 20 minutes any items that come into contact with your baby’s mouth, such as medicine droppers, spoons, pacifiers, pumps that cannot be boiled should be washed well with hot soapy water.
◆ Wash all of your bras, pads, nightgowns or other clothing
that comes in contact with your nipples. Use hot water
and bleach. Dry at a hot setting in the dryer or in the sun.
◆ Keep baby’s diaper area clean and dry. Put the cream on your baby’s diaper area during each changing.
◆ Talk with your public health nurse, lactation consultant or doctor if you need more help. You may need to be treated more than once and/or try different anti-fungal medications. Infections that don’t go away may need to be treated with an oral medication.
Slow weight gain
In the first days after birth, healthy full-term babies lose from 7–10% of their birth weight. Most babies return to their birth weight by about two weeks. It may be a little longer if your baby has had difficulties getting breastfeeding established. Most healthy breastfed babies gain about 155–241 grams (5–8 ounces) a week for the first four months. Between 4–6 months the average weight gain is 92–126 grams (3–4 ounces) a week. Slow weight gain is a gain of less than 120 grams (4 ounces) a week for the first four months. All babies grow at different rates. Some babies are slow gainers in the first few weeks but then go on to breastfeed
very well.
What causes it?
There are several possible causes of slow weight gain in babies. A baby may be incorrectly positioned or latched on, or may have poor sucking skills. Some mothers may wait too long between feedings or do not feed long enough at each feeding. Allowing a new baby to stay asleep too long can also cause problems with a mother’s milk production. The mother may have a foremilk/hindmilk imbalance. Mothers may have a lower milk supply because of doing too much (“super-mom syndrome”), being overtired, or because of using alcohol, drugs, or cigaretes
What can I do?◆ Continue to breastfeed your baby.
◆ Feed your baby every two hours during the day and every three hours at night, at least 10–12 times in a 24–hour period. Remember, your baby may not cry or demand feedings. You may need to wake him.
◆ Check your baby’s positioning, latching-on and sucking skill.
◆ Feed your baby from one breast at each feeding or allow your baby to feed for a longer period on one breast. This will help him get the hindmilk that he needs to gain weight.
◆ Try breast compression or super-switch nursing if your
baby falls asleep at the breast or suckles well for only a
short period.
◆ Avoid pacifiers.
◆ Try to get enough rest, eat well and drink when you feel thirsty.
◆ Some forms of birth control pills may also decrease milk
production. Talk with your health care provider about other recommended forms of birth control.
◆ Talk to your public health nurse, lactation consultant or
doctor about using a lactation aid at the breast. Your baby may need help from a lactation aid at the breast for a short period until breastfeeding is “back on track”.
*adapted from The Breastfeeding Handbook 2010. Gov. of Newfoundland and Labrador
