In the first few days following birth, you and your baby will be getting to know each other. It may take time to get the hang of breastfeeding, and it can happen quicker for some women than others.
It is good to find out as much as you can about breastfeeding before you have your baby as this will help you feel more confident when you start to breastfeed.
When experiencing problems with breastfeeding, it is important to ask for help from your midwife, health visitor or a breastfeeding specialist as soon as possible. The sooner you seek help, the sooner issues such as sore nipples or breast engorgement can be treated.
Sore or Cracked Nipples
It is completely normal to experience sore nipples (often described as a ‘pins and needles’ sensation) when you first start breastfeeding, especially if it is your first time. However, if the pain lasts longer than a few seconds in to the feeding session, there may be an issue with the baby’s latch. Sore nipples usually occur because the baby is not in the correct position and is therefore struggling to attach to the breast. The good news is this is often short lived and within a few weeks, your nipples adapt to the feeling.
When your baby is properly attached, your nipple should sit comfortably against the soft palate at the back of their mouth. If your baby is poorly attached to your breast, your nipple will sit nearer to the front of the mouth and can be pinched against the hard palate, resulting in pain. Flattened, white or wedged nipples at the end of a feed are signs that your baby has not be properly attached. Your baby may also seem unsettled following feeds.
Experiencing sore nipples when you are trying to breastfeed a new baby can be stressful and upsetting. It is important to ask for help and support for yourself and your baby as early as possible.
How to ease sore nipples
It is important to remember that the best treatment is to teach your baby how to latch on properly. Self-help tips will be ineffective if your baby is poorly attached during feeds. It may help you to:
- Change breast pads at each feed (if possible use pads without a plastic backing)
- Avoid using nipple shields or breast shells
- Wear a cotton bra so air can circulate
- Let your nipples air dry following a feed
Keep feeding your baby for as long as they want. Keeping breastfeeds shorter to rest your nipples will not help ease nipple pain and may affect your milk supply.
Not producing enough breast milk
In theory, breastfeeding is a supply and demand system. The more you nurse or pump, the more milk your body should make. When you first start breastfeeding, you may worry that your baby is not getting enough milk. This is the most common reason that mums stop breastfeeding. This is usually not the case. However, if you are supplementing with formula or stretching out the time in between feeds, particularly with a newborn, your breasts will not be stimulated enough to produce enough milk. Women who have medical conditions that are not under control, such as thyroid disease, may have difficulty producing enough milk.
The best way to tell if you have an adequate supply of milk is to monitor the baby’s weight. From the fourth day, your baby should do at least two soft, yellow poos the size of a £2 coin every day for the first few weeks. By 14 days, babies should return to their birth weight and start gaining around 4 – 7 ounces per week. If your baby is gulping and swallowing during feeds, it is a sign that they are swallowing the milk. Even if they are a silent eater but gaining weight, there is nothing to worry about.
It is worth noting there are several unreliable ways to determine if you have an adequate milk supply, including the way your breasts feel (empty or full), the let-down sensation, the frequency and length of feeds, absence of leaking milk or the amount of breast milk you are able to pump.
Newborns can be especially sleepy in the first few weeks following birth, so it is not uncommon for babies to nod off during nursing. However, falling asleep at the breast can be a sign that the baby is not getting enough milk.
How to help produce more milk
In the first few days, you and your baby are getting to know each other. It may take time for both of you to get the hang of breastfeeding, becoming easier for some women than others. Try the following steps to help produce more breastmilk:
- Offer your baby both breasts at each feed, alternating which breast you begin with
- Keep your baby close, holding them skin to skin
- Frequent nursing and pumping throughout the day
- Feed your baby on demand instead of following a schedule
- Getting enough rest and eating well
Producing Too Much Breast Milk (Oversupply)
Some women, particularly first time mums, can actually produce too much milk and their babies struggle to cope, causing the baby to cough or choke. This can also lead to painful nipples as your baby may bite down to clamp the nipple to stop overflow. Your baby may fuss a lot and seem hungry even if they are constantly eating. This is because the baby cannot get the last of the milk that contains the most calories. It is best to get your midwife or breastfeeding specialist to watch a feed and see if they can show you different positions to help your baby cope with large quantities of milk.
If you think you have an oversupply, it is best to let your doctor or midwife know. They may check you for a hormonal condition such as an over or underactive thyroid and check your medication (if you are taking any). In the meantime, make it easier for your baby to nurse by holding them in an upright position, using your fingers to reduce the flow of your milk.
It is important to let your baby interrupt feedings and burp often. Try to avoid pumping as it can encourage further milk production. Try applying cold water or ice to your nipples to lessen leaking.
An oversupply of breastmilk also known as hyperlactation or hypergalactia. Around 3 – 5 days following birth, you may notice that your breasts are uncomfortable and your milk supply is more than your baby requires. This is known as engorgement and is experienced frequently in breastfeeding mothers.
How to reduce Oversupply
An oversupply generally settles down over time as your supply regulates. However, if it continues beyond 6 – 8 weeks, try the following steps:
- Lean back while feeding as it can help to slow the flow down if your baby finds it hard to latch
- Limit or stop expressing your milk
- Be sure that your baby is latching well to the breast
- Ask for support from a doctor or breastfeeding specialist
- Attempt block feeding. It is recommended to seek breastfeeding support before starting block feeding. Block feeding is when you only offer your baby one breast at a feed or the same breast for a set amount of time if your baby feeds regularly.
In some cases, the oversupply can be due to a medical condition. If you think this could be the case, or your oversupply is persisting even though you have tried the above steps, you may need help and support from a healthcare professional.
Breast engorgement occurs when your breasts are too full of milk, causing them to feel hard, tight and painful. Engorgement develops in the early days when you and your baby are adapting to breastfeeding. It can take a few days for your milk supply to match your baby’s requirements. Engorgement can also occur when your baby is older and not feeding as regularly, perhaps when they begin having solid foods.
How to ease breast engorgement
- Wear a good fitting breastfeeding bra that does not restrict your breasts
- If they are leaking, use warm flannels under your breasts just before expressing
- Take some paracetamol or ibuprofen, following the recommended dose to ease the pain
What is the difference between oversupply and breast engorgement?
While engorgement may be normal, it is unusual for this to last longer than 6 – 8 weeks, unless there has been a longer gap in between feeds. Mums who experience oversupply can feel engorged the majority of the time and find their milk supply always appears to exceed the baby’s needs.
If your nipples are pink, burning or crusty, it may be due to a yeast infection known as thrush. Breastfed babies can also experience thrush in their mouths. Thrush infections can sometimes happen when your nipples become cracked or damaged. It is not clear why some women get thrush, although it is believed to be related to your baby’s mouth. Thrush infections can also occur after you or your baby has had a course of antibiotics. Antibiotics can reduce the number of helpful bacteria found in the body, allowing the fungus that causes thrush to flourish.
Signs of oral thrush include white or yellow irregularly shaped patches or sores that coat your baby’s gums, tongue, sides and roof of the mouth; a white film on the lips and in some babies, nappy rash that will not clear up.
Signs of thrush in your breasts include pain in your nipples or breasts following feeds, which can last up to an hour after every feed, having previously experienced no pain.
How to help treat thrush
If you think you have thrush, make an appointment with your doctor or midwife to get you and your baby treated at the same time, as the infection can easily spread between you both. The doctor may be able to prescribe a topical antifungal cream or gel, which will kill the yeast. If you use one, be sure to wipe any remaining medication off your nipples prior to nursing and reapply it straight after feeding. If that does not work, you will probably need to take prescription antifungal pills that are safe to use whilst breastfeeding.
Washing your hands thoroughly after nappy changes and using separate towels will help prevent the infection from spreading. You will also need to sterilise and clean any dummies, toys and treats your baby puts in their mouth. You should also ensure you wash your breastfeeding bras at a high temperature and change breast pads frequently whilst you are both being treated.
Once you and your baby have begun treatment, the symptoms should improve within a few days. It will take a little longer for the infection to clear completely. If you do not see any improvement within one week, speak with your doctor or midwife.
You can carry on feeding while you and your baby are being treated for thrush. If you express any breast milk while you have thrush you will need to give that milk to your baby while you are still having treatment. Do not freeze it and use it later as that may cause the thrush to return.
Blocked Milk Ducts
Sometimes a milk duct can get blocked, causing milk to back up, resulting in a red, tender lump. Even though a clogged duct itself is not serious, it can result in a breast infection if ignored.
The milk ducts in your breasts are divided into sections. Narrow tubes called ducts transport the milk from one section to your nipple to feed. If one of the sections is not drained fully during a feed, this can lead to a clogged duct causing a small, tender lump in your breast. Steps that may help the blockage include:
- Avoid wearing tight clothes or bras
- Regular feeding from the affected breast will eventually unclog the duct
- Apply warm flannels or have a warm shower to encourage the flow
- Gently massage the lump towards your nipple while breastfeeding your baby
- Once your baby is fed, drain the affected breast
- Soak your breasts several times a day with warm water
A blocked duct needs treating as soon as possible, as if left, it could lead to mastitis.
Mastitis is a bacterial infection of breast tissue that occurs when a blocked duct is not relieved, and the trapped breast milk becomes infected with bacteria form your baby’s mouth, due to cracked nipples or engorgement. It causes the breast to feel painful and tender sometimes causing you to feel unwell with flu-like symptoms. Up to 10% of all women may experience Mastitis, generally within the first 6 weeks of delivery (although it can happen anytime during breastfeeding).
If you have mastitis, you may experience the following symptoms:
- Hot and tender breast(s)
- A painful red patch of skin
- A general feeling of illness
- Feeling achy, emotional and tired
- A fever
How to treat mastitis
If you think you are experiencing mastitis or developing a blocked duct, try and carry on breast feeding, allowing your baby to feed on the tender breast first. If the affected breast still feels full following a feed, express your milk by hand. It is important to get as much rest as you can. If you feel no better within 12 – 24 hours, or you begin to feel worse, contact your doctor or out of hours service.
Your doctor will prescribe you with antibiotics that will help you feel better quickly. You can continue to breast feed whilst treating the infection. You can also take painkillers such as ibuprofen and apply warm compresses to the sore area to help ease pain. Stopping breastfeeding will make your symptoms worse and can lead to a breast abscess.
If mastitis is not treated, it can lead to a breast abscess that may require an operation to drain it. This can also develop if the mastitis does not respond to regular feeding, along with a course of antibiotics.
You can carry on breastfeeding following an abscess drainage.
Treatment in hospital
You will have an ultrasound scan of your breast to check for an abscess. The pus is drained from the abscess with either a needle or an incision (small cut in the skin). Your skin is numbed before the procedure is carried out. You can usually go home the same day and may be given antibiotics to take. Within a few weeks, the abscess should be fully healed.
Tongue-tie appears in around 1 in 10 babies, occurring when the strip of skin that attaches the tongue to the floor of the mouth (frenulum) is shorter and tighter than usual. Some babies who experience tongue-tie have no symptoms. However, in others it can stop the tongue moving freely, making it harder for them to breastfeed.
In some cases, tongue-tie is diagnosed during a baby’s newborn physical examination; however, it is not always easy to spot. If you are breastfeeding your baby and they have tongue tie, you may notice they struggle to latch on to the breast or find it difficult to stay latched on for a full feed. They may also feed for an extended period, take a short break and feed again. During feeding, a baby with tongue-tie may make a clicking sound (this could also be a sign that you need support with the positioning and attachment of your baby at the breast). Because of the difficulty with feeding a baby with tongue-tie, your baby may not gain weight as quickly as they should.
Tongue-tie can also cause problems for the mother when breastfeeding. Problems include:
- Sore or cracked nipples
- Low milk supply
How to fix tongue-tie
A noticeable sign of tongue-tie is a clicking noise during nursing, along with trouble latching on and staying latched on to the nipple. If you think your baby may have tongue-tie, make an appointment with your paediatrician who can diagnose it. A paediatrician or ENT consultant can perform a simple procedure known as frenotomy, where the frenulum is snipped so your baby can move their tongue freely. Most breastfeeding problems are not caused by tongue-tie and can be treated and fixed with the right support.
From the moment your baby is born, there are a number of things you can do to improve your chance of successfully breastfeeding.
Staying together after the birth will encourage a feeling of closeness and a strong hormonal reaction linked with success when breastfeeding.
The first few days following birth gives you the time to get your attachment and positioning right. Your breasts are still soft for a few days after birth, becoming full and firm as the milk changes.
Most importantly, be patient. Breastfeeding is a skill that comes easier for some mothers and babies. Like anything new, it can take some time and requires patience. Relax and enjoy the experience. If you find that you are getting frustrated or angry, stop and try again at another time. You can always express and then try from the breast for the next feed.
Remember, breastfeeding is not for everyone. For instance, if the mother cannot produce a healthy milk supply or is taking medication that is not safe during breastfeeding. There are also a number of medical conditions that are not compatible with breastfeeding. Ask questions, look for advice and listen to your body and your baby.
If you are concerned with breastfeeding problems, speak to your doctor for a referral to One Ashford Hospital. Our Paediatric Consultants are highly experienced in diagnosing and treating babies who are struggling with breastfeeding, and our medical team and paediatric nursing staff are here to offer support in a caring environment at all times.
To make an appointment to see a Consultant Paediatric Consultant, please contact the reservations team on 01233 364 036 or email email@example.com
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