Overcoming breastfeeding problems

Breastfeeding has many benefits including reducing the risk of infections in baby, helping baby and mother bond, reducing the risk of breast cancer in mothers and helping mothers lose weight after childbirth.

However, it comes with its own set of problems and challenges if the baby is not latching on correctly or if the breast is not drained properly.
 

Lactation consultant, childbirth educator and infant massage instructor Christine Choong of Mamalink, advises mothers to firstly try and avoid having problems.

“Most people have these problems because the first three days after birth get messed up. If they weren't messed up or they weren't given bad advice or they weren't too tired to feed in those first three days, then there is less likelihood of having problems later on,” she says.

“Basically you can avoid a whole pile of problems and issues by getting it right from the beginning but that starts with feeding in the labour room at birth without the baby being taken away from mum or disturbed until after the first feed.

“Most babies after birth lie and rest for half an hour before they actually look for the breast. People also mistakenly think that the baby isn't hungry and take him or her away when they give the mother the baby and the baby does not suck. If they left the baby there, the baby would actually feed, perhaps a bit later.

“You can tell your obstetrician that you want your baby delivered straight onto your chest, you want extra blankets to keep you and baby warm and you don't want baby removed until after the first feed unless the baby has problems,” advises Choong.

She explores some common breastfeeding problems here and how to overcome them:

Engorged breasts

Engorgement usually occurs around three to four days after birth and is usually due to the baby not feeding often enough in the first few days.

It is important to encourage baby to feed frequently. If baby is very sleepy which may occur if the mother has used pain medication in labour, it may be necessary to wake baby up to feed so that baby is taking at least eight feeds in 24 hours. As the milk supply increases initially the mother will feel the breast starting to become more full and heavy but at this stage the milk flow is still quite good. If the baby is not feeding frequently, it is helpful to massage the breast and then gently express enough milk for the breast to feel comfortable.

As the milk production increases correspondingly there is increased blood flow to the breasts and additional body fluids in the breast. Without frequent breast drainage, either by baby sucking or mother expressing, the breast can become extremely hard, to the degree that the breasts can literally feel like rocks on the mother’s chest.

If confinement practices allow, it is helpful to put a cold compress over the breast for approximately half an hour. If this can’t be done because of confinement practices, put on a hot compress. Following this the breasts should be massaged and then a small amount of milk expressed in order to soften the areola. Once the areola is soft enough the baby should be able to attach and take a good feed. If the breasts are still very firm and uncomfortable after the feed the mother can express sufficiently to relieve the discomfort. Either a cold compress or cold cabbage leaves can then be applied to the breast for approx 20-30 minutes. These compresses can be repeated around three times in 24 hours until the engorgement resolves.

Infection

Breast infection is usually referred to as mastitis. There are usually two main causes – either infection travelling up through a cracked nipple, or stasis of milk if the breast isn't well drained. If the breasts aren’t drained frequently the mother may develop blocked ducts which would result in a build up of milk which ultimately, if not resolved may become infected.

The important thing is to keep feeding frequently and making sure baby is well attached to ensure that the breast is drained well.

Before full blown mastitis occurs the mother will notice a red, hot segment on the breast. Full blown infective mastitis presents as a flu like illness with high temperature, body aches and generally feeling unwell. At that stage a mother would need to see a doctor to determine whether she needs to be treated with antibiotics. If a mother does have mastitis it is important to continue breastfeeding because if she stops breastfeeding and the breast is not drained well then the infection is likely to persist or recur.

Most of the antibiotics today are safe to take while you are breastfeeding. If the doctor prescribes antibiotics which are not compatible with breastfeeding, either ask for an alternative antibiotic or if the doctor is not agreeable to this seek a second opinion from a doctor who is more knowledgeable about breastfeeding.

Cracked and sore nipples

The commonest cause of cracked nipples is baby not attaching properly. It is vitally important to work on attachment right from the very beginning. Even with a cracked nipple a mother can continue with breastfeeding as long as she obtains help with attaching baby to the breast.

Often during the first few feeds, new mothers may feel discomfort at the beginning of the feed which is due to a kind of negative suction until the milk starts to flow. This may result in discomfort for the first few seconds of each feed. However, if the pain persists all the way through the feed it may indicate that the baby is not attached properly. It is important then to check how the baby is actually latching onto the breast. A good latch should be asymmetrical. This means the lower jaw takes in more breast tissue than the upper jaw and cheeks look full and round while baby is feeding. To assist baby in latching well mothers should support baby in such a way that baby is lying chest to chest with the mother and the nipple is level with baby’s nose not the centre of the mouth. If pain persists the mother should seek help from a lactation specialist.

Expressing a little breastmilk after a feed, massaging it into the nipples and then allowing it to air dry helps to protect the nipples. If the mother actually has a crack on her nipple then sometimes using a nipple cream will create a protective layer and enable continued breastfeeding. Most nursing creams now are safe to leave on through a breastfeed.

Another common cause of sore nipples is thrush which is a fungal infection. This is often a diagnosis to be considered if a mother has been breastfeeding with no discomfort and suddenly develops sore nipples. A mother with thrush on her nipples may experience soreness and / or a burning sensation. This sensation is sometimes akin to needles stabbing into the breast. The skin on the areola may be itchy, flaky and shiny. It is very common to develop thrush after being treated with antibiotics. If a mother suspects that she has this problem she should see a doctor to confirm the diagnosis. Treatment has to be given for both the mother’s nipples and the baby’s mouth and treatment should be continued for at least one week after the symptoms subside or it may recur.

Low milk supply

Milk production works on demand and supply – this means that the more milk that is removed form the breast, the more you make. Those first three days after birth are really critical in stimulating the milk production and the hormones involved in breastmilk production. Again, the sooner after birth the baby begins to breastfeed and the more frequent the feeds, the better the stimulation to the milk supply. Baby's attachment to the breast is also very important. If baby is not attached properly, sometimes even though the mother has a good milk supply, the milk does not transfer to the baby effectively. This can also occur if the mum is tense or in pain. In this situation the hormones which cause the milk to letdown are not stimulated sufficiently and the baby doesn't receive sufficient milk.

If a mum is experiencing pain, it is helpful to take regular pain medication as prescribed by a doctor.

If the baby isn't attached properly, then the mother should work on improving the attachment or if she is experiencing difficulty ask for professional assistance.

If the milk supply is genuinely low then it is important to encourage the baby to take more feeds. In the event that baby is too sleepy and not taking enough feeds then it is important to wake the baby regularly. It is necessary to look for the light sleep cycles ie baby’s eye movements are visible, in order to wake baby. A baby in a deep sleep can’t be woken sufficiently to feed effectively. In the case of a really low milk supply, if the mother is able to just rest with the baby then milk supply can be boosted quite effectively by encouraging baby to feed at both breasts and then repeat and feed from both sides again.

Following this, if baby is still sufficiently wakeful you can wait 20 minutes and feed both sides again.

If the baby isn’t sucking so actively, the mother can express after feeding in order to give extra stimulation to the breast. Usually following this pattern for about 24-36 hours will provide a good boost to the milk supply but it is important that mum has sufficient rest at this time. It is useful to arrange help in the home to care for mum enabling her to spend time resting and feeding the baby. During the time baby is working to build up the supply the feeds may be very frequent and irregular, sometimes only one hour or even half an hour apart but this really is the best method to increase the milk supply.

The half ripe papaya that features in many recipes worldwide may help to boost the milk supply. Fenugreek is also thought to boost milk supply & there are many anecdotal records of its effectiveness. There are medications that doctors can prescribe which increase milk supply effectively but only along with the stimulation of frequent feeding or expressing. Taking the medications without sufficient breast stimulation will not increase the supply.

It is critical to first look at attachment, frequent feeds, extra feeds, and only then if the milk supply doesn’t increase, speak to a doctor regarding medication.

Many mothers only perceive they have insufficient milk although in actual fact there is nothing wrong with the milk supply. It is important not to give formula milk as a solution without first checking out whether that is absolutely necessary. If a baby is given formula the tummy will feel full and because it takes longer to digest formula baby will not feed for a longer time. This will result in less stimulation to the breast and then when baby does suckle there will be less milk due to reduced stimulation. Once a mother starts adding in formula, her own milk supply will reduce and therefore supplements should only be given if there is a strong medical indication. Before assuming there is insufficient milk, parents should check baby’s output. If there are 5-6 wet diapers and 3-4 bowel movements in 24 hours and baby is alert and healthy this usually means the milk supply is sufficient for the baby.

One of the big mistakes people make is to give formula overnight to enable mothers to rest when they are in confinement. If formula is given overnight instead of breastfeeding the milk supply will probably diminish rapidly within two to three weeks.

Oversupply of milk

Too much milk and a fast flow can be a problem for the baby because when they go on to the breast to feed, the rapid milk flow can result in the baby choking and spluttering and pulling back off the breast. If the milk flow is really fast it can be helpful to express a little milk before putting baby to the breast. If the first letdown is released before the baby is put to the breast the milk flow will be slower and more manageable for a young baby.

It is also helpful to feed on one breast only per feed. This helps to gradually reduce the supply down to the amount that baby actually requires. If the second breast feels uncomfortably full then the mother can express off just enough milk to relieve the discomfort.

Posture feeding can also be helpful to reduce fast flow. This means positioning baby at the breast in such a way as to reduce gravity. For very fast flow, some mothers lie flat with baby lying on top of them facing the breast. For others bringing baby to the breast with baby in a sitting position facing the breast is sufficient. This can help to slow down the milk flow.

For many mums having too much milk is just as big a problem as having not enough milk.

Blocked ducts