Many women expect breastfeeding to come naturally. In reality, breastfeeding issues are common and it can take practice and patience as you and our baby navigate breastfeeding for the first time. There are a lot of issues that can come up during breastfeeding in the first few days, and even months down the road. The more you know about the small speed bumps you could run into the more likely you are to be able to get over those and correct small issues before they become big problems. This episode is focused on troubleshooting issues that could show up in your breasts. This can include leaking, sore nipples, nipple shields, pain during breastfeeding or pumping, vasospasms, blebs, plugged ducts, mastitis, and engorgement.
Article and Resources
Breastfeeding really is a relationship between you and your baby and it has to work for both parties involved. I wanted to break down this info into more bite sized pieces because there are a lot of random things that can come up with breastfeeding. This article will prepare you so that if you run into any of hiccups you know how to treat it and when to go to get help.
I have done so much reading and research and breastfeeding and I breastfed both my kids for quite some time but I am not a lactation consultant. I do not want to understate the value that a lactation consultant can bring to your breastfeeding relationship. Get help as soon as you need it, before a small issue becomes a bigger issue. I know for a lot of women the thought of hiring a consultant just sounds expensive, but many times you can find these resources for free. La Leche League is an amazing resource that is worldwide and you should be able to find a group meet up near you.
Kelly Mom is an excellent resource for breastfeeding related topics and I reference it throughout this article.
Leaking tends to be common in the beginning when you are getting everything calibrated with your supply and your baby’s demand. If your breasts are full and milk is not removed they will leak. It is also possible that will just leak at random times, like when you hear a baby cry. If you are concerned at all about leaking you will want to use some nursing pads. There are disposable and washable pads. I started out with disposable ones and ended up switching to washable ones. Bamboobies are my favorite washable pads.
You likely hear that breastfeeding is not supposed to hurt. It isn’t supposed to, but those first few days it is really common to have sore and sensitive nipples. This is a part of your body that isn’t used to this much stimulation all the time. Sore nipples are often related to a poor latch. As with anything breastfeeding, you always want to fix or correct the underlying problem, not just treat symptoms. As you are correcting the underlying issue you obviously want to give yourself some relief if you have damage to your nipple.
The first thing you can do is start your baby off on the other side. Their sucking tends to be more intense at the start. After breastfeeding you can use a saline solution on your nipple. This is easy to make with 8 ounces of warm water and ½ teaspoon of salt. Soak your nipples for about a minute, you don’t want to do it too long. Afterwards, pat them dry and then put breast milk on your nipple. Your breast milk has anti-inflammatory and anti-bacterial properties that can help promote healing. Nipple cream with lanolin can also provide some relief and may speed up healing. This isn’t something you should be using every day for your entire breastfeeding life. Nipple cream is something that should be short term to help in healing while the problem that caused the damage is fixed.
When you are not nursing try giving your nipples exposure to air and you can use mild soap once a day on your nipples if they are chapped or cracked. Damaged nipples are really uncomfortable, but they will heal and get better. The more proactive you are in correcting latching issues as soon as possible the more you can prevent problems like cracked nipples. You can visit the Kelly Mom blog for more info on healing tips for nipple cracks or abrasions.
Nipple shields are worn over your nipple during breastfeeding and are made from clear silicone. These are often recommended for nipple pain, cracked or damaged nipples, and can be used for a baby who is having a tough time latching. The downside is that breast shields are commonly misused and there are some disadvantages to using them. Before you use a nipple shield you should see a lactation consultant. These are more of a short term solution to some issues that there may be better solutions for, which is why it is best to refer you to a lactation consultant. If you want to read more on nipple shields you can visit the Kelly Mom blog that explains some of the challenges of using a shield including that it can be tough to get your baby off of it.
Your Baby is Latched and it Hurts
A painful latch is likely due to your little one not being latched on properly. There is a trick to get your baby off your nipple painlessly so you can help them latch properly. To do this you want to put a finger in the corner of their mouth and twist it. This will break the suction and give you an opportunity to start again. If you are doing this numerous times it could frustrate your baby, and possibly you too. In the long run it will save your nipples.
The first tip to help your baby latch is to tilt your nipple before it goes into your baby’s mouth. Aim the top of your nipple towards their upper lip and wait to put it in their mouth until it is open wide. You can also squeeze your breast to compress it and make it easier for your baby to fit in their mouth. With time and practice you and your baby will find what works best for you. I wish breastfeeding was natural and perfect from the start for every mom but the reality is that it may take some work. It is 100% worth it, but give yourself and your baby some patience and understanding that it may take some time and some practice to get this all figured out.
Pumping is Painful
If pumping is painful you can try lowering the suction on your pump. If it is too high and you are uncomfortable it isn’t going to work well. One, it is going to hurt, and two it will not be effective in removing very much milk. You may want to try a different sized flange. Most pumps come with just one size flange. The flange is the cone shaped piece that goes on your nipple, if it is too small this can be uncomfortable. A sign it is too small is if your nipple is swollen, or darker after pumping. It is normal for your nipple to be slightly bigger after pumping but it should not be swollen. Your nipple should move easily in and out of the flange. You can also try some olive oil to lubricate it and see if that helps.
While it may be easy to separate pumping and breastfeeding they are so related and a lactation consultant or a LLL member can help if you are having issues with pumping. After the birth of both my babies I pumped for over a year. I am very familiar with how much work it is to get pumping dialed in just right. I actually went to a lactation consultant because we were having trouble getting my son to take a bottle, and she was able to give us some tips and encouragement that got us over that issue. If you need help with pumping, bottle feeding, or supplementing, try a lactation consultant or a support group, please do not assume these resources are for breastfeeding where your baby is on your breast only.
Vasospasm or Nipple Blanching
Muscle spasms in your nipple can cause the blood to flow out of the nipple. You feel this as a stinging or burning sensation. This makes your nipple turn white during the spasm, then red afterwards, when the blood flows back in. Usually happens after a feeding, but can occur in between feedings. To stop a spasm you can squeeze the base of your nipple when it happens. Some women find keeping their nipples warm can help and cold can sometimes trigger this. For more details on nipple blanching and vasospasm visit the Kelly Mom blog.
A bleb is a tiny white spot on your nipple. It kind of looks like there is milk stuck in a pore. Also called a milk blister. If it isn’t painful, you do not need to do anything about it. If it is bothering you try soaking a cotton ball in vinegar and wear it over your nipple in your bra. Since milk has calcium in it, vinegar can help dissolve it. You can soak in the bathtub or shower and soak a cotton ball in water or olive oil and put it over your nipple in your bra. Another tip is to soak your nipple in a cup of warm water with 2 teaspoons of Epsom salt before nursing. For more info about blebs and what you can do to treat them visit the Kelly Mom blog.
You breast has many milk ducts that send milk to your nipple. When one of those ducts gets plugged that duct doesn’t get emptied. A plugged duct can get hard, swollen, red, and feel warm or hot to the touch.
This is usually due to ineffective removal of milk, if your baby isn’t eating well, and you are getting engorged. This can be could be caused by a bra that is too tight or doesn’t fit well. It is important that you are wearing comfortable bras and tops that are not digging into your skin or too tight. The best thing to do to treat a plugged duct is to empty the milk from your breast, make sure you are drinking plenty of fluids, and eating well. Before you breastfeed you can apply some heat to your breast with a warm compress or a warm shower and massage it. While you are nursing you want to massage from the plugged duct towards your nipple to try and help get in unclogged.
If a plugged duct is not resolved it can turn into mastitis. Which has the same symptoms but they are often more intense and can be accompanied by a fever and flu-like symptoms like aches and even chills.
Mastitis is basically a more severe plugged duct. This may or may not be an infection. If it is an infection it could be caused when bacteria enters through a point of damage on the nipple. Treating mastitis is similar to treating a plugged duct but you also want to rest, preferably in bed, with your baby. Antibiotics may be used if it is an infection. If you are running fever and have flu like symptoms you can contact your doctor or midwife to talk to them about their suggested course of action and whether or not you should consider antibiotics.
Plugged ducts and mastitis are very similar and there is a great article on Kelly Mom that compares and explains the two.
Weakened immunity is one of the risk factors for mastitis. I got mastitis with my son and it was not fun. In my most recent breastfeeding journey with my daughter I got mastitis and it turned into a full blown abscess. This was not a fun experience and you can visit this episode if you want to hear more about my experience and the lessons learned breastfeeding the second time around. It is so critical to take great care of your health anytime but definitely when you are breastfeeding, and especially in the first few weeks when mastitis is most common.
You will likely experience this when your milk first comes in. It can also happen if you go longer than usual in between feedings. Engorged breasts can feel really full, heavy, tender, hard, and even hot. It can also make it difficult for your baby to latch. The top tip to help with engorgement is to nurse your baby. If it is hard for your baby to latch you can try putting pressure around your areola with your finger tips. This can press some fluid back so the area around your nipple is softer and easier to latch onto. This is called reverse pressure softening. To get a better idea of how to do this check out the Kelly Mom article on reverse pressure softening that includes some pictures which may make this concept a little easier to understand.
You can also express a small amount of milk, by hand or with a pump. I say a small amount because remember your milk works on a demand and supply system. If you are engorged and you empty your breast completely then you just told your body that you need that amount of milk at that time. This will make it likely you will get engorged again. A warm shower can also make it easier to hand express some milk. The heat doesn’t help engorgement but it does seem to help you express milk. Cooler temperatures may be more helpful for dealing with the discomfort from engorgement. If you are having trouble with engorgement check out this Kelly Mom article.
See a Lactation Consultant
I cannot overstate the importance of getting help from a professional with any breastfeeding issues. An IBCLC (International Board Certified Lactation Consultant) can make a world of difference. Podcasts and articles will not be a substitution for a professional who can help to resolve any issue.
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