Breastfeeding and Lactation Support Challenges

Breast Fullness vs. Engorgement
Breast fullness: In two to three days after the baby is born, mother’s milk starts to change. Her body sends more blood to her breast to increase her milk supply and there may be some swelling of the breast tissue. The breasts become larger, firmer, and heavier. This fullness is normal. Some women are uncomfortable and may feel a throbbing sensation. This swelling only last a day or two if the baby is fed often and empties the breast regularly. Babies may have some trouble latching on if the breasts are too full. Use Reverse Pressure Softening (sustained finger pressure beginning at the nipple base and over the areola, pushing edema away from the nipple) before feeding can help the baby latch on

Breast engorgement: If breast fullness does not go away with frequent breastfeeding or softening of the breast, breast can become hard, heavy, swollen and painful. This is engorgement. It is important to remove the milk. If a mother has questions after discharge from the hospital, she can call a Lactation Consultant for assistance. Engorgement can reduce milk supply, lead to blocked ducts or cause a breast infection. To avoid engorgement, counsel mothers to not skip feedings or supplement with formula often after her milk supply comes in.

Effective Ways To Relieve Engorgement and Get Milk Flowing

• Apply warm compresses to the breast before feeding. A wet warm washcloth or a shower can help widen the ducts and help the milk to come into the ducts in the breast.
• Massage the breast while nursing or pumping. Massage can trigger a let down of milk. Expressing some milk before nursing can help to soften the breast so the baby can latch more easily.
• If the baby is not able to soften and empty the breast, express or pump milk until the breasts are no longer hard or lumpy.
• If the breast still feel swollen after feeding or pumping, apply a cool pack on the breast for 10 to 15 minutes.

Sore or Cracked Nipples
Sore nipples can be discouraging and interrupt the pleasantness of breastfeeding. Some tenderness of the nipples by the second or third day after birth is common. This should improve by day 7 to 10. Continuing tenderness that causes redness, cracking and sore nipples is probably due to improper positioning and latch. Positioning and latch issues can be easily fixed. Call our lactation consultants for help.

• Do not let the problem get worse.Prevent sore and cracked nipples with the following measures.
• Learn how to properly position babies at the breast.
• Break the suction prior to removing the baby’s mouth from the breast.
• Apply some expressed breast milk to the nipple after nursing and allow it to air dry.
• Keep the nipple moist by applying lanolin after each nursing session.
• Wear breast pads between nursing session and change them when they are wet.

IMPORTANT: Some sore nipples can be the result of an infection. This needs medical treatment. Instruct mothers to talk to their health care provider or a certified lactation consultant if she has bright red shiny skin on her nipples and is experiencing itching. If the baby is fussy, seems to not want to nurse, or has a bright red diaper rash along with mother’s sore nipples, instruct mother to call her health care provider right away.

Blocked Ducts
The milk in the breasts flows through a series of ducts toward the nipples. Milk ducts can become clogged when milk is not flowing freely. This creates pea-sized hard, tender areas in the breast. Blocked ducts can be caused by skipped feedings, heavy breasts that are not well supported, a tight bra or under wire bras that put pressure over a duct, breast surgery, or poor positioning with nursing. Blocked ducts need to be cleared to restore milk flow and prevent infection.

Effective Ways To Relieve Blocked Ducts and Get Your Milk Flowing

• Take a warm shower or use warm wet compresses.
• Gently massage the breast before breastfeeding.
• While breastfeeding, gently massage the blocked area.
• Nurse often on the breast with blocked ducts. Position the baby so the baby’s chin is facing the blocked duct. This allows maximum suction toward the blockage.
• Express or pump milk if needed.

Mastitis
Sore or cracked nipple and blocked ducts can lead to mastitis if they are not corrected. Mastitis is inflammation of the breast tissue. Mastitis may or may not be accompanied by infection.

IMPORTANT: Counsel a mother to call a healthcare provider immediately if she has the following symptoms.

• Red, very sore, hard area on her breast
• Red streaking or breast tissue that is pink and tender over a large area
• Fever, chills, and flu-like symptoms

Effective Ways To Treat Mastitis

• Antibiotic therapy: instruct to finish the whole prescription even if she is feeling better.
• Nurse frequently: this is not a good time to stop breastfeeding.
• Apply warm compresses to the affected breast.
• Massage while nursing.
• Gently pump after or between feedings to promote breast emptying.
• Get plenty of rest.
• Drink lots of fluids.