Breastfeeding Problems

Learning to breastfeed takes practice. New mothers and babies spend the majority of the first two days recuperating from the birthing process and getting to know each other. Some babies seem to be "born to nurse", while others take the first five to six days to adequately empty a breast.

Becoming more confident about breastfeeding requires effort and patience. You will learn how to recognize when your baby is hungry and how to hold your baby and offer your breast at the same time.

It is normal to experience some nipple sensitivity the first few days before milk production begins. However, with proper latch-on and onset of milk production, your nipples will become less sensitive. Many first-time mothers may experience some of the following problems during their first breastfeeding experience:

Cracked nipples
Plugged milk ducts
Engorgement
Sore nipples
Breast infection (mastitis)
Low milk supply
Baby’s growth spurts

Cracked nipples

After nursing, try expressing a few drops of milk after each nursing onto your nipple and allow the milk to dry.
Check to make sure you are latching the baby fully onto your breast. Remember: The baby should have a wide open mouth before latch-on. The top lip should be at least 1½ inches onto the areola from the tip of the nipple. Keep the baby’s nose and chin in gentle contact with the breast.
Apply a soothing emollient (medical grade lanolin) on your nipples to maintain internal moisture. Try using a moist, wound-healing pad over your nipples such as glycerin gel pads.
Allow air to circulate freely around your nipples for 10 minutes, three to four times a day after nursing. Use breast shells to keep your bra from sticking to your nipples.
If your nipple pain is severe enough that you cannot tolerate nursing your baby, use manual expression to keep milk free and flowing for one to two days. Avoid using a breast pump as this will further traumatize your nipples.
Your baby will not be hurt from swallowing a little blood with your breast milk. You may notice that your baby’s bowel movement is darker or streaked with black marks. Your baby may refuse the breast milk because it tastes different and/or may throw up after feeding. A small amount of blood is not a problem, but if the baby throws up a lot after each feeding, interrupt feeding on that side for one to two days to allow nipple to heal.

Plugged milk ducts

A tender spot, redness or a sore lump in the mother’s breast often signals plugged milk ducts. They may be caused by any of the following:

Improper positioning of the baby at the breast
Prolonged periods of time between breastfeeding
Giving supplementary bottles or overusing a pacifer
Wearing a nursing bra too tight or other clothes that constrict the breasts
May be a sign that you're trying to do too much and need to rest
A sudden change in schedule/routine that changes how often you are able to breastfeed

What you can do to treat a plugged duct:

Apply wet or dry heat to the affected area and remove any dried milk secretions on the nipple by soaking with warm water.
- Lean over a basin of warm water and soak your breast for 10 minutes, three times a day. You also can take warm showers, use hot, wet packs or a heating pad.
Nurse the baby on the affected side frequently to keep the breast fairly empty and allow milk to flow freely.
Loosen constrictive clothing, especially your bra.
Check your baby’s position at the breast. It is important for the baby to be positioned properly so all the milk ducts are emptied at every feeding.
Try changing nursing positions often to give the baby a better chance to reach all the milk ducts and keep them emptied.
Try a cabbage compress on the affected area, using your bra to hold it in place. Replace every two hours.

Engorgement

Engorgement is caused by a large supply of milk in combination with extra blood and fluids supplied to your breast in preparation for feeding. Most engorgement occurs three to five days after birth. Unresolved engorgement can lead to plugged ducts, mastitis and eventual loss of milk.

Do not pump during engorgement because it can cause additional swelling.
If your breasts are engorged, you can:

Take a warm shower or apply warm compresses for 10 minutes before breastfeeding. Use hand expression for comfort and flow.
Try to remove a small amount of milk by hand expression for about five minutes before breastfeeding. This will help your baby latch onto the breast.
Gently squeeze and stroke your breast throughout the feeding to empty it more using the breast compression technique.
Make sure your clothing, bra, baby carrier or seatbelt does not constrict your breasts.
Rest and breastfeed frequently, at least eight to 12 times in 24 hours. Use hand expression if breastfeeding is not possible.
Use cool compresses in between feedings to decrease swelling. Frozen bags of peas make great cold compresses.
Apply whole cabbage leaves to your breasts. They may be chilled in the freezer first. Replace every two hours.
Consult your doctor, midwife or lactation consultant if engorgement persists or if you have increased pain, fever or red streaks on the breast.

Sore nipples

Begin feeding on the least sore nipple for three to five minutes to trigger your milk ejection reflex. Then, switch to the one that is most sore. This will decrease the intensity of the baby’s latch onto the sore nipple. Early, mild discomfort is often present by the second day of nursing and improves once your milk starts to come in more abundantly.
Make sure your baby is properly positioned to nurse. The most common cause of severe nipple pain beyond the first week is improper positioning.
Frequent, shorter feedings are preferable. If you nurse 10 to 12 times a day, your baby won’t get overly hungry and he won’t be too hard on your nipples.
Gently pat your nipples dry with a clean cloth after nursing to remove surface wetness. Then apply one to two drops of breast milk to your nipples/areola. Allow your nipples to air-dry between nursing and avoid wearing a bra, especially while sleeping.
Bathing with plain water is all that is necessary to cleanse your nipples. Avoid using soaps as it can remove the natural, protective oils and predispose the nipples to cracking.

Sore nipples rarely last more than a few days. If soreness persists, schedule an appointment with a lactation consultant during your baby’s feeding time.

Breast infection (mastitis)

Mastitis is a bacterial infection of part or all of the breast. Mastitis is like a blocked duct but the mother also has the following symptoms:

Achy, flu-like feeling
Breast pain, redness and firmness
Fever and chills (101 degrees or higher)
Nipple/areola or breast pain

Factors that cause mastitis to occur:

Incomplete removal of milk from the breast
Too long an interval between feedings
Ineffective removal of milk by the infant or by a breast pump
Having a clogged duct that prevents proper milk drainage from a particular lobe
Wearing a nursing bra too tight, which keeps milk from flowing
Cracked nipples that have allowed bacteria to enter the breast
Any trauma to the breast like infant biting or incorrect latch-on
Maternal exhaustion

Treating mastitis:

Call your doctor or midwife if you have any symptoms of mastitis. You will most likely be put on antibiotics. Be sure to mention that you are breastfeeding.
Take the antibiotic your doctor prescribes for the full course of therapy, even if you feel much better after a few days.
Rest in bed as much as possible for one to two days.
Drink plenty of fluids, especially if you have a fever.
Nurse more often, especially on the affected side to keep your breast well-drained.

Low milk supply

To increase your milk supply:

Use warm compresses on your breasts before feeding.
Feed your baby frequently, at least every two to three hours. It is more important that you breastfeed often, rather than having long feedings. The more you breastfeed, the more breast milk your body will produce.
Massage breasts during breastfeeding (manual expression).
Check positioning to make sure that baby is nursing effectively.
Don’t go more than five hours between night feedings. You usually can safely stop waking your infant for feedings once he is gaining weight well and daytime nursing is going well.
Review any medications you are taking with your physician to see if they could be interfering with your milk supply.
Take time to rest and enjoy the closeness of your nursing time.
Drink plenty of fluids, especially water, and eat a nutritious diet. You may want to consider eating smaller, more frequent meals.
Use power pumping for three days in a row.

Baby’s growth spurts

Growth spurts usually last one to two days and happen around eight to 10 days, three to four weeks, six weeks, three months and six months of age.

A growth spurt is when your baby needs more breast milk to get bigger. You will know your baby is in a growth spurt if he wants to nurse more often and longer than usual. The baby also may be fussy and seem like he isn’t getting enough milk.

Nurse your baby as often as he wants, even if it is every hour.
Totally empty one breast before switching to the other breast.
Try to get extra rest.
Drink water whenever you are thirsty.
Cuddle your baby and be patient. Within one to two days, your baby will again be sleeping for two to three hours.