Breastfeeding Problems for Mothers

Sore Nipples

These can be caused by the baby sucking on the nipple instead of the surrounding areola, or being dragged off the breast without the suction being broken first. Other causes may be wet nipples from soggy breast pads; the baby sucking too long after the breast is emptied; use of too much soap which dries the skin; sensitivity to creams or sprays; or the baby feeding at an awkward angle.

The way to avoid these problems is to keep nipples dry and exposed to air as much as possible and to make sure the baby is fixed on and taken off the breast properly. Start each feed with the breast you finished with last time, so that alternate breasts are offered at the beginning of a feed when his suck is strongest. If you don’t mind laughing at yourself a bit, a hair drier is a good way to dry nipples, and you can use small nylon tea-strainers with the handles cut off inside your bra to allow air to circulate and prevent rubbing. Continue feeding, but cut comfort sucking until soreness has eased, and use a nipple shield if it helps. This is a sterilised rubber cap held over the nipple with a hole to allow milk through.

Cracked Nipples

These can follow from untreated sore nipples or appear without warning. The nipple bleeds through a small crack or split in the skin. If it is not too bad it will not do any harm to carry on breastfeeding. You could use a nipple shield but, if it hurts, don’t grit your teeth and carry on in agony – better rest for a day and allow it to heal and give bottles in the meantime. Express milk by hand to prevent engorgement and paint the nipple with Friar’s Balsam mixed with lanolin or gentian violet.

Reintroduce the baby to the breast cautiously for a couple of minutes of feed at first and use a nipple shield until the skin has healed.

Blocked Ducts

Blocked ducts cause a tender lump and can make you feel feverish. This can follow engorgement or pressure on the ducts, perhaps from a tight or ill-fitting bra or even an awkward feeding position. Do not stop feeding because this will make it much worse – instead try to clear the blockage by massaging the lump gently in the direction of the nipple, applying hot and cold compresses and offer that breast first at frequent feeds so that the baby’s strongest sucking at the beginning of a feed will help to get the milk moving through the ducts again.

Mastitis

Mastitis can cause similar symptoms and may be non-infective, caused by milk leaking from the blocked duct and surrounding tissue. Feverishness alone is not a sign that the mastitis is infective, even though you may have a temperature. Infective mastitis also has the same symptoms, although you may feel iller, and it is often caused by a germ in the baby’s nose which is transmitted to the mother’s breast and which may have been picked up in hospital. In both cases all the treatment described for engorgement and blocked ducts can help and the doctor will prescribe antibiotics. Remember to mention to him, even though it sounds obvious, that he needs to select an antibiotic suitable for a breastfeeding mother. If tests show the milk is infected you will have to stop feeding temporarily from the affected breast, and perhaps supplement with bottles, until the supply in the healthy breast is sufficient.

Breast Abscesses

These are rare and sometimes confused with blocked ducts, but they can be nasty. Treatment is with antibiotics, and possibly surgical drainage if this is not enough alone. You will have to stop feeding from the affected breast in the same way as with infective mastitis.

Breastfeeding after a Caesarean

This is easiest following an epidural because you will be fully conscious and alert and able to put the baby to the breast after delivery. Usually a cushion or two under the baby can prevent any pressure on your stitches, but don’t be afraid to ask for help to get into a comfortable position and be handed the baby. Mothers who cannot sit in a propped-up position, either because it is too painful because of the restrictions of drainage tubes or drips, or because they feel ill from the effects of a general anaesthetic, can feed lying to one side with the baby’s feet towards their head.(related topics)Either offer the other side by leaning over the baby more, or get help to move the baby to the other side and shift position. Take special care when feeding in a less than ideal position that the baby gets properly latched on to the breast. Try to vary the angle at which he sucks so that the pressure is not always on the same spot. In this way you will decrease the risk of getting sore.

Breastfeeding Twins

This is perfectly possible. During pregnancy, get in touch with the Twins Club in your area who can give advice and extra literature. Feeding both together saves a great deal of time and avoids the problem of one baby howling while the other is feeding, but in the early days you may want to feed each separately, both to give you experience of breastfeeding, if these are your first babies, and also to get to know each one individually. Put the baby that wakes first to the breast and wake the other to follow with a feed so their hungry times stand more chance of coinciding. Totally demand feeding both babies will leave little time for anything else, so you will have to impose some kind of routine on them from the beginning – aim for feeds about every three hours.

Once you begin to give all or some feeds together, experiment with a helper to find the position that suits you and the babies best. Resting them on pillows on either side so their bodies are cradled under each arm and the head supported on more pillows on your lap is one way, or while they are small you can adapt the conventional nursing position with both babies lying in the same direction. If one baby has a much stronger suck, always alternate breasts so that each breast receives the same amount of stimulation and then produces the same amount of milk.

If one baby is very much smaller and cannot go so long between feeds, you may have trouble synchronising feeding times. Begin by feeding both separately and move on to joint feeding times. If the smaller baby wakes less than two and a half hours later, feed him again, but also wake him for a joint feed when the bigger baby wakes. If the smaller baby sleeps two and a half hours or longer, then try to spin out a little extra time by giving him a small drink and a nappy change and then wake the bigger baby for a joint feed. It will save more time to feed both babies every three hours than one baby at three hours and another at four. Gradually the smaller baby should catch up. The rule of supply and demand will ensure that as long as you let both babies suck as much as they want, your body will produce enough milk for both.

Breastfeeding Triplets

It is possible to breastfeed three babies, but obviously it needs a lot of dedication and a great deal of extra help and support – as indeed does almost every aspect of caring for three new babies. One practical routine is to breastfeed with the third baby having a bottle on a rota system so that all the babies have some breast milk.

Whatever problems you may have with breastfeeding, try to take a positive attitude. Even if you manage to feed for only a very short time you will still have given your baby a valuable start which he would not otherwise have had, both from the anti-infective properties of colostrum and from the physical closeness. If you have to give up because, despite all your efforts, you cannot build up a supply of milk, or your baby does not gain weight or starts to lose weight, remember you can still combine breast- and bottle-feeding and do not have to give up completely. If you do have to switch completely to bottles because of repeated serious problems or illnesses, do not regard bottle-feeding as second best, but concentrate instead on making feeding times a time of enjoyment for both of you.