Ouch It Hurts - Common Breastfeeding Problems

ENGORGEMENT

• It is normal for a mother’s breasts to become larger, heavier and a little tender on the 2nd to 6th day of birth. This is due to the extra blood and lymph fluids travelling to the breasts to prepare for producing milk, as well as increased volume of the milk itself. This normal fullness usually decreases within the first 2-3 weeks after birth if baby is breastfeeding regularly and well.
• After the initial fullness disappears, the mother’s breasts will feel softer, even when her milk supply is plentiful. However, it is important to nurse regularly as infrequent breastfeeding causes the breasts to become congested with milk, slowing circulation. When blood and lymph move through the breasts slowly, fluid contained in the blood vessels can seep into the breast tissues, causing swelling.

DIY Treatment

1. Take a warm shower, drink hot soup/beverage, or apply warm moist heat right before breastfeeding. It helps you to relax and more effectively drain your breasts.
2. To help stimulate let-down, use your fingertips to gently knead the breast, massaging from the chest wall towards the nipple area in a circular motion.
3. Fully drain the breast with an effective breast pump.
4. Many women find cabbage leaves soothing. However, caution should be used as some report that prolonged use of cabbage on the breasts can decrease milk supply.
5. If engorgement persists in one breast for more than 48 hours of consistent treatment with no obvious reason, you may wish to see your doctor to rule out other causes.

MASTITIS

• Refers to any inflammation of the breasts, usually from a plugged duct or breast infection.
• How to differentiate between a plugged milk duct and breast infection

  Condition	Plugged Milk Duct	Breast Infection
  Initial onset	Comes on gradually	Comes on suddenly
  Affected area	May shift in location	Is localized
  Sensation	Feels little or no warmth in the area	Breast is red, hot and swollen
  Type of pain	Localised and mild	Localised and intense
  Symptoms	Feels generally well	Flu-like symptoms
  Temperature	Lower than 38.4°C	38.4°C or higher

•  Continued breastfeeding during mastitis is beneficial for both mother and baby.

DIY Treatment

1. Apply heat to the affected area and remove any dried milk secretions on the nipple by soaking it with plain water.
2. Massage the affected area gently while it is warm.
3. Breastfeed baby or hand-express some milk immediately after treating the area with warmth and massage.
4. Breastfeed baby frequently on the affected side.
5. Loosen constrictive clothing, especially your bra.
6. Vary nursing positions may help to relieve a plugged duct. Position baby at the breast so that his nose or chin points towards the plug.
7. Rest and relax – an important part of the treatment!
8. Breastfeeding-compatible antibiotic may be needed if the mother’s fever has not disappeared within 24 hours of home treatment or if her fever increases suddenly.

SORE NIPPLES

• It is normal to experience some nipple soreness in the first week or two of breastfeeding.
• However, if it persists, poor positioning or latch-on is the most common cause. Do check that baby is latched on well.
• Sore nipples can also be caused by the use of an ineffective breastpump. If you need to pump regularly, do invest in a good dual electric breastpump such as Hygeia Enjoye.
• If you are using an effective breastpump, but still develop sore nipples from pumping, you may wish to increase the speed (cycles per minute) and decrease the level of suction till you feel more comfortable.

DIY Treatment

1. Express a small amount of milk onto the nipple and allow it to air-dry.
2. Apply Hygeia Lanolis to keep nipples and areola moist. It is safe for mother and baby and does not need to be removed.
3. If your nipples are so sore that you can’t tolerate the pressure of your bra or clothing on them and it is painful for you to hold baby, you may wish to wear breast shells with air-holes to protect the sore nipples. However, do wear a bra one cup size larger than usual to accommodate them comfortably. Note that this should only be a temporary relief as overuse of breast shells can contribute to plugged ducts and mastitis. Any milk collected in a breast shell between feedings should be discarded.
4. Alternatively, you may use Hygeia Gel Pad – a soothing nipple therapy for instant relief of nipple soreness. It absorbs milk leakage and protects against irritating friction from clothing contact. Sterile pad provides a bacterial barrier and helps promote healing. It is safe and non-toxic for both mother and baby, and can be reused for 3-5 days.

THRUSH

• Thrush is an overgrowth of a fungus (Candida albicans) that is naturally present in our bodies.
• Possible symptoms

  In Mother	In Baby
  Intense nipple or breast pain that may last throughout the feeding and is not improved with better latch-on and positioning	White patches on baby’s gums, cheeks, palate, tonsils, and/or tongue
  Sudden onset of nipple and/or breast pain after a period of comfortable nursing	Diaper rash (may simply be red or red with raised dots)
  Itchy or burning nipples, and/or have a rash with tiny blisters	Whitish sheen to the inside of the lips or saliva
  Traces of white fungus in the folds of the nipple or breast	Baby repeatedly pulling off the breast, making a clicking sound while nursing, or refusing the breast because his mouth is sore
  Shooting pains in the breasts during or after feedings	Gassiness and fussiness
  Vaginal yeast infection	Baby may also be without visible symptoms

• If thrush is diagnosed, both mother and baby will need to be treated simultaneously, even if baby has no visible symptoms. Consult baby’s health care provider.
• Breastfeeding should continue during thrush treatment.
• Suggestions to make nursing less painful

1. Rinse nipples with clear water and air-dry them after each nursing
2. Offer short, frequent feedings
3. Nurse first on the least sore side (if there is one)
4. Break baby’s suction before taking him off the breast