Early Difficulties Breastfeeding

by Melissa D. Jaramillo

You've made the decision to breastfeed your baby. Good for you! It can be a very wonderful experience for you both, along with providing your infant with the best nutritional start possible. This does not mean that it always comes easy and most women will experience some discomfort and even pain during the early postpartum days.

Here are some of the more common problems and methods for coping:

Engorgement

This is one of the most common issues of breastfeeding that occurs within the first few days postpartum. Basically, when your milk comes in (normally on the 2nd or 3rd day following birth), the glands of your breast become filled (engorged) at a point before a stable production schedule has been established. When breasts are not sufficiently drained the results can be quite painful -- and the cycle begins. Tenderness, swelling, warmth, and pulsating pressure may occur. At times the inflammation may cause the breasts to feel feverish and hard lumps may startle the new mom to become concerned.

Treatment:

  1. First bit of advice is to breastfeed your baby often...and then breastfeed some more. Honestly, the more you nurse, the greater the relief. At this particular point creating the proper demand/supply balance is what you are after. To stabilize your supply you will need your baby's help. Remember, the two of you are a team!
  2. Second, don't skip feedings during this time particularly. While it is understandable to feel exhaustion and the thought of "it's just one bottle" is quite tempting, the outcome will serve to defeat your efforts to battle engorgement. Even pumping is not nearly as effective as your newborns suckling.
  3. Third, if your areola seems too large or hard for your infant to latch onto, try applying warm compresses or even hand expressing prior to your nursing session.
  4. Fourth, wear a supportive nursing bra -- even overnight -- until you are more comfortable.
  5. Fifth, massage your breasts (or have your partner do so), when you are completely relaxed. Doing so while in a shower is particularly soothing.

Sensitive/Painful Breastfeeding

Even when things start off well, suddenly you may experience a great sensitivity during the feeding. This, while normal, certainly is uncomfortable and as one mother described "is likened to someone shooting me with a thousand needles all at once." For some mothers, this sensation only lasts a couple of seconds and then goes away. For others, it can last throughout the feedings over the course of several days. Either way, it can become a detriment to your goal for breastfeeding if left untreated.

Treatment:

  • Positioning: Check to be certain that your baby is positioned properly and is not latching on solely to the nipple. Attempt to get as much of the areola in your baby's mouth as possible. For more on proper positioning, read Sore nipples and Starting out right.
  • Acetaminophen (Tylenol): If nursing sessions themselves are painful, take this pain medication approximately one half hour prior to feeding. This is considered safe for both you & your baby under most circumstances. Please check with your care provider if you have any questions or desire something stronger.
  • Massage/Numbing: You can choose to apply ice packs prior to nursing to numb the area if needed. Also, massaging the breast -- particularly the nipple -- helps stimulate the milk flow. This instigates relief in itself.

Cracked Nipples

Remember as a child after playing in the harsh winter winds how severely cracked and chapped your lips became? Now as a newly lactating mom, you may be painfully reminded - only this time in a much more sensitive area! The majority cause of cracked nipples is due to poor positioning.

Treatment:

  • Proper positioning: Again, check to insure that your baby is latching on correctly. Attempt a different hold to see if that provides more relief. If possible, meet with a lactation consultant to determine the remedy appropriate for your particular situation. Tips:
    • If the area chapped is at the tip of the nipple, it is most likely rubbing at the roof of your baby's mouth. Using a different hold may easily resolve this issue for you.
    • If the area chaffed is near the base of the nipple, this is a strong indication that your infant is latching on solely around the nipple itself. When this occurs, insert your finger into the baby's mouth to break the suction, squeeze the areola between your thumb and forefinger and try to place more of the areola within his/her mouth.
  • Starting place: If one of your breasts has more cracking than the other, then begin nursing on the opposite side. During the beginning of the feeding, the baby's suckling reaction is at its peak. This will provide some relief. It is not, however, recommended that you skip nursing on the painful side altogether. In fact, that will serve to prolong the agony and may result in even more problems.
  • Airing your breasts: After each feeding expose your breasts to air and sunshine for 15-30 minutes. If you are either uncomfortable with doing so or not in a place where public nudity is allowed, then at least attempt to leave your nursing bra open for that length of time.
  • Nursing Pads: Make sure to change these frequently. Allowing the moisture to remain trapped will worsen the problem. Try a brain without a plastic liner.
  • Fabric choices: Skip synthetic fibers and opt for 100 percent cotton. This applies to anything from nursing pads to bras, t-shirts and pajamas. Cotton allows for the skin to breathe and the chapping to heal.
  • Avoid ointments: If you go to the market and view the shelves you will find all sorts of ointments, lotions, and more promising to soften your nipples. Examples include cocoa butter, lanolin, and Vitamin E types. Contrary to their advertisement, they often cause more irritation than they prevent.
  • Breast Milk: Ever heard the phrase "Physician, heal thyself?" Guess what? You have the perfect solution right within your own body! Breast milk serves as the perfect lubricating agent to heal and soothe cracked nipples. Gently express several drops and rub over the area.

Thrush

Thrush, a yeast infection, is fairly simple to diagnose, even at home. If your nipples appear to be red, itchy, swollen or quite tender you may suspect thrush as a possibility. Look inside your baby's mouth for white patches located on the tongue, cheeks, and /or gums. Other infants will develop a painful diaper rash instead that appears as a mild burn would. There are several methods of contracting the infection -- through delivery (from the birth canal) or even in response to an early course of antibiotics.

Treatment:

  • If you suspect that you and your baby have thrush, please contact your care provider immediately. They will most likely prescribe an antifungal treatment such as nystatin to be applied. Another option often used is gentian violet. Please be aware that while safe it will turn everything it touches bright purple -- this includes your breasts, your baby's mouth, clothing, etc.

Mastitis

This is one of those infections that you definitely want to take steps to avoid. Unlike thrush, this infection does not transfer to your baby which is good news. The bad news is that you often feel horrible while battling this while your newborn is increasingly eager and ready to nurse! Early indications of mastitis are elevated temperatures and a noticeable tender /sore spot in one breast. After the infection fully takes hold, you may experience fevers up to 104°F, extreme fatigue, chills, body aches all over, swelling in your breast, and a very red tender area on the breast that is hurting.

Treatment:

  • Contact your care provider immediately.

Prevention:

  • Nurse frequently to prevent engorgement
  • Proper positioning and holds
  • Keep breasts free from moisture: Air dry after feedings; change nursing pads often; avoid ointments
  • Nursing bra: Make certain to have the proper fit for your bra. A bra that is too tight can contribute to the development of mastitis

Don't become overwhelmed if you are facing one (or even more) of the breastfeeding challenges listed above. With proper care and a "can do" attitude you can forge ahead through these first few weeks and then obtain a rewarding experience for you and your child. Before becoming discouraged to the point of giving up, surround yourself with excellent reading material, a strong support system, and the phone numbers of lactation consultants (or the local La Leche League) in your area. Enjoy! It's worth every minute!

Melissa Jaramillo is mom to many. She's passionate about building, encouraging, and strengthening families on this adventure known as parenthood!

Copyright © Melissa Jaramillo. Permission to republish granted to Pregnancy.org, LLC.