Post Partum Tips: Breast-Feeding Problems and Signs of Trouble

by Esther Rastegari, RN/BSN, EdM

Breast-feeding is definitely a mind-body process. While the mechanics of producing milk are physical, feeding your infant from your body, or having difficulty doing so, is emotional.

Facilitating let-down

Difficulty with "let-down," that is, when the milk begins to flow, may be a result of your not drinking enough fluid. A good guide is to have a glass of water or juice every time you nurse. This will help to replenish the fluid that goes into the milk, as well as provide you with the fluid you need. Another problem may be that you are very tired -- not an easy one to resolve -- or feeling very stressed. Resting when your baby sleeps can help, as well as making sure you are in a comfortable position when nursing: support your back with pillows and put your feet on a low stool.

Try putting on some soothing music or having a cup of decaffeinated tea. The more you are able to relax, the easier let-down will occur. If you are experiencing pain that is preventing you from relaxing during nursing, see the section below on pain management.

Easing sore nipples

Cracked or bleeding nipples are extremely painful and can disrupt the nursing process. [Poor latch and misposition are common causes.] They occur most commonly when the baby nurses for extended periods of time -- using the breast for comfort in addition to feeding. Moisture, first from the baby's mouth and then in a non-breathing brassiere, causes sore nipples to crack and then to bleed.

If your nipples are becoming sore, try to limit breast-feeding to ten to fifteen minutes per side. Let them air-dry after a feeding. Moms often feel guilty if they limit the nursing time, but if they don't, soreness can lead to cracking. Think of it this way: if the breast is very painful and bleeding, you may decide to stop nursing. By limiting the time until the soreness disappears, you are able to continue.

While the nipples are healing, talk to your health care provider about using a cream designed for breast-feeding moms. These creams are sold over-the-counter. After a feeding, apply the cream, and then rinse it off before the next feeding. Once breast-feeding is well-established, the nipples "toughen up," and cracking is less common.

Dehydration and jaundice

Your newborn requires about an ounce an hour of pumped milk or formula, or breast-feeding about every two hours. The output goal is six to eight wet diapers of clear/pale yellow urine in twenty-four hours. As the number of diapers drops below five, the urine tends to darken and may give the diaper a brownish hue. Orange spots indicating uric acid crystals may be seen in the diaper.

Signs that your baby needs more fluid intake

As the number of diapers drops below five, the urine tends to darken and may give the diaper a brownish hue. Orange spots indicating uric acid crystals may be seen in the diaper. As your baby becomes dehydrated, her mouth may appear quite dry, and the ridges of the fontanel (soft spot) on top of the head may be clearly felt. The baby becomes less active and more difficult to wake up to feed. This in turn results in less fluid intake, continuing the cycle of dehydration. Due to their small size, changes occur more rapidly in newborns than in young children or adults. Consequently, once set in motion, dehydration can become serious for a newborn and lead to a hospital admission. The solution is more fluid intake. If you feel your baby is getting dehydrated, increase his fluid intake, and call your pediatrician right away.

Jaundice

Jaundice is the yellowing of the skin and sclera (the white part of the eye). It is the result of an increased concentration of bilirubin in the body, referred to as hyperbilirubinemia. Bilirubin is something we all have; it is the by-product of the breakdown of red blood cells. Newborns have an excess of red blood cells circulating that they need to break down. This breakdown process takes place in the liver, and some infants may have livers that are a little slow in handling this job.

Newborns with jaundice are at increased risk for dehydration, since the rising bilirubin level causes the baby to be increasingly sleepy and, therefore, more difficult to feed. One form of jaundice sets in within the first twenty-four hours after birth; a more common form occurs about forty-eight hours after birth -- when most babies are on their way home. An initial sign of hyperbilirubinemia is yellowing of the skin, which begins in the head and, within a few days, moves towards the hands and feet. It is easily seen early on by comparing the skin color of the hand next to the skin color of the face.

If you suspect your baby has jaundice, he or she should be seen by the pediatrician who will most likely order a blood test to determine his or her bilirubin level. Hyperbilirubinemia is most commonly treated by ensuring the baby is well-hydrated, and by therapy with a special ultra-violet light, referred to as phototherapy. It may be treated in the hospital, or with a home phototherapy unit. Untreated hyperbilirubinemia can, very rarely, progress into a condition called kernicterus, which affects the central nervous system. If untreated, the bilirubin level may continue to rise, and although rare, it can progress to a harmful condition.

A quick review of dehydration warning signs:

  • Diminishing number of diapers
  • Dark urine, or brown stains (not from stool) in the diaper
  • Orange spots, uric acid crystals, in the diaper. Soft spot sunken in, not flat
  • Dry mouth
  • Sleepy, less active baby

What to do:

  • Call the pediatrician
  • Increase baby's fluid intake
  • Consider a visit with a lactation consultant, if breastfeeding

Esther Csapo Rastegari is a registered nurse with a Master's Degree in Education from Harvard University, as well as Bachelor degrees in Science, Psychology and French. Her studies have taken her to France, Hungary and Switzerland. She has worked as a nurse in Obstetrics & Gynecology as well as in Pediatrics. Her current work involves home phototherapy for newborns with jaundice, where she particularly enjoys educating new parents in newborn care, breastfeeding, and postpartum issues.

As a freelance writer, Ms. Rastegari.s work has been published in magazines, newspapers and on the World Wide Web. She is also trained in Therapeutic Touch and has been practicing meditation since 1973.

Copyright © Ester Rastegari. Permission to republish granted to Pregnancy.org, LLC.