What are the common Breastfeeding Problems?
[mme_highlight] Breastfeeding is the recommended method of infant feeding. However, it is not always easy as it takes time and practice and some problems can appear along the way: inadequate milk production, mastitis, sore nipples, engorgement and others. [mme_highlight]
Breastfeeding is the recommended method of infant feeding. However, it is not always easy as it takes time and practice and some problems can appear along the way. In the United States it is estimated that 75 percent of women start breastfeeding but only 44 percent are still nursing at six months. Knowing how to manage the different problems related with breastfeeding can prevent an early stop in breastfeeding.
Is my milk production inadequate?
This situation or perception is the most common reason for an early stop of breastfeeding. Previous breast augmentation surgery can lead to insufficient production of milk and there are also some medicines that can interfere in the process too.
Note that infrequent feeding and inadequate latch-on are among the most common causes for the problem of milk production, because it is the suction the baby does that triggers the process which in the end leads to milk production.
What is Engorgement?
Engorgement is a medical term for breasts which are too full of milk, which can cause swelling and pain. Some women in this situation can feel their breasts warm and redden and even experience a low fever. In addition, engorgement flattens the nipples, making it more difficult for babies to reach them. The best way to deal with engorgement is to breastfeed frequently and fully. If this is not enough, you can use a pump or your hand to extract some milk, but do not do this more than about 3 minutes or letting too much milk out, as this can worsen the engorgement.
To help reduce the swelling, put your fingers from both hands on the sides of the nipple and press them against the chest; you can also use ice in a fabric pocket to relieve pain. Another tip is to massage your breast gently prior to a feeding, because this can help stimulate milk flow.
Why are my nipples sore?
Nipples become increasingly more sensitive during pregnancy with a peak about the fourth day and postpartum and generally a return to normal after that. 96% of breastfeeding mothers experience sore, painful nipples during breastfeeding and stop nursing before they intended. This situation is common during the first minute of breastfeeding, but usually relieves after that. If the pain persists it may have been caused by nipple cracks, blisters, or bruises.
The main recommendation is to optimize the position of breastfeeding and latch-on. Lanolin-based nipple ointments and other creams are also recommended by doctors. The study shown below investigated the efficacy of some of these measures for sore nipples; 94 women with sore nipples were divided into 3 groups: group 1 received lanolin ad shells + assessment, education and corrective measures; group 2 received glycerin gel + assessment, education and corrective measures; group 3 received assessment, education and corrective measures (no commercial products).
Based on the results, although no statistic difference was found between groups, one can speculate that assessment, education and corrective measures alone are effective to treat sore nipples.
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Comparison of 3 different treatment plans for sore nipples – pain scores at the final midwife visit (after intervention) are shown:
- Average pain rating at first visit: 3.42.
- Average pain rating at the last visit: 1.69
- Group 1: pain rating at the last visit = 1.48
- Group 2: pain rating at the last visit = 1.29
- Group 1: pain rating at the last visit = 1.68
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What is mastitis?
Mastitis means inflammation in the breast, which in most cases is caused by an infection. It usually occurs in the first 6 weeks after delivery. You may feel ill, with fever, chills and muscle pain and your breasts may be swollen and hard, with redness. Risk factors implied are poor breastfeeding technique and a lowered immune status due to sleep deprivation or stress.
Some studies have suggested the entry door for the infection may be a fissure in the nipple. The most frequent bacterial agents implied are Staphylococcus aureus or coagulase-negative staphylococci. To treat your mastitis you can take a pain-relieving medicine (ex. Ibuprofen), massage your breasts and, if prescribed by a doctor, take antibiotic medicines.
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Associations of breastfeeding practices and other health behaviors with lactation mastitis (logistic regression analysis)
(Study design: prospective cohort study of lactation mastitis, Michigan and Nebraska, 1994–1998; 946 breastfeeding women included in the study, covariates from the same week as mastitis shown)
- Mastitis history (previously): 4 times more risk for lactation mastitis (OR 4.0 – 95% CI 2.64-6.11)
- Nipple cracks or sores: 3.4 times more risk for lactation mastitis (OR 3.4 – 95% CI 2.04-5.51)
- 1 to 5 feeds per day: 60% less risk for lactation mastitis (OR 0.4 – 95% CI 0.19-0.82)
OR – Odds Ratio; CI – Confidence Interval
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What other problems can occur while breastfeeding?
You can notice a color change in your nipples, which may happen because of alterations in the blood vessels of the nipples. A tendered or reddened lump may suggest that a milk duct is blocked; in this case the best measure is to breastfeed often; try to massage gently your breasts.
Summary and Recommendations
- While breastfeeding you can experience problems like: inadequate milk production, mastitis, sore nipples, engorgement, and blocked milk duct.
- Always seek for medical advice in the following situations:
- If you notice a blocked milk duct that persists more than 3 days;
- If you have a swollen and red area of the breast associated with fever;
- If you notice a bloody discharge from your nipples;
- If the pain in the nipples lasts during the whole feed.
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References
- Snowden HM, Renfrew MJ, Woolridge MW. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev 2001; :CD000046.
- Cadwell K, Turner-Maffei C, Blair A et al. Painreduction and treatment of sore nipples in nursing mothers. J Perinat Educ. 2004 Winter;13(1):29-35.
- Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol 2007; 109:479.
- Foxman B, D’Arcy H, Gillespie B et al. Lactationmastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002 Jan 15;155(2):103-14.
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