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Engorgement
& Related Issues
Engourgement is the swelling and tenderness of the breasts, and is caused by an increased flow of blood to the breast and the beginning of milk production. Some women only experience a slight fullness, while others (me!!!) experience extreme swelling and discomfort. Fortunately, engorgement should only last for a day or two. The best ways to relieve the discomfort are…
- longer and frequent nursing sessions (at least every 3 hours…this may mean waking the baby at night)
- gentle massaging of the breast during nursing
- cold compresses after nursing
- if all else fails…Tylenol
Sometimes, engorgement can cause your breasts to become so full, the nipple flats and the baby is unable to latch on. My midwife’s analogy was trying to nurse from a full water balloon. You might have to express just enough milk before nursing to soften up your breast so the baby can latch on more easily.
Difficult latch on is often due to flat or inverted nipples - or engourged breasts, creating what I call the "basket ball effect" - and can be exacerbated when the breasts become engorged, making it even more difficult for your baby to get good suction. Some things you might try to correct flat or inverted nipples include…
- wearing breast shells
- express a few drops of colostum or milk onto the baby’s lips to encourage her to latch on
- avoid supplemental bottles or other artificial nipples until breastfeeding is well established
- pinch you nipple between thumb and forefinger to get it to stand out more
- do not try to nurse if your baby is upset…try and calm her down first
- nurse as soon as possible following delivery!
Leaking or spraying milk is fairly common during the first weeks and is an indication of let down, which is good. This is where a hefty supply of breast pads come in! I can’t tell you how many times I have looked down in the middle of a grocery shopping excursion or a trip to the bank to find two round wet spot on my boob. Natural….yes…but humiliating all the same. You can keep yourself comfortable by changing your breast pads often to prevent irritation and if the leakage is worse at night, using extra pads. Do not pump to alleviate the leakage because it will stimulate extra milk production and you’ll end up leaking more. You don’t want to apply pressure to your breasts to prevent leaking either. This might decrease milk production and possibly cause clogged ducts.
Breast Pain
Clogged ducts are usually characterized by a hard, uncomfortable mass in your breast. A clogged duct occurs when milk flow is somehow inhibited, causing a back up of milk in a duct and can be caused by a bra that is too tight, a missed feeding or ending a feeding before your baby has finished. The general
comfort message should relieve some of your discomfort, but you should also try applying moist heat to the affected area before nursing, drink lots of fluids and apply gentle downward pressure on the affected area during nursing. Contact your doctor if the lump does not decrease in size in a week or so, or is you have the chills or a fever…this could be an indication of a breast infection, or mastitis.
Mastitis is an infection in the breast that causes achiness, chills, fever and sometimes even vomiting. Often times, a breast infection is the result of a clogged duct or irritated nipples, so treating these conditions right away may reduce your risk. If you suspect a breast infection, get plenty of rest, drink lots of fluid, go braless and nurse often. If you are not feeling better after a day or so, call your doctor. You may need antibiotics.
Sore Nipples
Nipple soreness is common for the first few days and can be alleviated by…
- nursing on the least sore side first
- releasing the baby’s suction hold carefully
- changing your nursing pads after each session
- letting you nipples air-dry before closing the flaps on your bra
- nursing for shorter, more frequent periods of time.
After the first week or so, nursing should become comfortable. If the soreness persists, chances are there is a problem (see the examples below) that requires treatment beyond these general comfort measures.
Traumatized nipples are a step beyond soreness - cracked, blistered, possibly even bleeding and usually caused by improper latch-on, or the baby sucking on the nipple only instead of the entire areola. Some remedies for traumatized nipples are…
- positioning your baby carefully (her whole body should be facing your breast rather than having to turn her head to meet your breast)
- express enough milk so you breast is soft enough for her to latch on to
- remove and reposition that baby is she is not latching on properly
- make sure her lips aren’t tucked in
- apply Lansinoh (love that stuff…comes in a purple box) or other 100% lanolin cream to you nipples after nursing sessions
Irritated nipples are red and swollen, they may be cracked and they always burn like heck! Thrush, dermatitis and ecxema can be possible causes. You should definitely check with your doctor as an anti-inflammatory or antibiotic may be needed. Be sure to apply you meds as directed, after your nursing session when your nipples have completely dried. Continue using your meds for the prescribed length of time…no cheating! In addition to the general comfort measures for sore nipples, you might try cold most compresses after nursing.
Thrush is a yeast infection that has spread from your baby’s mouth to your nipples. Thrush is usually the culprit if nipple become suddenly red and irritated after a couple weeks of comfortable nursing. If you think you may have thrush, look for white patches on the inside of your baby’s cheeks, lips and on her tongue. Mom and baby both need to be treated if thrush is the case, usually with Nystatin for the baby and abn anti-fungal cream for mom. Genetian Violet is another treatment option (for both mom and baby) and can be purchased over the counter in most drug stores. Be sure to boil bottle nipple and pacifiers, and change your nursing pads often to prevent reinfection.
Exhaustion & Depression
Exhaustion, or lack of adiquate rest, can also make establishing a good nursing relationship very difficult. Try to get as much help daily chores as possible so you can focus solely on your baby and yourself. Not only is rest absolutely necessary for your ability to function and your peace of mind, you need sufficient rest to produce enough milk.
Depression is fairly common after a birth experience and you might consider getting involved in a postpartum support group or seeking out the services of a doula, if you don’t already have one. Motherhood in a tremendous adjustment and you need all the support you can get!
| Common Problems for Mom | Common Problems for Baby |
| Choosing a Care Provider | Choosing a Birth Environment | Building a Birth Plan |
| Your Labor Support System | Pain Management | VBAC | Common Interventions & Procedures |
| Breastfeeding | Birth Stories | Recommended Reading | Doula Services (Denver)
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