Overcoming Breastfeeding Difficulties

Learning to breastfeed may be easy for some women, while more difficult for others.

Most mothers worry at some point that they do not have enough milk. A delay in the time when milk “comes in” sometimes occurs in mothers dealing with certain health conditions.Infrequent or insufficient breastfeeding (milk removal) is the most common reason for a delay in the time when the milk “comes in,” for insufficient milk production, or for any drop in production (1a).

Some of the conditions, or treatments, that experts think may contribute to a delay include the following: (1b).

  • severe stress
  • cesarean (surgical) delivery
  • postpartum hemorrhage
  • maternal obesity
  • infection or illness with fever
  • diabetes – juvenile, adult-onset and gestational
  • thyroid conditions
  • strict or prolonged bed rest during pregnancy

Mothers with previous breast surgery that cut some of the nerves, milk-making tissue, or milk ducts, may have difficulty producing enough milk to fully feed a baby.

Other factors can also lead to insufficient milk production. Maternal smoking has been shown to result in less milk. Some medications and herbal preparations have a negative effect on the amount of milk produced. Hormonal forms of birth control, especially any containing estrogen, have been found to have a big impact on milk production. However, some mothers report a drop in milk production after receiving/taking a progestin-only contraceptive during the first four to eight weeks after delivery (postpartum). Milk production may also decrease if you become pregnant again (1c).

A plugged duct feels like a tender lump in the breast. Some mothers seem to be more prone to developing them, but usually they occur when a mother goes too long without emptying her breasts, or if insufficient milk is removed during feedings. Review your baby’s feeding routine and see if the time between one or more feedings has recently changed for any reason (2a).

If you develop a plugged duct, be sure to breastfeed/remove milk often and alternate different feeding positions. It often helps to apply warm compresses to the area or soak the breast in warm water. Massage above and then over the affected area when breastfeeding and after application of warm compresses (2b).

Sore nipples are probably the most common difficulty mothers have when breastfeeding. Sore nipples may be caused by different factors. Breastfeeding should not hurt, and the skin on your nipple should not break down any more than the skin anywhere on your body should break down. However, mild tenderness, similar to the kind of tenderness some women experience with their menstrual cycles, is fairly common for the first week or two of breastfeeding. Then it should go away (2c).

When nipples become red and burn, or feel extremely sore after weeks or months of pain-free breastfeeding, it may be due to a yeast infection such as thrush. Yeast may appear as white patches in the baby’s mouth or it may show up as a bright red diaper rash. Specific medications are needed to treat yeast infections. Contact your baby’s physician for more information and treatment (2d).

Citations:

1: http://en.wikipedia.org/wiki/Breastfeeding_difficulties

2: http://medicalcenter.osu.edu/patientcare/healthcare_services/pregnancy_childbirth/breastfeeding/breastfeeding_difficulties_mother/Pages/index.aspx

Tips for Overcoming Common Breastfeeding Problems

Nursing your child may not always go as smoothly as you hope. There are a number of problems that could come up. In the following article, there will be several issues listed with corresponding preventative measures and treatments.

It is common to have some pain or discomfort when your baby first latches on and begins feeding in the first few days or weeks. Some breastfeeding mothers describe nipple soreness as a pinching, itching, or burning sensation. Over time, you should feel little discomfort or pain when breastfeeding.

Nipple soreness may be caused by many things, including poor feeding techniques, wrong positioning, and not taking care of your nipples, too dry or moist, or teething babies.

Breast engorgement is caused by congestion of the blood vessels in the breast. The breasts are swollen, hard, and painful. The nipples may not stick out enough to allow the baby to latch on correctly. The let-down reflex is a normal part of breastfeeding. Milk made in the milk glands is released into the milk ducts. Pain, stress, and anxiety can interfere with the reflex. As a result, milk will build up. Treatment includes learning to relax and finding a comfortable position, reducing distractions during nursing, performing a gentle massage, and applying heat to the breast. Nursing often (8 times or more in 24 hours) and for at least 15 minutes at each feeding can also prevent engorgement (1a).

A milk duct can become plugged if the baby does not feed well, if the mother skips feedings (common when the child is weaning), or if she wears a constricting bra. Symptoms of a plugged milk duct include tenderness, heat and redness in one area of the breast, or a lump that can be felt close to the skin.Sometimes, a tiny white dot can be seen at the opening of the duct on the nipple. Massaging the area and putting gentle pressure on it can help to remove the plug (1b).

A breast infection (mastitis) causes aching muscles, fever, and a red, hot, tender area on one breast. Consult your health care provider if you develop these symptoms.Breast infections often occur in mothers who are stressed and exhausted, have cracked nipples, plugged milk ducts, or breast engorgement, have been skipping feedings or wear a tight bra. Treatment often includes antibiotics for the infection, moist, warm compresses over the infected area, rest, and wearing a comfortable bra between feedings (1c).

Thrush is a common yeast infection that can be passed between the mother and the baby during breastfeeding. The baby’s mouth and the mother’s nipples are perfect places for this yeast to grow. A yeast infection can be difficult to cure, but fortunately this is uncommon. Yeast infections often occur during or after antibiotic treatments (1d).

Citations:

1:http://pediatrics.about.com/od/breastfeedingproblems/Breastfeeding_Problems.htm

My Baby is Gassy

No matter what you do, your breastfed baby will be gassy. It’s a part of digestion, it can’t be helped. However, if your baby has excessive gas or is very uncomfortable with it, you might want to look at your diet or at the way you’re nursing him.

Your first thought might be that it was the broccoli, cabbage, garlic, spicy foods, and potato chips that you ate this week, but it’s not. It doesn’t affect your milk. The foods that are most likely guilty of giving your baby gas are dairy products. Other foods too, such as wheat, corn, fish, eggs, or peanuts are capable of causing problems (1a).

If you become suspicious of any food, follow your hunch and remove it from your diet for week. See if it has any affects. If your baby’s fine when you abstain from the food, then try the food again and see how he responds. It might take some sleuthing, but by eliminating one suspect food at a time you might be able to find out what he doesn’t like. You can also talk to a lactation consultant, who can help you evaluate what’s going on (1b).

Foods high in acid content can cause infant digestive discomfort, as well. Citrus-based foods such as tomatoes, strawberries, oranges and grapefruit are highly acidic, and can be monitored in moderation to see if breastfeeding after consuming these foods has any effect on baby (2a).

If you have an abundance of milk  your baby may be suffering from what’s called “lactose overload.” This happens if your baby gets a lot of foremilk, which has less fat to slow down the digestive process. As a result, the enzyme in his system that digests lactose isn’t released quickly enough to do its job.To deal with this, nurse on only one side at each feeding, or nurse twice on one side before going to the other side. However, it’s important that you talk to a lactation consultant to make sure this is the problem before you try nursing on only one side each time. Otherwise, you could inadvertently cause your milk supply to diminish (1c).

Citations:

1: http://www.babycenter.com/404_will-my-breastfed-baby-get-gas-if-i-eat-certain-foods_9233.bc

2: http://www.livestrong.com/article/34344-foods-avoid-breastfeeding-gassy-newborns/

Tips For Reflux and Upset Stomachs

Even when I am not breastfeeding I try to correct for minor illness and discomfort like upset stomachs through diet. The best approach is to keep drinking water and eat simple foods. The BRAT diet is a simple food diet that is my first resort when my stomach is upset. I have found that using the BRAT diet eliminates outside variables and often the diarrhea or stomachache relieves itself in a few days.

BRAT Diet -

  • B – Bananas
  • R – Rice
  • A – Applesauce
  • T – Toast

Over-the-Counter Remedies – It is important to look for an over the counter drug that is safe to use while breastfeeding.  There are a lot of over-the-counter medications that are useful for treating upset stomach and symptoms of reflux. Here are two over-the-counter upset stomach and reflex remedies safe for breastfeeding that are recommended by my doctor:

Ranitidine - Ranitidine is used to treat ulcers; gastroesophageal reflux disease (GERD), prevent and treat symptoms of heartburn associated with acid indigestion and sour stomach.

Omeprazole – Omeprazole is used in the treatment of dyspepsia, peptic ulcer disease (PUD), gastroesophageal reflux disease (GORD/GERD), laryngopharyngeal reflux (LPR) and Zollinger–Ellison syndrome.

Find Out More About Medicine and Breastfeeding:
Finding Safe Medications While Breastfeeding
Herbal Remedies and Breastfeeding
What is a Galactagogue?
Meditations to Avoid While Breastfeeding

Tips on Relieving Constipation

Getting constipated after delivery is quite common, even if you never felt constipated during your pregnancy.

Are you dehydrated? A breastfeeding mom need at least twelve glasses of water a day. A daily glass of fruit juice, especially prune juice, can be helpful. Some women find that drinking any warm liquid first thing in the morning helps get things moving.Consume fresh fruits and vegetables,instead of juices. Because the fibers in the fresh vegetables and fruits greatly aid bowel movement Make an effort to eat high-fiber foods such as whole-grain cereals, whole-grain breads, and fresh fruits and vegetables every day (1a).

Even if you never had a problem with constipation during pregnancy, you may now. Give yourself a few days after delivery before you start worrying about it, though.When you stay at hospital, they probably provide you all the stool softeners and Milk of Magnesia to ease constipation (1b).

Never ignore the urge to pass stool, even though it might be uncomfortable the first few times. The longer you wait, the harder your stool will get, which will only make your pain worse in the end. Try taking another type of laxative until things start to settle down a little for you and of course, increase your fluid intake. Coloxyl with senna are available over the counter. They contain a laxative (gentle) and softener to make things easier. The problem with some type of laxatives is that unless your fluid intake is adequate, it will have the reverse effect and bind you up more (2a).

If you continue to have problems moving your bowels after that, here’s what may be going on. The systemic narcotics that you were given to ease discomfort during labor, or that you’re taking now for postpartum pain, may be slowing down your digestive system. Also, having a sore perineum because of hemorrhoids, an episiotomy, or a tear may lead to constipation if fear of more pain, or needless worry about putting strain on your stitches, causes you to hold in your feces (3a).

Your constipation is more likely to go away within a few days if you take steps to address the problem.

Citations:

1: http://www.babycenter.com/0_postpartum-constipation_11707.bc

2: http://www.articlesbase.com/womens-health-articles/constipation-while-breastfeeding-how-to-avoid-this-common-postpartum-constipation-trouble-while-breastfeeding-your-baby-amp-ease-bowel-movement-1874231.html

3: http://www.essentialbaby.com.au/forums/lofiversion/index.php/t545957.html

Common Breastfeeding Side Effects

Breastfeeding your baby may not always go smoothly. There are several side effects that a mother could experience.

At times, nipple could go sore. Until you get used to breastfeeding, your baby’s sucking can make them raw and tender. If your nipples become sore, you could try nursing on the least sore side first, limit the nursing time on the sore nipple to 10 minutes but at the same time increasing the frequency of feeding, using lanolin cream, or wear breasts shells in between feedings (1a).

Another side effect is engorgement. This happens when your breast milk production increases, causing your breasts to become firmer, bigger, and sometimes tender. This can lasts for two to three days. If your baby doesn’t remove enough milk during feeding, it can cause engorgement which makes your breasts become hard, painful and hot. This can be prevented by frequent feeding, expressing your milk into a bottle for later use, apply ice/cold compresses to ease swelling, or gentle massaging before and after feeding (1b).

Thrush can occur as well. This is a yeast infection that can happen if the mother or baby have been treated with antibiotics or at the time of birth if the mother has a vaginal yeast infection. Thrush can cause nipples to be itchy, sore, and tender (1c).

Sometimes a plugged duct can occur. This can happen if your start to delay or skip feedings. Even a bra can cause thrush from putting pressure on the duct. Symptoms come as a firm, tender, warm lump. There is no redness on the breasts and no fever associated with a plugged duct. Alleviation could be reached by warm compresses to the breasts before and after feeding, feeding with the plugged breasts more frequently, or nursing the baby in a position that points his or her chin toward the plugged area of the breast 1d).

The last common side effect that I will talk about today is Mastitis, an inflammation and/or infection in the breast tissue. Symptoms include chills and a fever above 100 degrees Fahrenheit, redness or red streaking on the breasts, and a tender area and swelling in the breasts. Harsher symptoms can include a headache, body aches and nausea, or flu-like symptoms. Antibiotics, pain killers, plenty of fluids, and good foods should help your immune system make quick work of the infection (1e).

 

Citation:

1:http://www.stronghealth.com/services/womenshealth/maternity/breastfeedingproblems.cfm

Itchy Breasts: The Itch you Can’t Scratch

While a mother is breastfeeding, there are a number of side-effects that could come with it. There are times when mothers suffer from itchiness of the breast. Not on the nipple or areole, but the breasts itself. It’s been described as a ticklish-itchy feeling.

The exact cause is hard to pinpoint. Doctors have come up with several reasons. Some lactation consultants say it could be from low estrogen from breastfeeding and it would go away after a mother is more weened (1a).

Another probable cause is thrush. Thrush is a common yeast infection that can occur when the mother or baby have been treated with antibiotics or can be contacted at the time of birth if the mother has vaginal yeast infection. Thrush is commonly guilty of causing sore nipples. The nipples or breasts may also appear reddened or bright pink.

Some treatments a mother could follow to remove thrush would be: (1b)

1) Cut out all sugars, and simple white foods from your diet. Yeast thrives on sugar and simple carbohydrates.

2) Drink A LOT of water. More than usual, to help clear toxins.

3) Start taking a probiotic. This gives your body good bacteria’s that will fight the overgrowth of yeast. Take 2 capsules 30 minutes before breakfast and take 2 more capsules on an empty stomach at bedtime, so the probiotic can work in your intestines all night long. It is best to drink filtered water while you are doing all this since the chlorine in tap water will reduce the number of beneficial bacteria in the probiotic.

4) Ask about All Purpose Nipple Ointment. It can be very effective.

Thrush can be treated and breastfeeding can and should continue during treatment. Both the mother and baby need to treated. Symptoms in the baby could appear as having a diaper rash or white patches on the inside of the mouth, gums or tongue (2a).

 

Citations:

1: http://www.circleofmoms.com/breastfeeding-moms/help-for-itchy-breasts-412724

2: http://www.stronghealth.com/services/womenshealth/maternity/breastfeedingproblems.cfm

Sore Nipples

Sore nipples are a common and frustrating difficulty of breastfeeding. The most likely cause of sore nipples is mechanical- how the baby latches on or how the baby sucks. Make certain that when the baby is going to latch on, she opens her mouth wide first. If she fails to do this, she might latch by essentially chewing her way onto your nipple, which will only make things worse. Get as much of the areola (the darker area surrounding the nipple) in her mouth as you can as well, as this facilitates good latch. Please see the article on latching the baby on. Do not hesitate to take the baby off of the breast if you think she has a bad latch!

A disorganized suck pattern can also contribute to making your nipples sore. This is a more complicated problem to solve and may be best addressed by your local lactation consultant.

Ways to treat the nipples, once you have the mechanical problems solved, involve comfort measures. Pure lanolin ointment applied to the nipple after each feeding can help to moisturize and reduce cracking of the nipple. Keeping your nipples dry by using breast pads during the day and letting them air dry in the evening is also helpful. Be gentle! Nipple tissue is delicate and sensitive. There are also breast gel pads on the market. These thick cooling pads of gel are good for about 5 days and you can use them whenever the baby is not nursing. A good trick is to have someone put them in the refrigerator for you while you nurse and then bring them back to you cold.

Fungal infections of the breast will also cause sore nipples. If your baby has thrush, or white pots in her mouth, this might be a cause. Go see your healthcare provider right away if you think this might be the cause of you sore nipples, most women with breast yeast infections will need medication for treatment.

Sore nipples can be frustrating, but try not to let them ruin your breastfeeding experience! If you feel like your nipple pain is not resolving with these changes, or it is getting worse, go see your healthcare provider or lactation consultant.

 

Early Engorgement

Engorgement is technically breast swelling. In reality, it is when your breasts feel like full, hard, hot, painful watermelons.

Engorgement comes in two varieties, early onset and late onset. Late onset engorgement will be discussed in another article. Early onset engorgement happens when the colostrum shifts to mature milk, usually a few days after your baby is born.  It is sometimes accompanied by a low grade fever and general achiness. Many women describe feeling like they have a mild flu just before their milk comes in.

What to do?! Feed the baby. The solution to engorgement is to get the milk out. It may be harder to latch the baby on while your breasts are engorged. Hand expressing a little milk before the feeding softens the breast a little, and may make latch on easier.  Ice packs to the breasts may also give some relief. Ibuprofen will reduce inflammation and discomfort and is considered safe with breastfeeding. Another trick is to stand in a warm shower with the water gently running on your breasts and let some of the milk drain out.

There are just a couple of things to avoid in early engorgement. No heating pads, as they can worsen the swelling. And if you can avoid using a breast pump for more than 10 minutes at a stretch, that will also help. Pumps are not nearly as effective at removing the milk in early engorgement, and may make things worse.

Early engorgement is just one of the things that happen when you breastfeed your baby. It can be managed fairly easily, without much fuss. Uncomfortable though it may be, try to look at it as the fabulous beginning of your milk supply!

Consequence of Sore Nipple

Early mild nipple discomfort is often present by the second day of nursing and improves once your milk starts to come in abundantly.  The discomfort is usually greatest at the beginning of feedings and should seldom last throughout nursing.  Sore nipple can be more than a nuisance as this complaint is the major cause of early breastfeeding termination.

Nipple pain can interfere with your relationship with you baby and also lead to insufficient milk production and then in extreme cases impair infant growth. The most common cause of severe or persistent nipple soreness  is improper positioning of your baby’s mouth on your breast.  If your child does not grasp the entire nipple and a good portion of the surrounding areola you will cause yourself pain and your baby will not effectively breastfeed.  If your child repeatedly fails to consume as much as they need your milk production may diminish and as a long term result your child will not have sufficient nourishment to grow.

So when you are feeling some pain in your nipples check how your child is positioned and if needed break latch and help them reconnect.