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).