Breastfeeding Problems?

It is common during the early stages of breastfeeding to experience temporary discomfort that should resolve within a few minutes of feeding. In these early stages, breastfeeding may leave your nipples chafed and tender due to initial breastfeeding adjustments or from washing nipples with soap or alcohol-based products. Ask for breastfeeding support if these symptoms persist.

Basic remedies

• To give your nipples a break, try skin-to-skin contact between feedings instead of feeding to soothe.
• Get the best attachment. Wait until your baby is calm and begins to look around. This will be a perfect time to help guide them to your breast and get best attachment. If baby's nose is pressed into your breast, lower their body slightly to help their nose come out and chin come into your breast for a better latch. Your baby’s head should not be overly tilted in or back.
• Experiment with different feeding positions such as the “cross-cradle” and “rugby” holds. Both provide a little more head and neck support, which may encourage a better latch.
• Feed baby from the least sore breast first to minimise an aggressive feeding on a sensitive nipple.
• Learn how to get your baby off your breast safely - never pull them off before breaking the suction of the latch. Break your baby’s suction by placing your finger between your breast and their gums before taking them off your breast.
• Express a few drops of breastmilk and rub on your nipples and areola (area around the nipple) after a feed to help protect and soothe tender nipples. Allow your nipples to air dry after feeding as well.
• If you’re using a breast pump, see if it came with different attachments (flange) that will fit your breast better. A lactation consultant may also be able to assess and find a properly fitted flange for you.
• Wear cotton clothing next to your breasts, use a breastfeeding bra or a loose-fitting top.
• If your nipples are too sore to have your bra or clothing touch them, use breast shells with large nipple openings and holes for air circulation over your nipple and under your bra.
• For cracked nipples, apply some expressed breastmilk on your nipples and allow them to air dry. 
• Gently wash breasts and nipples with water, and don't use soap or rubbing alcohol, which can dry the skin and cause cracking.
• Try a gentle moisturising balm (for example a lanolin-based barrier cream) to soothe chafed and tender breasts.
• Place a soothing gel patch inside your bra to prevent friction. The patches cool on contact.
   

Hard and swollen breasts (otherwise known as breast engorgement) is a normal experience when your milk first comes in. Engorgement after this time can be caused by infrequent or delayed feedings, over-production of milk, poor or inefficient milk removal, supplemental feedings, rapid or sudden weaning, or breast oedema (swelling).

Basic remedies

• Relieve the pressure in your breast as soon as possible by either breastfeeding, gently hand expressing your milk, or using a breast pump. If your breasts are too full for baby to latch on, express a little milk by hand or pump first.
• Breastfeed or pump every two hours to help build a good milk supply while relieving the fullness. Remember, your newborn baby should be breastfed around 8 to 12 times every 24 hours!
• Take a warm shower or place a clean warm, wet cloth on breasts.
• If your baby doesn’t breastfeed long enough to soften them, hand-express or use a breast pump to express more milk until both breasts feel comfortable.
• Use cold packs between feedings.
• If your hands and/or ankles are swollen due to retaining extra fluids, your breasts might also be swollen from retained fluids. Try gently massaging the excess fluid away from the nipple and areola (area around the nipple). Place your fingers and thumb at the neck of your nipple and press into your breast for about a minute. The nipple should become more supple to allow breastfeeding or pumping to be more effective.

You may experience some tingling as your breasts adjust to breastfeeding.

Basic remedies

• If tingling only lasts a few seconds and occurs when your baby starts nursing, don’t worry, it's a normal sign of "let-down”, the release of milk from your breast.
• If the tingling is painful and doesn’t subside, consult your healthcare professional for advice regarding pain relief.

Feeling pain during the first few days? Full breasts during the early days can be caused by the transition from first milk to the surge of mature milk—about 2 to 5 days after birth.  Call your healthcare professional if your breasts are painful, hot, have an area of spreading redness or you feel feverish (your temperature is over 38° C). You may have a breast infection or mastitis and require medication.

Basic remedies

• Gently massage the upper part of your breasts.
• Apply a clean warm cloth before feeding, and a cool pack between feedings.
• Take warm showers.
• Breastfeed frequently - at least 8 to 12 times over a 24-hour period.
• Make sure your baby is positioned correctly during each feeding. Your baby should be lying with their whole body facing you.
• Check that your nipple, and as much of the area around the nipple is covered completely with your baby’s mouth, their tongue on the underside of your areola. When removing your baby from your breast, remember to break the suction by gently sliding your finger in between your nipple and their gums.

Is your baby opening their mouth for your breast but not latching on correctly to feed? Common causes could include using bottles or dummies (which have slightly different teats and milk flows), flat or inverted nipples or even an over-tired baby.

Basic remedies

• Where possible, avoid dummies and bottle-feeding for the first three to four weeks to firmly establish breastfeeding.
• Practice skin-to-skin contact as often as possible between feedings to help soothe your baby. Try to help them get a nice deep sleep so they are more rested and interested in the next feeding.
• Recognise your baby’s hunger cues so you can offer your breast as soon as your baby shows they’re hungry. 
• Express a small amount of milk from your breast by hand or with a breast pump before feeding to soften the areola and stimulate milk flow, so your baby will receive milk flow right away.
• Try different feeding positions.
• Consider a nipple shield for flat or inverted nipples if the nipple does not stay stimulated even after the use of a breast pump. Ask your lactation consultant about the proper use of a nipple shield. Improper use can result in additional concerns.

Forceful spraying of your milk may result in your baby coughing, gagging and even pulling off the breast. Individual hormone response or overactive milk supply may be the cause of this.

Basic remedies

• Increase your baby’s control of the milk flow by adjusting their feeding positioning to an upright football hold, side-lying hold or a laid-back feeding position.
• Express some milk to catch the initial forceful flow before putting your baby to your breast may be helpful.
• Use of a breast shield to allow for a slight barrier from the milk spray during the initial forceful “let-down” is another option. Proper use of the breast shield is very important and should be discussed with a lactation consultant as to not cause additional concerns due to improper use.

A tender-to-the-touch lump anywhere on your breast or in your underarm area can be signs of a plugged milk duct. Several things may cause a milk duct to get plugged including inadequate feeding (emptying), scar tissue in the breast, underwire bras, tight-fitting bras, or tight-fitting sleeveless tops, feeding in the same position for all feedings or a plugged pore.

Basic remedies

• Apply dry or moist heat to the area by taking a warm shower or applying a warm wet cloth.
• Breastfeed or hand-express some milk while your breast is still warm.
• Offer the sore breast first and encourage your baby to feed longer on that side.
• Apply gentle massage or pressure to the area during and between feedings.
• Alternate feeding positions.
• Avoid wearing a tight-fitting bra or one with underwire that may hold back milk flow.
• If the lump persists and becomes red and the redness spreads, you may develop a breast infection and fever, which will require immediate attention from your doctor.

Milk “let-down” (release) from your breasts that is delayed and taking longer than 10 minutes, may be due to feeling stressed or anxious about feedings or sitting in an uncomfortable feeding position.

Basic remedies

• Stay relaxed by singing or humming a song, reading a book, or calmly talking to your baby during feedings.
• Gently massage your breast with your hand before putting your baby to your breast.
• Breastfeed your baby in a calm, stress-free environment.
• Adjust to a more comfortable feeding position.
   

Women may find that their breasts leak milk between feeds. It may be because it’s getting close to feeding time but can also occur as a hormonal response to hearing a crying baby. Which is perfectly normal!

Basic remedies

• Use an absorbent breastfeeding pad or clean folded handkerchief inside your bra to catch the drip. Don’t forget to change it often. A clean pad prevents growth of bacteria, which thrive where it’s warm and moist!
• Place some direct pressure over the nipple of your breast to minimise the response.
• If it’s close to a feed time and your baby is not ready to feed yet, you can hand-express a small amount to relieve the pressure.

There are several reasons why milk supply may reduce that has nothing to do with your body’s ability to produce enough breast milk. Some common causes include:

• Formula supplementation.
• Return to work.
• Medications with decreasing milk production as a side effect.
• Significant increased, sudden stress.
• You may be a little dehydrated.

Basic remedies

• Add an extra feeding or pumping session to your daily routine.
• Practice skin-to-skin contact between feedings.
• Practice breast massage before and during feedings.
• Try to relax with your baby and get some rest.
• Take it easy and drink more fluids.
• If you are concerned that your baby is not getting enough breastmilk talk to your doctor for advice 

If your breasts are very full and not “emptied” after full feedings, milk may spray after your baby comes off your breast satisfied. Your baby may also seem uncomfortable after just a few minutes of feeding and come off your breast frequently. The most common reasons for over-supply are hormones, over-pumping, and your initial supply adjusting to your baby’s feeding needs during the first 4 to 6 weeks after birth.

Basic remedies

• Increase your baby’s control of the milk flow by adjusting the feeding position to an upright football hold, side-lying hold or a laid-back feeding position.
• Feed from one breast per feeding session and pump the other breast only to provide comfort if it becomes uncomfortable between feedings. This may be less than a minute of pumping. Remember at the next feed to start with the alternate breast that is full.