Common breastfeeding problems include:
The most common cause for sore nipples is poor attachment –Breast tenderness in the first few days of breastfeeding is normal, but it’s not normal to feel actual pain. If you are in pain, try a new breastfeeding position or seek help from a maternal and child health nurse or lactation consultant. Here are some useful points to be aware of:
- The pain of a damaged nipple will usually subside as your milk starts flowing, so try to trigger a letdown manually before your baby attaches to the breast.
- If your baby has a tongue tie, this could be affecting their ability to attach properly. Your health care professional can examine your baby’s mouth to see if this is the problem.
- Try to delay the use of bottles or dummies. Early use of bottles and dummies (pacifiers), especially before the first breastfeed, can interfere with the natural processes of breastfeeding as their suckling technique is different on these.
- Nipple shields may be of use to some breastfeeding mums and it’s best to get professional advice on how and when to use these
- Express a few drops of your own milk after each feed – it’s moisturising quality (due to high fat content), and antibacterial properties make it a great ‘nipple cream’.
- Avoid using soaps on your breasts when showering as this may be drying.
- Make sure you replace wet breast pads regularly to avoid infections developing in cracked nipples.
If your pain doesn’t go away seek medical help from someone who has experience with breastfeeding and breastfeeding problems.
Blocked milk ducts and mastitis
If you develop a sore lump in your breast yet otherwise feel well, you most likely have a blocked milk duct. It is important to do the following to avoid mastitis (an infection in the milk duct):
- Your baby is the best at draining the affected breast so continue to feed them often and always offer the affected breast first. As you feed, very gently massage the lump towards the nipple, or simply place a little pressure against the lump.
- Before your next feed, try a hot shower and massage the breast under water to help break up the lump or use a warm (not hot) heat pack, over the affected part of your breast for a few minutes before a feed.
- Change breastfeeding positions to ensure best drainage – your baby’s chin should ideally be on the side of the breast that is affected.
- If your baby still doesn’t clear the blockage by feeding, try expressing by hand or use a breast pump after you breast feed to further drain the breast.
- Use an ice-pack (wrapped in a soft cloth) on your breast to relieve pain after a feed.
- Wear a comfortable bra with no underwire and you may need to remove it during the feed.
- If you haven’t managed to clear the blockage within 12 hours, or you start to feel unwell (as if you’re coming down with the flu), see your GP immediately – you may have mastitis.
This can happen but does not usually last long and normally sorts itself out. It does not necessarily mean your baby wants to wean. It may be caused if your baby is:
- Not actually hungry. Play with your baby for half an hour and wait for hunger signals and try feeding again.
- Over stimulated, over tired or distracted. Try sitting in a darkened quiet room and play some relaxing music.
- Uncomfortable or in pain. Try a new feeding position, give your baby a warm bath or rub their back to ease a tummy pain.
- Unwell and irritable. Check your baby’s temperature and seek medical help if elevated. Try feeding when your baby is first stirring or even still asleep.
- Effected by a change in the taste of your milk. This may be due to any new medication; or hormonal changes as your periods return; or you have eaten something with a strong taste that your baby doesn’t enjoy.
Low milk supply
Some mums worry about not making enough milk but this is rarely the case. Your breasts will produce milk based on a supply and demand principal — the more you breastfeed, the more milk you make. Mums of twins for example make twice as much. So if you feel your baby is not getting enough then try to feed a little more often throughout the day. You know your baby is getting enough breast milk when your baby:
- Has a good attachment and settles during the feeds;
- Is settled after most feeds;
- Is alert, active and happy when awake;
- Has at least six wet nappies in 24 hours (after your milk has come in);
- Passes one or more yellowish, loose bowel motion every day after the initial meconium (first blackish bowel motion) is passed;
- Is gaining weight in line with what your healthcare professional is recommending
Regular check-ups with your local community nurse, GP or paediatrician for a weight and growth check to ensure your baby is growing and developing correctly is encouraged. Seek help and advice from your support team as soon as you feel there is a problem, early intervention always yields the best outcome.
How to build up your supply
Continued breastfeeding is often the best way to build up your milk supply. Feed your baby more often with snack feeds between each feed, or simply shortening the time between each feed and be very alert to their hunger signals so you may be able to feed sooner.
If your baby still seems hungry at the end of the feed, take a break and try giving a top up feed later or even repeat this a few times to cluster feed your baby. The aim is that the extra suckling will help build up your supply and there will be more milk produced.
It can be very stressful if your baby is unsettled after a feed. Relaxing during feeds is so important not just for mental health but also for hormonal responses during breastfeeding and milk production. Here are some useful tips to help your breastfeed more relaxing:
- Sit in a comfortable chair, in a warm relaxing room,
- Play relaxing music and stop any distractions,
- Look at your baby and stroke their skin.
- Make sure you are eating, sleeping and drinking plenty of water.
If you are still concerned about your milk supply, seek help from your health care professional to check if your baby is growing and developing correctly, and more advice on building your milk supply if it is an under-supply problem.
There are a number of symptoms you may see your baby experience if you have an oversupply of milk, these may include your baby:
- Having plenty of wet nappies;
- Having a lot of tummy aches and wind;
- Crying a lot especially after feeds and you notice your milk is flowing very quickly;
- Dropping off the breast and coughing as they can’t keep up with the flow.
This problem doesn’t usually last as your milk supply should adjust to how much milk your baby takes out.
If oversupply sounds like your problem, you might like to try the following:
- Feed your baby from only one breast at each feed and offer the other breast the next feed a few hours later;
- If your breast is so engorged your baby finds it hard to latch on, expressing a little milk before the feed to soften the nipple may allow them to attach properly and drain the breast effectively;
- Also, you may find using a warm cloth before breastfeeding will help your let-down and soften your breast which will help baby attach.
- Take off your bra during feeds to assist with adequate drainage;
- Vary breastfeeding positions to assist with breast drainage;
- Massage your breast gently while breastfeeding to assist with breast drainage;
- Express a little bit of milk after your feed if your breasts still feel full and uncomfortable. Just be mindful that if you keep doing this it may simply encourage your breast to continue to over produce your milk;
- Place an ice-pack wrapped in cloth on your breast to relieve pain after breastfeeding. Some mothers find a chilled cabbage leaf placed over the breast can be helpful too
Top tips for successful breast feeding and avoiding potential problems
- Begin breastfeeding as soon as possible after birth. Babies are very alert after birthing and eager to suckle. When you arrive at the hospital, let the nurses know that you plan to breastfeed so they can assist you after the birth. Besides helping both of you adjust to breastfeeding, frequent and early breastfeeding also helps increase your milk supply.
- Offer your baby your breast whenever they show signs of hunger, this may be every 1 to 3 hours to start with. Have your baby with you as much as possible following the birth, that way you’ll see and hear their signs of hunger and can attend to them quickly. Signs of hunger to look out for may include increased alertness or activity; turning their head searching for your breast; sucking their fist, sticking out their tongue or opening and closing their mouth.
- Try to relax during breastfeeds, and avoid too many distractions. It’s a great time towatch your baby, touch and stroke their skin – not only is this calming but is a great bonding activity with your little one.
- Avoid using additional water or formula as this may interfere with your milk supply. If your baby is in the nursery at the hospital, insist that they be brought to you to breastfeed when they are hungry. This ensures that your baby’s only source of nutrition is breastmilk. If you feel baby needs extra fluid, then you can always try breastfeeding your baby more often.
- Delay using a dummy until after breastfeeding and milk supply is well established. Your milk supply increases the more your baby suckles, so make sure all the sucking is done at your breast not on a dummy (pacifier) to start with.
- Ask the nurses to help you with breastfeeding at any time during your hospital stay. Ideally you will also have a community nurse visit you at home the first week after you are discharged from hospital to assist you with any breastfeeding or other concerns with your new baby.
- All infants should be seen by a health care provider within the first month, usually at around 2 weeks. And at any other time you are concerned about you or your baby’s health or feeding regime.
- Ask for help and support, women who are supported and encouraged to breastfeed will usually be more successful than those who don’t ask for help or have little support from relatives and friends.
- Seek help and advice when you plan to go back to work. Returning to work may require a slight change to your routine but definitely doesn’t mean you need to stop breastfeeding all together. Good planning and support from your friends, family and workplace are important ingredients for continued successful breastfeeding.
In your baby’s first four to six months before solids are introduced, water, juice, and other foods are not necessary or recommended. Remember breastmilk is nature’s perfect food and will provide your baby with all the nutrition they need. Even as you introduce solid foods, breastmilk will still be your baby’s primary source of nutrition.