BREASTFEEDING: COMMON PROBLEMS & SOLUTIONS
I’ve worked with hundreds of new Edinburgh mummies and these are the most common problems I see in the studio. Most of these are easily fixed but, if left untreated, can lead to bigger issues. It’s always important to deal with things quickly, not sit on your laurels and to ask for help. You are NOT being a wuss, or a muppet – if it hurts, get it sorted for the benefit of your baby and yourself.
1. Cracked Nipples
Cracked and sore nipples can be extremely painful (understatement of the year!) and it’s not unusual in the first one or two weeks of feeding. It’s normally caused by the friction of feeding, and is totally normal and natural…. Still hurts though!
The simple solution is lanolin so take it with you to hospital (it’s better to be prepared than to suffer while you wait for your husband to figure out what he’s supposed to be buying!). As a precaution, begin using lanolin as soon as you start breastfeeding as a preventative measure. This will help and minimize any chapping that occurs. Put on lanolin…and more lanolin... and then some more! Keep applying as often as you need it – you’ll find it is very soothing and healing.
Breast shields will help too while feeding to give your nipples a rest. Use silver nipple cups as well, particularly if your nipples are bleeding, and pop them into the fridge before you use them. This will relieve the soreness and prevent the sores from sticking onto any cotton breast pads.
Mastitis (inflammation of the breast) can occur when a blocked duct doesn’t clear or when the build-up of milk causes swelling and inflammation. Mastitis will make the breast extremely sore and tender but it is so important that you keep feeding and fully drain the breast with every feed as stopping will make it worse. This, for a newborn, will take 45 minutes or more.
You are also likely to feel achy, run-down and, if it isn’t solved within 24 hours, you might get feverish with flu-like symptoms. Early signs are over-fullness of the breast, with red patches like a pressure sore that is hot and inflamed. The inflammation can often start around the under-arm area.
If there is anything that will stop your breastfeeding journey in its tracks, it is mastitis. Don’t muck around with this. Get yourself off to the doctor straight away if there are any changes in your breasts. (If you’ve ever had a urine infection, you’ll know how quickly it can escalate…mastitis is exactly the same. So don’t wait.)
The doctor will give you antibiotics and that should help in a few days. It is vital to take the full course of antibiotics, even if you feel better, as reoccurrence is very common.
In the meantime, there are things you can do at home to ease the symptoms:
Rest– easier said than done when you have a new, small baby. But try to rest as much as possible.
Feed frequently– mastitis doesn’t harm the baby or affect the quality of your milk and feeding often will help with inflammation and will help to clear any clogged milk. As painful as it is, feed as much as possible.
Express– try to feed, but if this doesn’t work empty the breast by expressing to get rid of as much milk as possible. While expressing take the opportunity to put a warm flannel on the breast and massage with two fists to help move the milk through the blocked ducts.
Cabbage leaves– sounds mad, but these can be very soothing. Make sure these are nice and cold, straight from the fridge. Tuck them into your bra and remove when they are wilted and warm.
Warmth– apply a warm, damp towel to your breasts just before feeding to help with the milk flow. A warm shower or bath works equally well too.
Massage– using firm movements, massage from the chest wall towards the nipple. Milk may be expressed, which is fine and should cause some relief.
Bra– make sure your nursing bra is supportive and well-fitting. You don’t want it to be too tight or put pressure on areas of your breast. Consider going bra-less for a few days. Let the girls swing!
Medication– Go to the doctor. Understand that there are two strengths of mastitis medication and if mastitis reoccurs, you can ask and insist on the stronger version. It’s okay to stick up for yourself.
Engorgement occurs when the breast tissue overfills with milk. This causes your breasts to be congested and swollen and feel very full, hard and sensitive. You need to reduce the swelling and keep the milk flowing.
Try the following:
Express as much of it as you can. Engorgement is usually a one-off so expressing shouldn’t make the engorgement worse. It will definitely relieve the swelling and make it easier for the baby to feed.
Often the engorgement is because of a growth spurt. Your baby’s growth spurt will last a few days making your baby hungrier and the breasts will respond by making more milk. This is all good. But at the end, when feeding goes back to normal, your breasts might take a while to catch up. Hence the engorgement. Expressing will help until your breasts settle down.
Drink water. Lots and lots of it.
4. Inverted Nipples
It's estimated up to 10% of first-time mums have at least one inverted nipple. It makes things trickier to breastfeed but it is certainly still possible. I recommend using a breast shield which is simply placed over the nipple so that the baby can latch on more easily.
You might think that your nipple is inverted when it is, in fact, a flat nipple. This will give the appearance of being inverted but it is worth trying the ‘pinch test’ to check. Just compress your breast gently, with your thumb and forefinger either side of the areola. Most nipples will poke out when you do this. (If it goes back into itself, creating a hole in the areola, then this is an inversion. See photo below.)
A breast shield will help with this too, making it easier for your baby to feed. Over time, as your baby’s suck gets stronger and your nipples become more accustomed to breastfeeding, you might be able to breastfeed without the nipple shields, But if it never 'pops' out then please chat with your doctor about what can be done to correct it.
A tongue-tie is where the skin joining a baby's tongue to the bottom of their mouth is shorter than usual. Even though a tongue-tie is common, affecting nearly 5 percent of all newborns, it is not routinely checked in the hospital. So if you suspect, or have any relatives who have had a tongue-tie, ask the nurse to take a look before you leave the maternity ward.
Any tongue-tie that restricts your baby’s normal tongue movement can lead to breastfeeding difficulties and painful nipples. (This can affect bottle feeding babies as well as they can’t latch onto the bottle correctly. It often causes them to gulp down more air, sometimes resulting in colic.)
This is something that will not sort itself out and is often the reason why mums with two-week-old babies (or older) still have sore nipples. A tongue-tie makes it extremely painful to breastfeed and the only thing that will make it better for both mum and baby is to go and get it snipped. A baby needs to be able to move his tongue freely and extend it over the lower gum with his mouth open wide to be able to latch properly and breastfeed well.
The waiting time in the NHS for a tongue-tie to be snipped can be around three or four months so I’d recommend getting it done straight-away privately, if you can.
The Spire Hospital in Edinburgh carries out the procedure. Please call them on: 0131 341 5491
It will be a simple out-patient appointment and won’t harm the baby at all. The advantage is that breastfeeding will become so much easier instantly and prevent other long term health issues such as lisps or a delay in speech development. While you wait for your appointment, use nipple shields to help with the feeding.