It is common in the early days to hear of mums having breastfeeding problems. Even though breastfeeding may be natural, it is a learned skill. Taking an Antenatal breastfeeding class, before you have your baby, can give you great confidence and knowledge on how to breastfeed your baby. If you do then face problems, knowing about these problems can make you overcome them quicker. I often called them speed bumps. Getting the right support and the correct help can let you get over these speed bumps and get your breastfeeding journey back on track again.

Guest Blog by Orla Dorgan, IBCLC

Let’s look at some of the more common problems I see:

Nipple Pain

Nipple tenderness can be experienced when baby first latches on to the breast and lasts about 10 to 20 seconds some moms say it is like a tingling a strong sensation or nipples feel tender. This is normal and shouldn’t be confused with nipple pain. Nipple Pain lasts for the entire feed and can cause sore, cracked, damaged bleeding nipples. This is not normal and help to see what is happening is crucial.

How to help Nipple Pain

·         Look at your positioning – to get a good latch, you have to have good positioning.

·         Changing positioning from a cradle hold to a position that will get a deeper latch e.g. a laid-back position or a rugby hold ensuring baby's body is straight - ears, shoulders, hips all in a straight line.

·         Have a look at baby’s’ latch - is their chin well tucked in and is their mouth open wide? Is their head tilted back?

·         Can you hear swallows?

·         Is there good jaw movement?

If you have looked at all of this and there is still nipple pain, you may need to see a Lactation Consultant for support and a plan.

Vasospasm

This is where the blood flow is compromised to the tip of the nipple when baby is feeding. Why? Baby is clamping down on nipple either to slow flow or get more milk. This pain happens in between feeds and cold temperatures can make it worse. It can be really painful.

How to help Vasospasm

·         Find out why baby is clamping on the nipple - fix the latch.

·         Apply heat to the nipples directly after feeding.

·         Do not let the air get at the nipples this can cause more pain.

If this persists other options are available, for example medication.

 

Engorgement

This is where the breasts are extremely full. They feel really hard.  They can be painful and they can be quite taut.  It can be hard for the baby to latch on. This can happen on the day where your milk supply increases and it's transitioning from colostrum into breast milk, on average at about day three, but can be up to day 7.  It can also happen if a baby misses a feed or slept a bit longer, your breasts may become full and hard. This can happen more frequently at the start of your breastfeeding journey where milk supply is increasing up.

How to help Engorgement

·         You can take paracetamol if you need to.

·         Cold compresses to the breast can help.

·         Hand expressing before you feed your baby to relieve the real hard fullness before baby latches on.

·         Feeding your baby as frequently as you need to or trying to feel more frequently (baby is always a better drainer of the breast.)

 

Blocked ducts or Plugged ducts

This can happen when the breasts are overly full or you've gone a lot longer in between feeds than normal and baby is not fully draining the breast. The milk can become blocked in the ducts and sometimes you might feel a hard little lump like a hard pea.

It's important to clear a plugged duct otherwise it could lead to mastitis.

How to relieve a plugged duct

·         Let baby feed as much as they can.

·         Change positioning of baby.

·         Aiming the babies chin on to the plugged duct e.g. if you normally feed in a cradle hold change it to a rugby hold.

·         When baby is latched on massage the area around the blocked duct to relieve it.

·         Applying heat to the breast even in the shower and massage the blocked duct either side of it to relieve it.

·         Using the head of an electric toothbrush can help transmit vibration on to the blocked duct to help relieve it.

·         Ultrasound by a physiotherapist can also help too.

·         Resting is also very important.

If blocked ducks are recurrent, it is worth checking the baby’s latch with a lactation consultant.

 

Mastitis

Mastitis is inflammation of the breast tissue that sometimes involves an infection. The inflammation results in breast pain, swelling, warmth and redness. You may also have a fever and chills. Mastitis often happens when bacteria enter the breast through the nipple and this can happen when a nursing mother has a cracked or sore nipple or going for long stretches between breastfeeds or failing to empty the breast completely. Mastitis means milk stasis.

How to help Mastitis

·         Breastfeed your baby as frequently as you can.

·         Heat, Rest and Empty breast are the most important things to do -

o    Applying heat to the affected area of the breast before a feed can increase milk flow.

o    Massaging the breast can also help increase the milk flow.

·         Keep well hydrated.

·         Ensure you empty the breast fully.

·         If you have a fever you will need an antibiotic prescribed by your GP -

o    If you're not allergic to penicillin the dosage is flucloxacillin 500MG four times a day for 10 days.

o   If you are allergic to penicillin clindamycin 300 to 450 MG four times a day for 10 days is the treatment.

The breast milk can taste saltier due to high sodium content when you have mastitis, your baby may be a little bit fussier at the breast due to this.

Do reach out for help if you experience any of the above and they are not resolved. Ensuring good positioning and a good latch will avoid a lot of breastfeeding problems and knowing how to do will give you great confidence. I offer monthly online antenatal Introduction to Breastfeeding classes to give you great confidence and knowledge to breastfeed your baby and to avoid a lot of the above speedbumps.  If you are then faced with them, you are much more confident in dealing with them. I really enjoy empowering couples in these classes and the feedback is great.

Orla Dorgan

RGN IBCLC