An old adage says the best laid plans of mice and men often go awry. Well, it’s true for new moms as well. We know breastfeeding is best, and we may be committed to providing that important good start for our babies, but can we stay committed when our nipples crack, our breasts become engorged or the baby has trouble latching on?
The answer is a resounding yes. Most breast-feeding setbacks can be overcome with patience, support and the right information. Here’s advice from two nurses and lactation specialists — Sharon Perkins and Carol Vannais, authors of Breastfeeding For Dummies (For Dummies; $16.99) — to help you overcome the most common breast-feeding setbacks.
Setback: Low Milk Supply
Symptoms: Most indicators come from the baby. If there is inadequate weight gain, or if the baby doesn't have regular wet diapers and bowel movements on a daily basis, he may not be getting enough to eat.
Solution: To improve letdown, apply warm compresses before feeding. Since breast milk supply usually meets demand, make sure the baby is breastfeeding often — every two to three hours. Frequent feedings are more important than the length of time spent nursing. Massage your breasts while the baby feeds to assure all ducts are emptied.
Unfortunately, milk supply can be affected by a variety of factors. Smoking, stress and certain medications can all interfere with breast milk production, so try to eliminate these if possible. Also, be sure to drink plenty of fluids and consume a healthy number of calories in your diet.
Setback: Sore Nipples
Symptoms: Discomfort is often experienced during the first few minutes of a feeding, but sometimes the pain is severe and prolonged, accompanied by bleeding, blistering and cracking of the nipples.
Solution: Sore nipples are commonly caused by improper latching or positioning at the breast. Make sure the baby takes in as much of your areola as he can while nursing, and that his lower lip is splayed below your nipple. Also be sure to break the suction before removing the baby from the breast by gently inserting your smallest finger between your breast and baby's mouth. Correct the latching and the problem should subside. Continue to nurse while using warm compresses, lanolin-based cream and glycerin gel pads to help your nipples heal.
Symptoms: Those telltale wet marks created when leaked breast milk soaks your favorite blouse. Many moms only leak when milk is let down, but for others, the cups overflow — almost constantly!
Solution: Actually, leaking is natural and, though it may be embarrassing, it really doesn’t present a problem to your breastfeeding. Use nursing pads that don’t have plastic liners to save your clothing. Feeding the baby more frequently may alleviate the leaking.
Symptoms: Primary engorgement may happen when the milk first comes in, congesting the blood vessels in the breast and making them hard, swollen and painful. Secondary engorgement can occur when feedings are missed or spaced further apart, and can be similarly painful.
Solution: First and foremost, have your baby nurse frequently — even before the milk comes in. (Colostrum produced before mature milk arrives is the perfect nutrition for newborns.) Using a breast pump to express milk will also relieve engorgement. Even without these measures, engorgement usually disappears within two to three days. However, if milk isn’t expressed or the baby isn’t fed frequently, the milk supply may diminish to reflect that a volume of milk has been unused. Remember, supply and demand — you must use the milk in the breast to keep getting more.
Setback: Inverted or Flat Nipples
Symptoms: Sometimes when a girl develops, her breasts form adhesions that keep her nipples from everting. She may be unaware of the problem until she attempts to breastfeed, only to be told that her nipples are flat or inverted.
Solution: Some nipples evert naturally during pregnancy. To help, you can wear breast shells in your bra during waking hours. These hard plastic domes can stretch the adhesions, allowing the nipples to emerge. Sometimes use of the breast pump will also draw a nipple out, making it easier for baby to latch on.
Setback: Plugged Ducts
Symptoms: Ducts become plugged when blocked by a thickened mass of milk or cast-off cells, which creates a hard, tender lump in the breast. This could happen when the baby does not empty the breast, leaving milk to harden, or if the bra is too tight.
Solution: Warm compresses to the area may soften the milk and increase drainage. Rest (if at all possible!) and take a mild pain reliever for the discomfort. Nurse the baby as much as possible. Offer the affected side first, and position the baby’s chin or nose on that area. Massage your breast downward from the plugged duct to the nipple as the baby feeds.
Symptoms: This is an actual infection of the breast, resulting in flu-like symptoms such as fever and achiness. Mom may get headaches, feel nauseous or even vomit. Her breasts may also become swollen and red.
Solution: First, call your obstetrician as antibiotics may be needed. Then get some rest. Line up some family members or friends to care for the baby so you can sleep. Drink plenty of fluids and continue to breastfeed.
Symptoms: Sometimes you won’t see any on your body, but you’ll spot white, milky patches or a coating in your baby’s mouth. That’s thrush — a yeast infection that affects both Mom and Baby. For the mom, symptoms include severe pain with intact nipples, which may look pinkish or shiny.
Solution: Because thrush is shared, both the baby’s pediatrician and your obstetrician should be aware of the situation. The baby’s oral thrush is usually treated with applications of Nystatin oral suspension — available by prescription. To treat yourself, make sure to wash your hands before touching your breasts. Rinse your nipples after each feeding. Eliminate yeasty foods and sugary drinks from your diet. Local anti-fungal treatments can be used to combat the yeast, but remember — yeast is hard to get rid of. If topical solutions aren’t working, consult your doctor and lactation consultant for help.
Symptoms: Baby is unable to nurse immediately.
Solution: First, remember that your milk is still the right food for your child. If the baby is born early, the milk you produce will contain more protein, iron and sodium than the milk produced at full term. It will also contain antibodies and will be easier to digest so the baby will use fewer calories to break it down. In short, it’s the perfect food!
So how do you deliver the breast milk to your baby? You should use a breast pump to establish your supply while the baby is hospitalized. If possible, use a pump that can empty both breasts at the same time. If your baby is tube feeding, provide fresh breast milk for your child each day. If not, you can freeze the milk for later use.
To establish your milk supply, you should pump eight to 12 times a day. When the baby is ready to try the breast, you may need to use a preemie-sized nipple shield, which helps keep the nipple in the mouth easily. As the baby grows stronger, he can be weaned from the artificial nipple to your own.
Symptoms: A feeling of being overwhelmed. After all, Mom only has two hands — and two breasts!
Solution: Each baby should be taught to latch on individually, and once established, Mom should try simultaneously feeding two babies at one time. It’s the best way to avoid feeding babies constantly. Also, try attending a meeting for mothers of multiples for advice.
— Mary Dixon Lebeau is a freelance writer.