In Breastfeeding

Breastfeeding problems

Common breastfeeding problems can often be resolved by providing parents and carers with the right information and assistance. By asking appropriate questions, healthcare professionals can identify if parents are experiencing breastfeeding difficulties and can provide appropriate support. If a mother requires assistance with breastfeeding issues not discussed here, seek further help.

Low supply/not enough milk | Sore and damaged nipples | Engorgement (full) breasts | Mastitis

Low supply/not enough milk

Approximately one third of mothers think that they don’t have enough milk, and will introduce infant formula. There are a number of reasons mothers may believe they have insufficient milk:

The baby is unsettled
The baby is constantly feeding
The baby is not sleeping through the night
The breastmilk looks watery
Between 6-12 weeks after birth, breasts may become softer, smaller and stop leaking.

Each mother and baby is different and the above signs can differ between individuals, while still being normal. Parents need to be informed about what to expect and how to check their babies for signs they are getting enough milk.

What causes low milk supply?

There are different reasons why a mother may experience low milk supply. If signs of low milk supply have been identified, explore the following with the parents:

Perception of the mother that she doesn’t have enough breastmilk for her baby (“my milk dried up” –occurs frequently)
Baby not attaching well to the breast
Breast refusal
Baby not feeding often enough at the breast
Frequent use of dummies or introduction of complementary feeds (e.g. infant formula, solids)
Missing night feeds
Health conditions of mother.

Management of low milk supply

Once the cause of low milk supply is identified, health professionals can provide assistance and advice or refer to an appropriate healthcare provider for assistance. Encourage mothers to:

Ensure the baby is well attached to the breast and feeding at least 8 times per day
Hold baby in skin-to-skin contact
Encourage the baby to feed well on the first breast before offering the second breast
Express milk after feeds to maintain or increase supply
Give the baby dummies infrequently
Eat a healthy well balanced diet based on a range of healthy foods and plenty of water
Find time to rest
Avoid herbal preparations to increase milk supply (e.g. fenugreek) as their effectiveness and safety have not been established.

Sore or damaged nipples

Breastfeeding can be a little sensitive for the first few days; this is partly to do with hormones. However, breastfeeding should not be painful through a whole feed, or continue to be painful over time.

Cracked or bleeding nipples can be painful but often heal quickly. This is often a sign that the baby is not attached to the breast correctly.

To prevent or treat pain when breastfeeding, discuss the following with the breastfeeding mother:

Ensure the baby is well attached to the breast and not just attached to the nipple.
Apply warm water compresses or small amounts of expressed breastmilk on the nipple after feeding and air dry.
Replace damp breast pads frequently, if used.
Avoid using shampoos, soaps, ointments and powders on the nipples.
If there is a need to rest breasts, the mother may consider expressing breastmilk to keep up supply.

If breastfeeding continues to be painful, or there is nipple damage, mothers should be advised to seek expert help to identify and treat the cause of pain.

Engorgement (full breasts)

About three days after having a baby, many mothers will experience breast ‘fullness' as their milk 'comes in'. Engorgement usually presents between 3-5 days following birth but can appear as late as 9-10days. This ‘fullness’ usually only lasts for 24 hours, however may develop into engorgement, where the breasts become swollen and tender. Engorgement is common, particularly when establishing breastfeeding, but needs to be managed. Early initiation of breastfeeding, with frequent and unrestricted feeds can assist in preventing full breasts and engorgement.

Signs of engorgement

Breasts full and painful
Swelling down to areola (brown part) of breast
Baby unable to attach to breast because of fullness.

What causes engorgement?

Hormones
Large volumes of intravenous fluids during labour
Limiting the time or frequency babies feed at the breast
Using dummies to extend time between breastfeeds
The baby not being latched well at the breast.

How to treat engorgement

Health professionals can provide assistance by discussing the following with mothers or parents:

Give advice about engorgement prior to discharge
Feeds should be frequent and unrestricted
Express small amounts of milk before feeds or apply reverse pressure softening to the areola to make the breast softer which will help the baby attach
Allow the baby to completely empty the first breast before offering the second, alternating between what breast is offered first at each feed
If the mother is separated from the baby, expressing of the breasts will be necessary
Cool packs may help ease discomfort
Pain medication, such as paracetamol or ibuprofen can help. Check for any reasons why they may not be recommended for individual women
Wear a well fitted, supportive bra
Avoid deep massage of the breasts
Get plenty of rest and drink plenty of fluids.

If symptoms continue, or worsen (see ‘Mastitis’ below), encourage the mother to seek assistance from an appropriate healthcare provider.

Mastitis

Mastitis is an inflammation and/or infection of the breast tissue. Mastitis can be caused by:

Breast engorgement that is not managed well
Narrowing of the milk ducts due to inflammation, and slowing of milk flow
Ongoing nipple damage
Milk oversupply that is ongoing
The baby not being latched well at the breast
Poor overall health (stress, fatigue, poor nutrition).

Signs of mastitis

An area on the breast that is red and swollen
Breast feels hot
Skin on breast may look tight, shiny and red
The mother may feel unwell with flu type symptoms, including shivers and aches.

Management of mastitis

Mastitis may resolve by introducing the following recommendations for the mother/parent:

Feed in response to the baby’s cues (or pump if baby is not breastfeeding)
Unless instructed otherwise, the milk from the affected breast is safe for the baby, even when the mother is taking antibiotics
If unable to latch the baby to the breast, begin by hand expressing the affected breast to soften the areola
Avoid increased expressing or use of breast pump
Avoid use of nipple shields where possible
Avoid deep massage of the breast
Cool packs may help ease discomfort
Pain medication, such as paracetamol or ibuprofen can help. Check for any reasons why they may not be recommended for individual women
Get plenty of rest and drink plenty of fluids
If symptoms are not improving within 12-24 hours or if the mother becomes unwell (including fever and rapid heart rate), seek further medical advice.

If a mother decides she no longer wants to breastfeed to reduce the risk of complications from the mastitis, it is recommended that she continue to express until the mastitis is gone, and then wean gradually.