COMMON BREASTFEEDING CHALLENGES

                                     COMMON BREASTFEEDING CHALLENGES

• Many women have no problems breastfeeding, while others will experience some challenges. These challenges can often be overcome.
• Developing a good latch is important to prevent sore nipples.
• Checking a baby's weight and growth is the best way to make sure he or she is getting enough milk.
• Engorgement refers to the feeling of pain or fullness in the lactating breasts.
• Clogged or plugged ducts are relatively common and can be relieved by massage, warm compresses, and frequent breastfeeding.
• A plugged duct feels like a tender, sore lump in the breast.
• Mastitis is an inflammation or infection of the breasts that can be accompanied by fever.
• Breast infections that do not heal within 24 to 48 hours may need treatment with antibiotics.
• Most mothers are able to make enough milk for twins, and some fully breastfeed triplets or quadruplets.
• Breastfeeding after breast surgery is usually possible; the extent depends upon the type of surgery and the reasons it was performed.
• Some health problems in babies can make breastfeeding more difficult.

Common breastfeeding challenges overview

Breastfeeding can be challenging at times, especially in the early days. But it is important to remember that you are not alone. Lactation consultants are trained to help you find ways to make breastfeeding work for you. And while many women are faced with one or more of the challenges listed here, many women do not struggle at all! Also, many women may have certain problems with one baby that they don't have with their second or third babies. Read on for ways to troubleshoot problems.

Sore nipples

Many moms report that nipples can be tender at first. Breastfeeding should be comfortable once you have found some positions that work and a good latch is established. Yet it is possible to still have pain from an abrasion you already have. You may also have pain if your baby is sucking on only the nipples.
Ask a lactation consultant for help to improve your baby's latch. Talk to your doctor if your pain does not go away or if you suddenly get sore nipples after several weeks of pain-free breastfeeding. Sore nipples may lead to a breast infection, which needs to be treated by a doctor.

What you can do

• A good latch is key, so visit the Bringing your baby to the breast to latch section for detailed instructions. If your baby is sucking only on the nipple, gently break your baby's suction to your breast by placing a clean finger in the corner of your baby's mouth and try again. (Your nipple should not look flat or compressed when it comes out of your baby's mouth. It should look round and long, or the same shape as it was before the feeding.)
• If you find yourself wanting to delay feedings because of pain, get help from a lactation consultant. Delaying feedings can cause more pain and harm your supply.
• Try changing positions each time you breastfeed. This puts the pressure on a different part of the breast.
• After breastfeeding, express a few drops of milk and gently rub it on your nipples with clean hands. Human milk has natural healing properties and emollients that soothe. Also try letting your nipples air-dry after feeding, or wear a soft cotton shirt.
• If you are thinking about using creams, hydrogel pads, or a nipple shield, get help from a health care provider first.
• Avoid wearing bras or clothes that are too tight and put pressure on your nipples.
• Change nursing pads often to avoid trapping in moisture.
• Avoid using soap or ointments that contain astringents or other chemicals on your nipples. Make sure to avoid products that must be removed before breastfeeding. Washing with clean water is all that is needed to keep your nipples and breasts clean.
• If you have very sore nipples, you can ask your doctor about using non-aspirin pain relievers.

 Low milk supply

• Most mothers can make plenty of milk for their babies. But many mothers are concerned about having enough.
  Checking your baby's weight and growth is the best way to make sure he or she is getting enough milk. Let the doctor know if you are concerned. For more ways to tell if your baby is getting enough milk, visit the How to know your baby is getting enough milk section.
  There may be times when you think your supply is low, but it is actually just fine:
  When your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes at a time. This can mean that you and baby are just adjusting to the breastfeeding process -  and getting good at it!
  Growth spurts can cause your baby to want to nurse longer and more often. These growth spurts can happen around 2 to 3 weeks, 6 weeks, and 3 months of age. They can also happen at any time. Don't be alarmed that your supply is too low to satisfy your baby. Follow your baby's lead - nursing more and more often will help build up your milk supply. Once your supply increases, you will likely be back to your usual routine.
  

  What you can do

• Make sure your baby is latched on and positioned well.
• Breastfeed often and let your baby decide when to end the feeding.
• Offer both breasts at each feeding. Have your baby stay at the first breast as long as he or she is still sucking and swallowing. Offer the second breast when the baby slows down or stops.
• Try to avoid giving your baby formula or cereal as it may lead to less interest in breast milk. This will decrease your milk supply. Your baby doesn't need solid foods until he or she is at least 6 months old. If you need to supplement the baby's feedings, try using a spoon, cup, or a dropper.
• Limit or stop pacifier use while trying the above tips at the same time.

Ask for help! Let your baby's doctor know if you think the baby is not getting enough milk.

Oversupply of milk

Some mothers are concerned about having an oversupply of milk. Having an overfull breast can make feedings stressful and uncomfortable for both mother and baby.

What you can do

1. Breastfeed on one side for each feeding. Continue to offer that same side for at least two hours until the next full feeding, gradually increasing the length of time per feeding.
2. If the other breast feels unbearably full before you are ready to breastfeed on it, hand express for a few moments to relieve some of the pressure. You can also use a cold compress or washcloth to reduce discomfort and swelling.
3. Feed your baby before he or she becomes overly hungry to prevent aggressive sucking. (Learn about hunger signs in the Tips for making it work section.)
4. Try positions that don't allow the force of gravity to help as much with milk ejection, such as the side-lying position or the football hold.
5. Burp your baby frequently if he or she is gassy.

Some women have a strong milk ejection reflex or let-down. This can happen along with an oversupply of milk. If you have a rush of milk, try the following:

1. Hold your nipple between your forefinger and middle finger or with the side of your hand to lightly compress milk ducts to reduce the force of the milk ejection.
2. If baby chokes or sputters, unlatch him or her and let the excess milk spray into a towel or cloth.
3. Allow your baby to come on and off the breast at will.

Ask for help! Ask a lactation consultant for help if you are unable to manage an oversupply of milk on your own.

Engorgement

It is normal for your breasts to become larger, heavier, and a little tender when they begin making more milk. Sometimes this fullness may turn into engorgement, when your breasts feel very hard and painful. You also may have breast swelling, tenderness, warmth, redness, throbbing, and flattening of the nipple. Engorgement sometimes also causes a low-grade fever and can be confused with a breast infection. Engorgement is the result of the milk building up. It usually happens during the third to fifth day after birth, but it can happen at any time.
Engorgement can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens. If treated properly, engorgement should resolve.

What you can do

1. Breastfeed often after birth, allowing the baby to feed as long as he or she likes, as long as he or she is latched on well and sucking effectively. In the early weeks after birth, you should wake your baby to feed if four hours have passed since the beginning of the last feeding.
2. Work with a lactation consultant to improve the baby's latch.
3. Breastfeed often on the affected side to remove the milk, keep it moving freely, and prevent the breast from becoming overly full.
4. Avoid overusing pacifiers and using bottles to supplement feedings.
5. Hand express or pump a little milk to first soften the breast, areola, and nipple before breastfeeding.
6. Massage the breast.
7. Use cold compresses in between feedings to help ease pain.
8. If you are returning to work, try to pump your milk on the same schedule that the baby breastfed at home. Or, you can pump at least every four hours.
9. Get enough rest, proper nutrition, and fluids.
10. Wear a well-fitting, supportive bra that is not too tight.

Plugged ducts

It is common for many women to have a plugged duct at some point breastfeeding. A plugged milk duct feels like a tender and sore lump in the breast. It is not accompanied by a fever or other symptoms. It happens when a milk duct does not properly drain and becomes inflamed. Then, pressure builds up behind the plug, and surrounding tissue becomes inflamed. A plugged duct usually only occurs in one breast at a time.

What you can do

• Breastfeed often on the affected side, as often as every two hours. This helps loosen the plug, and keeps the milk moving freely.
• Massage the area, starting behind the sore spot.
• Use your fingers in a circular motion and massage toward the nipple. Use a warm compress on the sore area.
• Get extra sleep or relax with your feet up to help speed healing. Often a plugged duct is the first sign that a mother is doing too much.
• Wear a well-fitting supportive bra that is not too tight, since this can constrict milk ducts. Consider trying a bra without underwear.

Ask for help! If your plugged duct doesn't loosen up, ask for help from a lactation consultant. Plugged ducts can lead to a breast infection.

Breast infection (mastitis)

Even if you are taking medicine, continue to breastfeed during treatment. This is best for both you and your baby. Ask a lactation consultant for help if needed.
Mastitis (mast-EYE-tiss) is soreness or a lump in the breast that can be accompanied by a fever and/or flu-like symptoms, such as feeling run down or very achy. Some women with a breast infection also have nausea and vomiting. You also may have yellowish discharge from the nipple that looks like colostrum. Or, the breasts may feel warm or hot to the touch and appear pink or red. A breast infection can occur when other family members have a cold or the flu. It usually only occurs in one breast. It is not always easy to tell the difference between a breast infection and a plugged duct because both have similar symptoms and can improve within 24 to 48 hours. Most breast infections that do not improve on their own within this time period need to be treated with medicine given by a doctor.

What you can do

1. Breastfeed often on the affected side, as often as every two hours. This keeps the milk moving freely, and keeps the breast from becoming overly full.
2. Massage the area, starting behind the sore spot. Use your fingers in a circular motion and massage toward the nipple.
3. Apply heat to the sore area with a warm compress.
4. Get extra sleep or relax with your feet up to help speed healing. Often a breast infection is the first sign that a mother is doing too much and becoming overly tired.
5. Wear a well-fitting supportive bra that is not too tight, since this can constrict milk ducts.