COMMON BREASTFEEDING PROBLEMS

Mrs BY had a baby 3 weeks ago, she was said to have developed a high grade fever with chills and rigor. She said she cannot go for outings due to her cultural belief which forbids new mum with babies who are less than 6 weeks from going out. She then called the hospital she delivered who recommended antimalarial and paracetamol for her. She did not get better and decides to see a doctor in a clinic close to her house. She was examined by the doctor, the temp was 39 degree centigrade, the two breasts were swollen, tender and an area of redness (inflammation) was seen. The doctor explained saying that this is a breastfeeding problem and not malaria but mastitis. She was treated with antibiotics and analgesics and got well. She was also reassured that she can continue with her medications and breastfeeding.

Worldwide, breastfeeding is recognized as the best way to feed an infant because it protects mother and infant from a variety of health problems. Even so, many women who start out breastfeeding stop before the recommended minimum of exclusive breastfeeding for six months. Often women stop because common problems (listed below) interfere with their ability to breastfeed. With sound guidance and appropriate medical treatment, most women can overcome these obstacles and continue breastfeeding for longer periods.

BREAST ENGORGEMENT

Engorgement is a medical condition that can be experienced by breastfeeding mothers. The breast milk will come in around 24 to 72 hours after birth. A degree of fullness may be experienced in the breasts at this time. After a feed at least one breast should feel soft and light (well drained). Engorgement is caused by a build-up of blood, milk and other fluids in the breast. It will occur if the baby is not feeding and attaching well and the breasts aren’t drained well during a feed. Less commonly it may occur if the body is making more milk than the baby needs. 

Signs and symptoms: Engorgement results in very full and often painful breasts.

Treatment of engorgement: Ensure your baby is attached well when breastfeeding. Feed the baby frequently at least 8 to 12 times every 24 hours. Do not limit the baby’s time at the breast. Express a small amount of milk before you feed to soften your breast and help the baby to attach. Use cool towel or clothe from the refrigerator (not freezer) for comfort.

BLOCKED MILK DUCTS

A blocked duct causes tender or painful lumps as a result of milk building up in the breast behind a duct. Milk ducts are small tubes inside the breast that carry milk through to the nipples.

Signs and symptoms: A painful red lump or swollen spot on the breast. One may also see a white spot on the nipple which is another sign that a duct may be blocked. Blocked or plugged ducts are areas of the breast where the flow of milk is blocked. They can stretch the nearby breast tissue and cause a painful breast lump.

Management of blocked ducts: Feed frequently from the affected side first. Gently stroke the breast towards the nipple during the feed. This may assist the let-down reflex. For comfort and to reduce swelling from excess fluid apply a cold cloth or towel. Express after feeding. If there is a white spot on the nipple – soak the nipple with a warm moist cloth and the health worker rub or scratch off the spot with a sterile needle to allow the duct to open and the milk to flow again. Use paracetamol or anti-inflammatory tablets according to directions.

Prevention: Ensure correct positioning and attachment. Frequent drainage of the breast. Alter your position during breast feeds to include underarm position, cradle position or lying on your side. Check for a white ‘spot’ on the nipple as this may be blocking the milk duct. Avoid sudden long gaps between breastfeeds or expressing for your baby, tight or restrictive clothing such as a bra, pressing or holding one area of the breast too tightly, especially close to the nipple.

MASTITIS

Mastitis occurs when there is a blockage of milk in the milk duct. Some milk may leak out of the duct into the surrounding tissues causing inflammation and infection. Milk ducts are small tubes inside the breast that carry milk through to the nipples

Signs and symptoms: the breast has a red, painful area, An aching flu-like feeling such as a fever, feeling shivery and generally unwell. Seek medical help if fever lasts more than 6 hours.

Treatment of mastitis Drain the breast frequently. Attach the baby to the affected side first. You may need antibiotics for 10 to 14 days. Keep the breast drained by expressing the affected breast after each feed. Cool cloths from refrigerator (not freezer) can relieve discomfort and pain. Anti-inflammatory medication such as ibuprofen will reduce the inflammation and pain. Paracetamol may be taken to ease discomfort.

NIPPLE PAIN, SORES AND CRACKS

Another common reason mother’s stop breastfeeding early is nipple pain. The causes of nipple pain includes: Nipple injury (caused by the baby or a breast pump), Sore nipples are one of the most common complaints by new mothers. If the nipples are cracked or raw, one can put expressed breastmilk or a nipple cream, petroleum jelly, ointment on them, and cover them with a nonstick pad. This will keep the injured part of the nipple from sticking to the bra Nipple vasoconstriction, which means the blood vessels in the nipple tighten and do not let enough blood through. To determine the cause of your pain, your healthcare provider will examine you and your baby, and watch you breastfeed.

Are you having issues with establishing breastfeeding? Talk to a lactation expert today (doctors, gynaecologists, paediatricians, nurses and other health workers who are highly skilled in breastfeeding issues). There are foods and medications called galactagogue that can help to increase breastmilk supply, this works best when a mother has low prolactin levels (i.e when there is a genuine, not a perceived, low milk supply issue), and after a mother has received support and education to improve her breastfeeding or expressing technique.