Breastfeeding, like parenting, is not always easy – especially in the first few weeks after birth. Like all new skills, breastfeeding can take a while to learn and sometimes it can take a while to become really comfortable breastfeeding your baby.
Some mums may experience problems including engorged breasts, sore or cracked nipples and thrush infections. There might be physical factors causing problems like mum having inverted nipples or baby having tongue tie. The most important thing to remember is, if you are experiencing difficulties with breastfeeding, most of them can be resolved. Seek advice early and talk to your midwife, or get advice from a lactation consultant or La Leche League professional.
Engorged breasts
A few days after you give birth, the mature milk comes in. In some women this happens very quickly (often overnight) and their breasts may become swollen, hard, hot and painful. Here are some things you can do if you have engorged breasts:
- Feed your baby on demand until they have had enough.
- If you have a strong ‘let down’ and milk pours from the breast during the feed, take your bra off and let it run out freely. You can catch it in a towel, cup or even in a sterilised container for freezing and using later.
- Put your baby to the more painful breast first. Try using one side for each feed rather than offering both breasts. If your baby is still hungry, offer the other breast.
- Stand in a warm shower for five minutes before feeding. It is soothing and comfortable. Although is it generally not a good idea to express off excess milk by hand, expressing a little in the shower can make it easier for a very new baby to ‘latch on’ correctly.
- Massage your breast lumps gently towards the nipple while feeding.
- There is no greater relief for engorged breasts than feeding baby, so don’t give your baby any other fluids.
- After feeding, apply a cold pack or refrigerated cabbage leaves over the whole breast – many mums find this can be very soothing.
- If your breasts are very painful, take some paracetamol. You may feel reluctant to do this, however, remember that being in pain makes establishing a healthy, satisfying breastfeeding pattern much more difficult.
Sore or cracked nipples
Not all women experience sore or cracked nipples, but if you do it may really test your resolve to breastfeed. At times you might feel that it is not worth it, and that breastfeeding is just not for you. It is very difficult to establish a healthy, breastfeeding pattern if you are in pain, so ask for help as soon as possible. Sore and cracked nipples are generally caused because:
- Your baby is not in the correct position for feeding. The baby will chew on your nipples if they don’t get the areola into their mouth – your baby is nipple-feeding instead of breastfeeding.
- You have sensitive skin.
- Your baby may be ‘tongue-tied’ (occurs in up to 5% of newborns).
- You may have inverted nipples (this is very rare).
If you have sore or cracked nipples, ask for help from your midwife or a lactation consultant. They will help you position or ‘latch’ your baby to the breast correctly. In most cases, once the baby is correctly positioned the nipple heals within two or three days.
If your baby does not latch on to the breast well, remove them carefully from the breast and re-latch your baby, ensuring that the baby takes a large mouthful of the areola and breast. Take care to release the suction by gently sliding your finger between their mouth and the breast. Pulling baby off the breast while they are enthusiastically sucking will further damage your nipple. Other things that may help include:
- Make sure you are sitting comfortably to feed your baby.
- If one nipple is sorer than the other, start feeding from the less painful side so that your baby does not feed furiously on the sore breast.
- Some women find that feeding from one breast per feed (rather than both) lets them ‘rest’ the nipple for a longer duration and helps with healing.
- Try expressing a little milk before breastfeeding. This will soften and lubricate the nipple.
- Do not use creams or drying agents on the nipples.
- Some women use a warm hot water bottle or wheat bag to relieve pain. Others find that they get good relief from cold packs.
- Go without a bra if it feels more comfortable.
- Paracetamol is considered safe to take for the pain. Follow the instructions carefully.
- If you are reluctant to take pain relief, talk with your doctor or midwife.
Thrush infection
Sore, itchy or cracked nipples may also mean you and your baby have thrush. It can affect your baby as a red nappy rash, or white spots may appear inside baby’s mouth. It is easily treated with medication from your midwife or doctor. You should continue breastfeeding as normal if you have thrush.
Inverted nipples
If you are concerned that you have an inverted nipple or nipples, seek advice from your doctor, midwife or lactation consultant. Don’t forget that babies breastfeed, not nipple feed and that it is very rare for women to not be able to feed because of an inverted nipple.
Tongue tie
Tongue tie is a problem that affects some babies when the thin membrane connecting the tongue to the base of the mouth limits movement of the tongue, making it hard for them to attach properly to their mother’s breast. This may be because it is too short, or it is attached in such a way that it “ties down” the tip of the tongue. Some tongue-tied babies breastfeed well, but many struggle to make a good latch and are unable to feed as well as babies without tongue tie. Tongue tie has been linked to a number of symptoms in mother and baby including:
- reduced milk supply
- sore nipples or a sensation of “chomping” when baby feeds
- trouble latching baby, who may become frustrated
- thrush – damage caused by the poor latch is a great place for thrush to settle
- mastitis – inflammation of the breast tissue, particularly the milk ducts and glands in breastfeeding mums
- very long or frequent feeds
- baby making a clicking noise or spilling milk out the side of their mouth
- baby being described as “windy” or as having “colic”
- low weight gains or “failure to thrive”
- reflux – when baby spits up or spills when the stomach contents are released up into the throat.
If you or your baby are experiencing any of these symptoms, talk to your midwife, doctor or a lactation consultant who will be able to discuss the different treatment options available to you to cope with your baby’s tongue tie, depending on the age of your baby and the type of tie that is present.
This article was prepared with the assistance of Health Navigator New Zealand.
Reviewed by: Lee-Ora Lewis, Clinical Nurse Director, Totara Health, and Liz Pearce, Parent Education and Operations Manager, Parents Centre.
