Breastfeeding Problems

WHEN TO SEE YOUR DOCTOR

* Your breast is red, warm and sore for 24 hours and you have a fever, chills and feel achy as if you have the flu.

* You're not producing milk within a week after giving birth.

What Your Symptom Is Telling You

Nursing a baby doesn't always go smoothly, especially in the first weeks after birth. "Breastfeeding takes skill that mothers have traditionally learned by watching other mothers," says Ruth Lawrence, M.D., professor of pediatrics and obstetrics and gynecology at the University of Rochester School of Medicine in New York. "The problem is that many of today's mothers don't get to witness breastfeeding firsthand to learn the correct technique."

As a result, she says, a mother may not know how to properly position her baby at the breast. Held at an awkward angle, the infant can't latch onto the nipple correctly, and the nipples become sore.

And until the mother understands the baby's needs—and her own—her breasts may not be emptied enough at each nursing. This can cause the milk to back up, creating painful engorgement and sore nipples, says Dr. Lawrence. Also, milk ducts can get plugged up in overly full breasts. And a plugged milk duct can become infected, a condition known as mastitis. You'll know you have mastitis if, in addition to having a sore, red breast, you also feel feverish and achy, as if you have the flu.

Nursing technique is not the only source of problems, however. Both stress and fatigue can interfere with milk flow.

Symptom Relief

Most breastfeeding problems can be easily relieved with a little know-how.

Try a dab of cream. An over-the-counter breast cream like Massé helps soothe sore, cracked nipples without harming the baby, says Betty Crase, director of scientific information of La Leche League International in Chicago.

Warm your breasts. If your breasts feel full and sore, you may have a plugged milk duct. Get things moving again by leaning over a basin of warm water and immersing your breasts for five minutes, says Dr. Lawrence. Or cover your breasts with a warm, wet washcloth to encourage milk flow.

Get a bra that fits. "Anything that presses against a milk duct and interferes with the flow can lead to engorgement and possibly infection," says Karen Ogle, M.D., associate professor of family practice at Michigan State University in Lansing. Make sure your bra fits well and try not to sleep on your stomach for prolonged periods, she adds.

Use your own milk. Soothe and strengthen tender nipples between feedings by applying a thin layer of breast milk and allowing them to dry uncovered. "Breast milk has healing properties," says Dr. Lawrence. To speed the drying, use a blow dryer set on low.

Get some R and R. Rest and relaxation is absolutely essential for milk flow, says Dr. Lawrence. You need it to build your resistance and to counteract stress. Let someone else comfort the baby now and then. Let Dad do the cuddling or give the baby a bottle of pumped breast milk while you take a snooze. During breastfeeding or pumping, take the phone off the hook and remove other distractions, she adds.

Get an antibiotic. If you feel achy and feverish, see your doctor promptly. If you have infectious mastitis, your doctor will prescribe an antibiotic. You can still nurse, since it's the breast tissue, not the breast milk that is infected, says Dr. Ogle. The antibiotic that passes into the breast milk is probably fine for your baby, she adds, but you should check with your doctor to be sure. Ask your doctor about taking aspirin to relieve the discomfort while you're waiting for the antibiotic to kick in.

Get some support. If you're having a lot of breastfeeding problems and you've never been around other nursing women, it might be helpful to review your nursing technique. Ask your doctor to recommend someone who can show you the ropes. There are women's breastfeeding support groups, such as La Leche League International, that can provide detailed information and answer any questions that you may have.

Getting Off to a Good Start

Learning proper nursing technique before you ever put your baby to the breast will go a long way toward preventing problems. Here are a few things to be aware of.

Keep baby close after birth. A Swedish study found that when newborns are taken away from their mothers for measuring and dressing within the first 20 minutes following birth, they do not latch onto the breast as well as babies who are allowed to rest naked on their mothers' abdomens for an hour. "Don't hesitate to let the delivery room staff know that you wish to keep your baby on your tummy for a short while following birth," says Dr. Lawrence.

Assume the right position for nursing. The baby should be squarely facing the breast with his tummy touching yours, says Dr. Lawrence. Make a V with your fingers around the nipple to angle it up slightly. (If the breasts are so full that the nipple has flattened out, hand-pump a little milk to soften it.) Stroke the baby's cheek to make him open his mouth, then pull him in rapidly, thrusting the entire nipple and ¼ to ½ inch of the areola (darkened area around the nipple) into his mouth.

Easy does it. When the baby is finished feeding, insert your finger in the corner of his mouth. This breaks the suction of the baby's mouth around the nipple and prevents soreness.

Trust your baby's cues. Within a day or so after birth, breast milk will naturally "let down" into the breasts, replacing the initial yellowish secretions. As a rule of thumb, use both breasts during a feeding and let your baby suckle as much or as little as he wants. "Don't worry about underfeeding," says Dr. Lawrence. "Worry can lead to reduced milk. Breastfeeding is a baby-led phenomenon. The breast makes what the baby takes. If you have six soaked diapers a day during the first few weeks and the baby is gaining weight, you're making enough milk."

Try it on your side. Breastfeeding in various positions, such as lying on your side with the baby placed on the bed, helps evenly distribute the stress on the nipples and relieves soreness, says Crase.