Problem-Solving Guide

Many breastfeeding women experience problems or difficulties during the time they are expressing breast milk or breastfeeding their baby. Some of the most common problems are discussed below.

Sore nipples

Sore nipples are common for many women during the first few days as they begin pumping for their hospitalized baby. The following measures may be helpful:

• Place a clean, warm, wet washcloth on the breasts just before pumping. This will help stimulate your milk flow.
• Massage both breasts and gently roll the nipples between your fingertips just before you pump. This will help your milk flow more readily, hopefully allowing you to use a lower suction setting.
• Gently hand-express a small amount of milk just before you pump. This will stimulate milk to flow more easily because of the hormones your body releases in response to the hand expression.
• Try a different size flange or a different brand of pump if your nipples do not fit comfortably within the flange.
• Use the lowest suction setting that removes milk.
• Place a warm, wet washcloth on your nipples for a few minutes after pumping sessions to soothe sore nipples.
• Massage breast milk into your nipples and allow them to air-dry after pumping. Apply a small amount of hydrous lanolin onto your nipples after they are dry. Hydrous lanolin is extremely pure lanolin. An example of a brand of lanolin safe for use with breastfeeding is Lansinoh® or PurLan.
• Wear breast shells between pumping sessions during the day to keep clothing from rubbing your nipples and irritating them. Do not wear the breast shells while sleeping. The shell may shift during sleep and cause pressure on tender breast tissue.
• Nipple or breast pain that lasts throughout the feeding and does not improve after baby has a better latch or changes position may be due to a yeast infection called thrush. If you have thrush, your nipples may itch or burn, appear pink or red, and may have a rash. If your baby has thrush, creamy white patches may appear inside your baby¹s mouth or on your baby¹s tongue. Babies often also get a red, bumpy diaper rash. If you suspect a yeast infection or thrush, contact your doctor and your baby¹s doctor. This condition requires special medicine to treat both you and your baby.

Engorgement

About 2 or 3 days after the birth of your baby, your breasts will increase in size and feel much fuller and heavier. This is normal engorgement and is caused not only by an increase in the volume of milk in your breasts but also by increased blood flow and tissue swelling. They may feel slightly warm when you touch them and may be slightly reddened. This is the beginning of milk production. The following list includes techniques that will help you manage engorgement so it will end in 2 to 3 days.

• Pump often, at least every 2-1/2 to 3 hours. Pump for at least 2 full minutes after your milk stops flowing.
• Before pumping, apply a clean, warm, moist washcloth to the breasts for 10 to 15 minutes, or take a warm shower. Heat will help your milk to flow more easily.
• Massage your breasts and gently roll your nipples between your fingertips before pumping. This will stimulate milk flow.
• Massage both breasts during the pumping session. This will also help the milk flow.
• Be sure not to skip any pumping sessions, even at night.
• Cold compresses or ³icy diapers² applied to the breasts between pumping sessions will be soothing and may help reduce swelling. To make ³icy diapers,² fill disposable diapers with water and place the diapers in your refrigerator or freezer for 20 to 30 minutes. These cold, wet diapers can be tucked and worn inside your bra until they lose their chill.
• Pumping often will help relieve your engorgement, not make it worse!!

Plugged ducts and mastitis

Occasionally, a hard, painful knot may develop inside a breast. This is usually caused by a milk duct that is not draining well or is plugged. The area may be slightly reddened and warm when you touch it. It is important to unblock a plugged duct as soon as you become aware of it. If a plugged duct is not corrected, it can lead to an infection called mastitis. If you have a plugged duct, try following the strategies listed to help relieve a plugged duct.

Symptoms of mastitis include headache, fever, chills, backache, body aches, and a flu-like feeling in addition to those symptoms experienced with a plugged duct. If you have the symptoms of mastitis, call your OB doctor. He or she will likely prescribe antibiotics. If you have mastitis, it is important that you rest in bed, drink plenty of fluids, take your prescribed medicine, and follow the suggestions listed for relieving a plugged duct. Inform your nurse if you have mastitis and are taking antibiotics for this condition. Continue to pump or nurse frequently.

Relieving a plugged duct

• Apply a clean, warm, wet washcloth to the sore breast or take a warm bath or shower just before pumping.
• Massage the breasts gently, especially over the sore, hardened area, stroking gently toward the nipple.
• Massage the breast during the pumping session, gently stroking down toward the nipple.
• Pump more often during the day and at night until you can no longer feel the knot.
• Position the baby¹s chin toward the plugged duct if feeding at the breast.
• Begin feeding on the affected breast until resolved.