Lactation help with information on prevention and treatment of breast infections, mastitis, engorgement, nipple confusion, overactive milk supply, plugged milk ducts, sleepy baby, sore nipples, yeast and thrush.
Mastitis is an infection of the breast usually following an untreated plugged milk duct. Watch for chills, fever, and flu-like symptoms. Use the same techniques as for a plugged milk duct and call the doctor for an antibiotic. If you have been wearing tight-fitting or under wire bras, treat yourself to a supportive nursing bra that won't plug your milk ducts. Remember...heat, rest, empty the breast.
If nipples are cracked or bleeding, follow the steps above for sore nipples, but use breast shells to keep the skin from pulling away when you change bra pads. A little blood won't hurt the baby because breast milk is blood product. A new product is now available that had been used to treat burn victims in the past. These Hydrogel Comfortgel pads are extremely helpful in healing wounded nipples.
If you are experiencing difficulty with breast pain or latch-on 3 to 5 days postpartum, it is probably due to engorgement. Advil is safe for breastfeeding and contains an anti-inflammatory that may reduce some swelling and discomfort. Your best friend during this time is a hot compress. Turn the tap water and let it run until hot. Take two disposable baby diaper and swipe it under the tap three or four times. Mold the diapers around your breast. Repeat this procedure before each feeding. Commercial hot packs are also available, but the diapers work just as well so you may want to save your money for a good breast pump. If the areola is still too hard for the baby to grasp, use a quality breast pump for three to five minutes before latching the baby on. If the baby goes to sleep before emptying the breast, finish pumping afterward. Take heart! Engorgement only lasts for 48-72 hours.
Nipple confusion can occur when a baby is given a bottle before they have learned to breastfeed well. It is important to wait to feed breast milk from a bottle until the baby is at least 4-6 weeks old and is latching on and nursing well. If nipple confusion occurs, one remedy is to follow these steps. Purchase a nipple shield and change the bottle nipple to a wide mouth silicone style like Avent. For 24-48 hours, turn the baby tummy to tummy with you and with your bra flap down, hold the bottle tight against your breast while feeding. Once the baby stops fighting being held tightly, use a nipple shield on your breast to get them to take your nipple. Drip breast milk onto the tip of the nipple shield or fill the nipple shield with milk while holding your finger over the holes prior to putting on the breast in order to give the baby the immediate gratification he or she is used to with the bottle. This process will take several days, but be patient and don't show stress or the baby will sense your tension. See more info on the topic of Nipple Shields in our Q & A list.
Plugged Milk Ducts
Plugged milk ducts feel like a pebble or a pea under the skin or areola. They are best treated with hot compresses, breast massage during feeding , and pumping after the feeding. Place the baby's chin toward the plug if possible, massage from behind the plug towards the nipple, and pump for ten minutes after each nursing until resolved. Make sure you are not wearing a nursing bra that is too tight or that has an under wire pushing into your milk ducts.
This is a common concern for newborn infants. First I would take a look at any painkillers you are taking. Pain medication from the hospital can cause the baby to be sleepy. Tylenol, Advil, and Aleve are all safe for breastfeeding and will not make the baby sleepy. Next, be aggressive. New moms tend to be very gentle, but newborns don't always know when they are hungry, so you have to wake them up every two to three hours with no more than one five hour stretch in any 24 hour period. Techniques for waking a baby include, stripping him/her down to a diaper, using the clutch/football hold so the baby is more upright, washing their face before nursing, changing their diaper, rubbing their hands, face, feet, or back. My personal favorite is alternate breast massage. As soon as the baby stops sucking or swallowing and begins to fall asleep. Massage the breast from underneath towards the nipple. This wiggles the nipple and "milks" the breast into the baby's, reminding him or her to start nursing again.
Early onset of nipple soreness can be due to a number of things. Poor positioning, poor latch-on, not breaking the suction properly, bras and pads that aren't cotton or changed infrequently, or bad breast pumps. Make sure that the baby's ear, shoulder, and hips are aligned. Make sure the baby has 1 - 1 1/2" of the areola in his/her mouth. Make sure you break the suction when you take the baby off the breast by releasing the seal with your finger. Keep the baby from slipping down by supporting the breast during the entire feeding. Use a firm pillow or nursing pillow to the baby's body from becoming too heavy to hold. Air dry the nipples after each feeding. Use expressed milk or hospital grade lanolin sparingly on sore spots. Comfortgel pads can also be used to speed healing. Use only 100% cotton or paper, breathable nursing pads and change them frequently. Nipples may still be uncomfortable for a few seconds after latch-on, but they should be getting better daily.
The most common misconception is that nipple shields are a barrier to protect your nipple from pain if the baby latches on incorrectly or if you already have an abrasion. This is a myth. If the baby latches on wrong to your nipple, he will also latch on and cause pain through a nipple shield. Nipple shields are a tool for use if the baby is nipple confused and should be used for short term transition from bottle to breast. If nipple shields are used for more than 3-4 days, it is imperative to double pump twice a day for 10-15 minutes to offset the decrease in milk supply that they will cause.
Yeast - Thrush
Vaginal yeast infections are something every woman wants to avoid. Mothers may get yeast infections on their nipples as well if the conditions are right for yeast to overgrow. Antibiotics are the culprit in many situations. If you find yourself on an antibiotic for any reason or if your baby has thrush, it is important to protect yourself from a yeast infection by limiting wheat, refined sugar, honey and of course alcohol in your diet. Acidophilus is a supplement that can be helpful in maintaining normal intestinal flora. If you do get a yeast infection on your nipples, symptoms may include a red "sunburned" area around the nipple covering part of the areola, white bumps on this nipple or areola, OR you may have neither of these visible signs, but you have sharp shooting burning pains even in-between
feedings, not just when the baby latches on. Healing always necessitates that you and the baby are treated simultaneously. If the pediatrician has prescribed oral Nystatin for oral thrush or Nystatin cream for a yeast diaper rash, these products can be used on your nipple as well. Diflucan may be prescribed by your OB-GYN or family doctor, but if you have topical symptoms, treat them as well with cream or Gentian Violet. If you are using over-the counter-medications, Monistat cream can be used on your nipples after the baby nurses and on the baby's bottom. The baby's mouth would need to be treated with Gentian Violet which is a purple substance obtained at a pharmacy. It usually comes in 1% solution, but need to be diluted to .5% by using half Gentian Violet and half water. If using Gentian Violet, it is not necessary to use another product on the same area. Paint the baby's mouth or your nipples with the diluted solution. Wait for the purple to disappear before re-applying. Do not apply more than three times! If you are using a cream instead, you may want to rinse the nipples in a glass bowl filled with warm water and a tablespoon of vinegar.
To prevent yeast from re-occurring:
Do not freeze breast milk for later use. Spores with become active again when defrosted.
Use breathable disposable bra pads like the La Leche League Disposable pads. Most other brands are not 100% paper and will greenhouse the yeast. Change them with every feeding.
Boil plastic items like bottle nipples, bottles, and breast pump parts with each use. Use as few of these items at this time as possible because they will need to be replaced near the end of your treatment.
Treat both mom and baby until both no longer exhibit symptoms. Then treat for three days after that point to prevent recurrence. During this time, discard and replace bottle nipples, breast pump parts that touch the milk, plastic bottles, pacifiers, etc.
Never loan out your breast pump or use another mom's used personal breast pump. It is just like sharing underwear, a toothbrush or a swimsuit!
Take Acidophilus, eat plain vanilla yogurt, limit refined sugar, wheat, honey and alcohol in your diet for two weeks after yeast infection.