This page covers some of the common breastfeeding concerns that military mothers have including: engorgement, mastitis, plugged ducts, sore nipples and thrush. Also a brief overview of medication use while breastfeeding is covered. It cannot begin to cover the many concerns and questions that all mothers have about breastfeeding (such as premature babies, twins, tongue-tie, etc.). So I urge you to buy a comprehensive breastfeeding book and have the name and number of a lactation consultant or La Leche League Leader should you need further assistance for anything not covered on this page.
Engorgement is the swelling and filling with milk of your breasts that occurs when your milk “comes-in.” Your breasts will become larger, firmer, heavier, warmer, and oftentimes tender. This generally occurs about two to three days after the birth of your baby for a normal, vaginal, full-term birth. Engorgement can be delayed if you have had a cesarean or medications during labor. It is usually worse in first-time mothers or mothers who do not breastfeed often in the first few days. Engorgement occurs when your milk becomes more abundant, and it can be prevented by nursing on demand or at least every two hours from birth. But engorgement is not due just to milk, it is also caused by increased fluids and blood flow to the breast. Your breasts may be engorged because of IV fluids you received during labor. Should your breasts become rock hard, swollen, or tender despite frequent nursing, there are a few things you can do keep the milk flowing and reduce the swelling:
- Use a pump or hand expression to soften the breast enough for your baby to latch.
- Apply warm, moist heat to your breasts, stand in the shower with warm water flowing over your breasts, or lean over and soak your breasts in a sink of warm water right before nursing.
- Use cold packs between nursing sessions, 20 minutes on, 20 minutes off.
- Apply cabbage leaves (washed) inside your bra, wear them until they wilt, and then replace.
- If pain is severe, you can take a mild pain reliever.
- If engorgement is severe or lasts beyond 24-48 hours, you need to see an IBCLC.
If your breasts remain engorged, it can affect your milk supply. But more importantly, engorgement makes it hard for your baby to latch correctly because your nipple is flattened out. If he cannot latch correctly, he can’t remove milk, and this can lead to sore nipples. There is a technique you can use called Reverse Pressure Softening (RPS) to help reduce the swelling around your nipples, so your baby can latch properly. RPS works by moving the extra fluid away from the areola, relieves overfull ducts, and often triggers a let-down. It is done by practicing the following steps, which you can find at this page, along with pictures http://www.kellymom/bf/concerns/mom/rev_pressure_soft_cotterman.html:
- Using your fingertips (if your nails are short), place six fingers on your breast, three on each side at the base of your nipple.
- Press inward towards your ribs, firmly but gently (this should be painless).
- Hold the pressure from one to five minutes or until you see ‘dimples’ or can feel the areola softening.
- Do RPS sitting up or lying down (lying down will speed the process).
- Quickly latch your baby after removing your fingers.
Remember that nursing frequently after birth should prevent engorgement from occurring. But if it does happen, you can still breastfeed. Engorgement is usually temporary, so don’t give up. And get help if it is not getting better within 24-48 hours. For further information see this page about Engorgement .
Plugged Ducts and Mastitis
A plugged duct is a milk duct that is plugged and not draining. The milk backs up in the duct, which then becomes hardened and inflamed and often results in a tender spot or lump. The area can become infected if the plug is not loosened and drained. Plugged ducts are not as common as sore nipples, but every bit as bothersome. Most of the time they are your body’s way of saying you are doing too much!
Unfortunately, working mothers tend to suffer from plugged ducts more often than their stay-at-home counterparts for a few reasons. Plugged ducts occur when feedings or pumpings are missed or the breast is not drained completely, due to increased activity, fatigue, stress, incorrect positioning and latch, and pressure or anything that restricts the flow of milk (underwire bras, backpack straps, or heavy gear on the chest). Some mothers find that they get plugged ducts when their baby sleeps through the night for the first time. Low fluid intake and eating food high in saturated fat and salt can also cause them. Other mothers suffer plugged ducts repeatedly no matter what they do. Plugged ducts are easy to treat if they are caught in time. You will need to break up and move the hardened milk out of the duct by doing the following:
- Go to bed and rest.
- Nurse frequently.
- Start on the affected side and vary position, so all ducts are emptied.
- Apply warm, moist heat, and massage towards nipple. (You may see the plug come out, it will look like strings or beads of dried milk).
- Keep nursing or pumping to fully clear the plug (the milk will not hurt your baby).
Make sure you take care of plugged ducts quickly as they can turn into mastitis if not treated. Mastitis starts with a red, hard, warm, very painful spot on breast and includes fatigue, fever, and body aches (it feels like you have the flu). If your fever is above 101 or lasts more than 12 hours, you need to see a doctor and may be prescribed antibiotics. You do NOT need to wean. In fact, you should continue to nurse frequently to keep the milk moving so that you don’t become engorged or develop an abscess. The treatment for mastitis is rest and frequent breastfeeding on the affected side, massage, and warm, moist heat. If it is too painful to nurse on the affected side, you can pump (but the best pump is your baby). Mastitis also tends to cause a drop in milk supply (and the milk can develop a slightly salty flavor), so your baby may not want to nurse from that side, but you need to keep the milk flowing, so pump the affected side regularly. Your milk is safe for your baby: your breast is infected, not your milk. Any antibiotics you are given will not harm your baby. Be sure to finish all your medication, even if you begin to feel better, or the infection might come back. Mastitis is serious, but if caught early, it usually resolves with 24-48 hours. If left untreated, a breast infection can turn into an abscess, which requires surgical draining. Go to this page for more information on Plugged Ducts and Mastitis.
Sore nipples are by far the most common complaint made by new mothers, and many women think that having sore nipples is part and parcel of breastfeeding. That is NOT true, if your nipples are sore, then something is wrong and needs to be corrected. Breastfeeding should not hurt! The soreness can range from mild tenderness to toe-curling pain and is usually caused by incorrect latch and positioning. In most cases, sore nipples can be fixed quickly and easily, with the pain resolving within a day or so, if you see a La Leche League Leader or IBCLC at the first sign of a problem. It has been said before and it bears repeating: breastfeeding should NOT hurt, if it does, something is wrong.
Prevention of sore nipples is the best medicine, so be sure that your baby is latching properly. Bring your baby TO the breast, rather than bringing the breast to your baby. You should snuggle your baby in tight to your body, tummy to tummy without his head turned or tilted at an odd angle to the breast. There shouldn’t be any clicking or smacking sounds, and your nipple should not be misshapen when it comes out his mouth. Some mothers may have an initial, very mild tenderness that goes away within seconds during the first few days of nursing that can be considered normal. But anything more than that warrants a closer look at what might be the matter, as there could be something inside the baby’s mouth that is causing the problem, such as a tongue-tie. If your baby is incorrectly latched, he will not stimulate your breasts correctly and your milk supply may suffer.
If you are already suffering from sore nipples, here are some remedies to try while you wait to get professional help.
- Nurse on the least sore side
- first when your baby’s suck is the strongest, save the more sore side for when his hunger is subsided.
- Alternate positions at every feeding, this puts pressure on a different spot.
- Nurse more frequently, but for shorter lengths of time, so that he does not become ravenous and suck even harder.
- Take an over-the-counter pain reliever about 20 minutes before nursing.
- Use moist healing to prevent scabs (Lansinoh© or PurLan©).
For very severe sore nipples, where there is bleeding, blistering, or cracking, you will need to see an IBCLC to diagnose what is wrong and a plan for treatment. You may be advised to rest your nipples for 24 hours to allow them time to heal by pumping and feeding your baby in another manner (cup, medicine dropper, spoon). You will probably also need to see your HCP (healthcare provider) for antibiotics, as open wounds can lead to infection. However, if you get help at the first sign of pain, they should not progress to this point.
Thrush is a fungal infection caused by Candida albicans, that thrives on the milk on your nipples and in your baby’s mouth. Thrush usually starts after the first week of breastfeeding and causes intense pain, itching, and flaking on the nipples, along with a shiny, red rash. It also shows up as white patches in your baby’s mouth, along with a bright red diaper rash. Thrush often occurs after a round of antibiotics, when the good and bad bacteria are both wiped out and the normal fungi we all have on our bodies takes over.
If you feel that you might have thrush, you’ll need to see your doctor and get a prescription for medication to treat BOTH of you. Keep taking the treatment for two weeks, even if you feel better after only a few days because thrush can be hard to kill. Wash all bras and cloth breast pads in hot, soapy water, and be sure to wash your hands to prevent re-infection. If you get a thrush infection once you are back at work, you’ll need to boil all your nipples, pacifiers, and bottles, as well as pump parts every day until the infection is clear. You can and should continue to breastfeed throughout a bout with thrush. However, thrush can live in frozen breastmilk and will re-infect your baby if given to him at a later date. You can either toss the frozen, contaminated milk, or you can boil it before using it (although some of the nutrients will be lost). You can find more information about Thrush here.
Medications & Breastfeeding
A big question that many new mothers have is whether it is safe to take medications while breastfeeding. For the most part, yes, it is. But there are a lot of factors that go into any decision regarding taking medications, and this is one area that you will want to discuss with both your HCP and an IBCLC. Unfortunately, many doctors do NOT have updated references on the transfer of medications into breastmilk and will often tell you to wean or use formula while taking any medication. Talk with an IBCLC who has a copy of the book, Medications and Mother’s Milk, to determine if the drug you need to take will be safe. You can also logon to LACTMED, a drugs and lactation database hosted by the National Library of Medicine. If you have a smartphone, there is a LACTMED app that you can download to check medications on the fly. It is available for the iPhone and Android. You can also call the Infant Risk Center and talk to a qualified counselor at (806)-352-2519, they are available Momday-Friday from 8-5 CST or you can visit the website at http://www.infantrisk.com/.
Medication transfer into milk is dependent on many factors such as: the chemistry and molecular structure of the individual drug, how the drug is administered (oral, injections, topically), how it is absorbed, the age of your baby, how long you need to take the drug, and so on. Generally only one percent or less of a medication transfers to your baby through breastmilk. However, some medications affect milk production rather than the baby. There are many other factors to consider when discussing medications taken while breastfeeding. This is only a brief overview. Like most things with breastfeeding, you’ll need to weigh the risk of the medication and the need to take it for your condition, against the very real risks of using formula.
There are a few things to keep in mind when taking any medications that are prescribed to you:
- Take only medications that are absolutely necessary
- Take the lowest dose possible that is effective for your condition
- Medications that are safe for your baby to take directly are generally safe for you to take while breastfeeding
- Take medications right after nursing so that it has peaked in your milk before the next nursing session
- Once-a-day medications should be taken right before your baby’s longest sleep period
Remember, breastfeeding is the “best” medicine you can give your baby. It is worth it to insist that your doctor take the time to research and find a suitable medication.