Up to 6 weeks

What to do about breastfeeding difficulties

Sore and cracked nipples
Sore nipples are usually caused by incorrect positioning of the baby at the breast. Make sure baby is attaching properly.

To help heal sore and cracked nipples:

• express a few drops of breastmilk, gently massage it on the nipples, and allow to dry
• leave them uncovered or loosely covered between feeds to help them heal
• avoid using soap on them.

Pain may be helped by taking paracetamol as directed on the packet; prolonged (for more than a couple of days) or excessive use may be harmful. See your health professional if pain continues.

Other causes of sore nipples

• Pain may also be caused by blocked ducts or nipple and breast infections.
• Thrush infections - thrush pain usually occurs throughout and even after the feed; it can feel like a burning pain.
• A spasm of blood vessels can cause some women to experience pain after the feed. It is often felt as a burning pain, the nipple looks white, then a throbbing pain occurs as the nipple turns back to its normal colour.  (This may be a condition called Raynauds disease.)

If you cannot improve your baby’s position, and your nipples are not healing or continue to be painful, get help from your midwife, Plunket staff, other well child health provider, La Leche League, a lactation consultant or doctor.

Engorgement/breast fullness
Breast fullness usually occurs 2–4 days after birth. The breasts become swollen and are hot and painful to touch. To relieve breast fullness and engorgement try:

• frequent feeding', making sure your baby is attached well to avoid sore, cracked nipples
• gently expressing enough milk to soften the areola if it is too swollen to allow baby to get onto the breast correctly
• using different feeding positions or try to feed lying down
• warm showers before feeding
• putting cool face cloths (flannels) on the breasts between feeds
• wearing a comfortable, non-restrictive, supportive bra
• taking paracetamol as directed on the packet for pain; prolonged (for more than a couple of days) or excessive use may be harmful. See your health professional if pain continues.

Blocked ducts and breast infections (mastitis)
Breastfeeding mothers may experience breast lumps, which may mean a blocked duct. To help clear blocked ducts try feeding frequently from the affected breast, but continue to feed from both breasts. Change breastfeeding positions or try hot showers or applying warm face cloths to the affected breast. Gently massage any lumpy areas towards the nipple. A painless, persistent lump should be checked by your midwife or doctor. Symptoms of a breast infection are aches and pains, fever, feeling shivery like the flu, or a painful pink or red area on the breast. If any of these symptoms are present contact your midwife or doctor as soon as possible.

To help recover from a breast infection:

• keep feeding your baby as advised for blocked ducts as the symptoms clear more quickly if the breasts are kept from getting too full - having a breast infection does not make the milk harmful for baby to drink
• take paracetamol as directed on the packet for pain; prolonged (for more than a couple of days) or excessive use may be harmful - see your health professional if pain continues
• drink extra fluids
• get plenty of rest and try to sleep when your baby sleeps.

To help prevent breast infections and blocked ducts, avoid wearing tight clothing or poorly fitting bras. If you are having problems or concerns with breastfeeding, talk to your midwife, Plunket staff, other well child health provider, La Leche League, a lactation consultant or doctor.

Drugs and breastfeeding
Before taking any medication talk to your midwife, Plunket nurse or other well child health provider, doctor or pharmacist, about the effect of the drug on your baby (through the breastmilk). Over-the-counter medicines from the chemist and alternative medicines may pass through the breastmilk. It is best not to use these when breastfeeding unless discussed with your health professional.

Alcohol and breastfeeding
The long-term effects on the baby if the mother drinks alcohol when breastfeeding are unknown. It is safest for breastfeeding mothers not to drink alcohol.

Smoking, marijuana and P and breastfeeding
Smoking has been found to reduce the amount of milk produced and babies may have slower weight gain. Smoking also increases the risk of SUDI (SIDS or cot death). Marijuana and the drug P also pass through to the breastmilk and are known to affect babies.