- Abscesses, Plugged Ducts & Lumps
- Insufficient Glandular Tissue (Hypoplasia)
- Large Breasts
- Mastitis (Breast Infection)
MILK & SUPPLY
Biting & Baby Teeth
Abscesses, Plugged Ducts & Lumps
Learn how to continue milk flow as the baby sucks even if the baby cannot or will not drink.
Colic in the Breastfed Baby
Insufficient Glandular Tissue (Hypoplasia)
When I learned that 2% of women have this condition that renders it impossible to breastfeed in the way that the other 98% can, I considered what that would have been like for me. With my heart in another’s chest, I read and listened to the stories — then I cried. I looked at my baby later on when he nursed, and I cried some more, which made my milk shoot out in emotion-driven torrents at his face. He could hardly stand how much milk was coming at him. He choked.
One mother I met in a La Leche League meeting told me that when she first learned about breastfeeding, she understood that it would feel like running a marathon every day for a while. Then reality hit: with her second baby, she was finally diagnosed with Insufficient Glandular Tissue/Hypoplasia, and suddenly everything made sense — unfortunately, it was the sense of knowing breastfeeding wouldn’t work like she’d hoped. Without warning, she found herself at the starting line of the marathon with paralyzed legs, wondering why the hell she signed up for this. But she was already there, ready to race, and though she struggled enormously, she ended up breastfeeding two babies (with another on the way).
Sometimes even all the determination, motherly love, multiple diagnoses by doctors, endless cups of Fenugreek tea and all the steel-cut galact-OAT-gogues in the world can’t fix what simply cannot work. For a mother who desperately wanted to breastfeed, the devastation in learning she is one of the rare women afflicted with IGT/hypoplasia can not only break her heart, but also everything she’d imagined for her world as a mother. It’s important to be especially sensitive if a woman you know recognizes that she has IGT.
- “Breastfeeding with Insufficient Glandular Tissue” – Jennifer Johnson
- “Hypoplasia/Insufficient Glandular Tissue” – Diana Cassar-Uhl, IBCLC
- “Supporting Mothers with Mammary Hypoplasia” – Diana Cassar-Uhl for LLLI
Low Milk Supply and/or Slow Letdown
Mastitis (Breast Infection)
Milk Blister (Bleb)
A milk blister (not to be confused with a blood blister), also known as a “bleb,” is a blocked nipple pore that looks like a white pimple. I attempted to pop mine (a leftover habit from, uh, pubescent dermatological issues), and guess what happened? Thrush happened. Learn from my mistake and instead check out these easy home remedies to fix a bleb. You should continue breastfeeding if you have a bleb. Also please note that herpes blisters can be mistaken for milk blisters, and in this case breastfeeding should cease until the lesions are healed.
- “How Do You Treat a Milk Blister?” – Kelly Bonyata, BS IBCLC
- “Milk Blister” – BFeeding Mamma, Tracy Behr
- “Nipple Blebs/Blisters” – Catherine Watson Genna, BS, IBCLC
- “White “pimple” on nipple” – Kathy Kuhn, RN, BSN, IBCLC
Nipple dermatitis and eczema can cause pain while breastfeeding and put a mother at greater risk for breast infection and thrush. Anne M. Montgomery, MD, IBCLC describes contributing factors to various areolar dermatoses:
“Breastfeeding may cause irritation of the nipple and areolar skin leading to outbreaks of these dermatoses in susceptible women. Topical agents can lead to contact dermatitis. Maternal allergy to foods or cow’s milk or soy formula consumed by the nursling and still in the mouth during breastfeeding can also contribute.”
Susceptible breastfeeding women include those a history of eczema, sensitive skin, history of yeast infection, whose babies use bottles and/or pacifiers which spread bacteria, or those whose babies have started consuming solids (contact dermatitis).
SkinSight recommends to “[c]leanse the area after nursing with a soft warm-water-moistened cloth and then apply either a purified lanolin cream or petroleum jelly,” which you should leave on while nursing. Natural nipple butter or the prescription created by Dr. Newman called All-Purpose Nipple Ointment (APNO) can also help demolish dermatitis.
Also please note that one of the first symptoms of a rare form of breast cancer called Paget’s disease is an eczema-like rash on the nipple (usually just one to start) so it’s crucial to have this ruled out by a doctor.
- “Eczema of the Areola and Nipple in the Breastfeeding Woman” – Penny Lane DNP, CNM, IBCLC
- Eczema Q&A – Anne Smith, IBCLC
- “Helping a Breastfeeding Mother With Poison Ivy Dermatitis” – Sue Iwinski, AAPL
- “Nipple and Areolar Eczema in the Breastfeeding Patient” – B. Barankin
- “Nipple Dermatitis” – SkinSight
Read “It’s Closing Time.”
Oversupply and/or Overactive Letdown
Sore, Bleeding or Cracked Nipples
At some point in your breastfeeding journey, you will probably have sore nipples. Your nipples can feel sore from virtually any reason under the sun–postpartum hormonal changes, early engorgement, shallow latch, dryness, medical conditions such as thrush and vasospasm, suction trauma, a biting baby, allergic reaction to a lotion or fragrance, even sunburn if you’ve been spending your summer beach days all Europa-style. Sore nipples is also one of the first signs of pregnancy for many women.
“The best treatment for sore nipples is prevention.” Probably not what you wanted to hear, but it’s true, says Dr. Jack Newman. The most important part of treating sore nipples is to target the cause of the pain and effectively treating that.
If you’re suffering from sore nipples (whether unbroken skin or broken, cracked skin), it’s time to evaluate a few things:
- How’s your latch?
- How about your positioning?
- Are you engorged so much that your areola skin is constantly stretched very tight?
- If nipple trauma is persisting, have you considered whether baby might have nipple confusion? (If you use bottles or pacifiers, baby might be enacting the “bottle suck” on your very un-bottle-like nipple).
- How’s your breast pump working for you–are your flanges the correct size?
- Are you reacting to the material in a nipple shield or ingredients in a nipple cream?
- If you’ve introduced solids, have you noticed if leftover crumbs/particles are still hanging out in baby’s mouth when nursing?
- Have you been following your great-granny’s “sage” advice to scour your nips with something super rough in preparation for nursing? (I really hope not!)
- Is your baby teething and chewing, or even biting?
- Have you noticed oozing pus, bleeding, swelling, or indications of a bacterial/fungal infection? At this point, you should consult with your doctor for a diagnosis and possibly antibiotic.
…okay, that was more than a few things!
While working on a resolution to the source problem, there are a few ways you can find relief for the nipple pain. A little dab oughta do ya:
- Breast milk has amazing healing properties. You can hand-express a bit and swipe it over the areola to benefit from the sterile, anti-infective, anti-bacterial properties.
- Medical-grade Lanolin such as Lansinoh is the go-to for most nursing mothers (vegans should avoid as it’s derived from sheep’s wool). This is safe to leave on the nipples while nursing. Please note, any cream or oil that you use on your nipple–even if you plan to wipe it off before nursing–must be deemed safe for consumption by your baby.
- Use All-Purpose Nipple Ointment (APNO), created by Dr. Jack Newman, after each feeding.
- Apply Evening Primrose Oil for soreness around the time of ovulation/menstruation.
- Coconut oil can re-establish moisture balance to especially dry nipples.
- If nipples are cracked, apply an ice pack to numb the areola before latching. Then do a salt water rinse (saline soak) after nursing.
- Between feedings, protect your nipples from rubbing against your bra with clean disposable breast pads. Better still, go topless and give them plenty of air-time.
Some old wives’ tales about nipple care during breastfeeding still circulate in mothers’ groups, families, and even medical communities. Here are a few myths and misconceptions:
- Despite what granny might insist, it’s not necessary to “prepare” your nipples during pregnancy for breastfeeding. You might hear that you should twist and pull them, rub them with a rough towel, sand them (seriously, women did this), and various other pretty horrible things to “toughen” them. Well, you shouldn’t! If you really feel you must do something, you can give them lots of air-time, or practice breast compressions.
- You should avoid soaps and body lotions on your nipples. The areola has a protective secretion already that is meant to keep the area’s moisture balance in check. Nipples that are supple from their natural oils are good for breastfeeding, not ones that are regularly wiped off and scrubbed.
- Though it seems like the damp warmth of wet tea bags would feel really good on achy nips, they can increase dryness and pain.
- Drying your nipples with a sunlamp or hair dryer is an outdated, bad idea. You want to promote what’s called moist wound healing (which speaks of internal hydration balance in tissues rather than external moisture), which has been proven to heal nipple abrasions twice as quickly as drying out the area.
- Be careful with hydrogel dressings commonly given in hospitals because they’ve been reported to have high infection rates.
- Avoid nipple shields as they aren’t proven to prevent (or even decrease, in many cases) nipple soreness.
- “Assessing the evidence: Cracked Nipples and Moist Wound Healing” – P. Buchanan and the Breastfeeding Network
- “Nipple Pain: Causes, Treatments, and Remedies” – Jahaan Martin
- “Sore Nipples” – Jack Newman, MD, FRCPC
- “Why are my nipples sore after months of pain-free nursing?” – Kelly Bonyata, BS, IBCLC
Vasospasm in breastfeeding mothers is an extremely painful spasm in the breast’ blood vessels due to lack of oxygen. It occurs with nipple damage.
Nipple blanching is an associated symptom of a present vasospasm. There are two reasons for blanching: compression (due to poor latch, tongue tie, clamping reflex, etc) and vasospasm. If the cause of blanching is compression, latch is usually the culprit; the nipple emerges from the baby’s mouth appearing misshapen and white but will soon regain its color and form. Otherwise if the issue is vasospasm, the blanching is not caused by poor latch but by trauma to the nipple, which doesn’t turn white until after breastfeeding.
Though less common, vasospasm sometimes results from Raynaud’s disease or Raynaud’s phenomenon.
- “Nipple Blanching and Vasospasm” – Kelly Bonyata, BS, IBCLC
- “Nipple compression stripe” – Kathy Kuhn, IBCLC
- “Vasospasm and Raynaud’s Phenomenon” – Jack Newman, MD
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