Got a Milking Problem?

BABY BEHAVIOR

BREAST TISSUE

MILK & SUPPLY

NIPPLES

TIPS

breastfeeding-room-189

Atypical Nipples

See the “Another Round of Anatomy” page here.

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Biting & Baby Teeth


Read about it in my post “Biting & Baby Teeth With Breastfeeding.”

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Abscesses, Plugged Ducts & Lumps


For more info read my post “Don’t Let a Breast Lump Turn You Into a Grump!

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Breast Compression

Learn how to continue milk flow as the baby sucks even if the baby cannot or will not drink.

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Colic in the Breastfed Baby

Read my post on this topic here.

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Engorgement

Read my post on this topic here.

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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.

And how fucked up and fucking unfair is that?? Why does there have to be this minority of women afflicted with this condition? Why can’t nature round the statistic population down to zero already? Why are scientists giving us Cialis and Viagra and funding research on the obvious ill effects of soda consumption, but we’re still waiting on a cure for cancer–oh, and better solutions for IGT affected women so they can feed their babies as they wish, as the babies expect and deserve and have the right to be fed?

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 true 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 in knowing that breastfeeding wouldn’t work like she’d hoped it could. 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 devastating reality of learning that 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.

Do you think you might have IGT? Diagnose yourself here, or click here to see photos of hypoplastic breasts.

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Large Breasts

Obese women are less likely to breastfeed than normal-weight mothers, a study found. This may begin soon after birth as obese mothers’ milk is often delayed to come in, causing these mothers to abandon it. Even if a mother is not obese but simply has very large (DD-cup or bigger) breasts, she may struggle with unique problems that are typically not discussed in breastfeeding classes that speak to a largely (see what I did there?) average demographic. Unless you believe you might have gigantomastia (read about it in the links below), here are a few tips that can help.

FOR MAMAS WITH TA-TAS SIZED ON THE LATER END OF THE ALPHABET:

Use the football hold (clutch hold). This is a good way to encourage proper latch without making the baby feel trapped, or overwhelmed by the shared body heat. Traditional cradle hold can be difficult with large breasts, but side-lying position tends to be much easier for top-heavy gals than for flat-chested ones. Football/clutch is good for allowing at least one of your arms control of your breast and baby’s head position without needing a free hand to act solely as support for your baby’s weight or your breast’s weight:

Supported football/clutch hold via allinahealth.org

Make sure baby is breastfeeding, not nipple-feeding. See “Anatomy” if you need a biology crash course. Babies need to compress the areola to transfer the milk, so make sure as much of the areola is in the mouth as possible. This can be especially hard to tell with newborns as their mouths are teensy-tiny, so if you aren’t sure what you should be looking for, don’t hesitate to ask for a lactation consultant’s help. Also, make sure to keep breast tissue from pressing into the baby’s nose so she is able to breathe freely. With football/clutch hold, its easier to see how much of the areola is in baby’s mouth.

Football/clutch via phdinparenting.com.ph

Always have a support for the breast. This is especially important for babies who don’t have independent head control yet. Try “c-hold” or place a pillow or rolled-up towel beneath the breast. When in public, try clutching your diaper bag so your breasts can rest on top and baby can remain at your side in clutch-hold position. Keep baby level with the nipple and bring baby TO the breast; do not bring your breast to the baby. This can be scary, intimidating, and too forceful for an infant. Think comforting, not smothering (ironic how the word “mother” is in there, huh?). By positioning baby in the vicinity of the breast, you allow him the choice to hang out for a while or immediately root around, depending on his fulfillment instinct.

Speaking of support, you’ll need properly-fitting nursing bras. Ones that shift between sizes, ones that stretch, ones that un-snap or detach for easy public nursing, ones that hold the twinsies up without underwire, pads, or gel inserts, ones that feel comfy, and of course they have to be cute enough to help you make more babies 🙂 The best time to purchase bras is in your final trimester when breasts are closest to their milk-bearing size (1-2 sizes larger). Consider using a band extender until your ribcage settles back into pre-pregnancy position.

  • Anita – Well-reviewed maternity/nursing bras an lingerie, plus an easy-to-use size calculator.
  • Breakout Bras – Full Figure & Plus Size nursing bra sizes up to 40GG.
  • Mommy Gear – Many full-figured women swear by Goddess brand nursing bras, found here and at other retailers.

Nursing in public can be an exceptional bitch for mothers with large breasts. Plan accordingly, and practice during pregnancy with a doll if you have any lying around. Finding a carrier or sling that works for nursing will take a sense of experimentation, too. Sometimes bustier mamas are at greater risk for stranger harassment, which is even without my emphasis, unequivocally unfair. It’s a nitpicky kind of bullying. Do women with smaller chests seem to “get away with it” as if they were somehow more graceful and socially sensitive to nurse in public with less of a “show”?

If more of one mother is (God forbid!) exposed to offer to her child as comfort and food, simply because she happens to have more of it, then so be it because the same rules apply to all of us: breastfeeding however it needs to happen, whatever you look like doing it, is always a beautiful thing. And our children know that, too. It’s the offended onlooker’s attitude that is poisonous to society, not a mother’s act of familial love.

The clothes we wear and the size and shape of what’s below them are irrelevant to the fact that we are all doing the SAME THING — providing for our babies. And remind everyone else by continuing to serve up your milkshakes as requested by your child. By your child! Yep, also remind those who have a problem that this is about children, not boobs!

Now for a bit of a strange transition: Know the signs of a yeast infection under the breasts (okay, so sometimes it IS about boobs. And I apologize for the awkward topic change. Moving on). For prevention: keep the breasts free from moisture–especially in the folds underneath, the cleavage, and in any folds near the armpits–by rinsing and drying on a daily basis with water only (no soap, cream, astringents or shampoos).

Trust that your infant has got this nursing thing down. However, you may not…but that’s okay! Babies are entirely driven by needs (often confused mainstream beliefs as “spoiled” wants), and they know what they need. It’s usually pretty freaking hard to know what they’re communicating, but if you listen hard you’ll at least catch the important bits. Those usually translate as: “Boob! Boooob! Closer to BOOB!”

breastfeeding-individuals-069

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Leaking

Leaky boobs are really an imposition upon convenience rather than a condition that needs a “cure.” If your faucets just don’t seem to turn off, know that even though your shirts will get damp, it shouldn’t put a damper on your breastfeeding success.

The amount of leakage is not necessarily related to how much milk you make; alas, if you never leak or only leak minimally, that is not a sign that you have low supply or slow letdown. Predisposition to leak milk is related to a woman’s physical duct anatomy, not necessarily how much those ducts can hold, and also what’s going on with her hormonally (is she hearing or seeing crying babies or puppies or looking at photos of cute little beings often? Is she leaking at oxytocin surges during sexytime? Many women leak when they merely think about their babies, as this stimulates the letdown response).

Of course, it can be embarrassing (and messy) if you have to deal with wet spots the size of, well, milk saucers on your shirt every time you hear a baby whimper at the grocery store. No one signs up for motherhood expecting to look like a Wet T-Shirt Contest participant, right? A variety of different breast pads are on the market to help wick away and absorb spillage so you can leave the house without fear of looking like a pair of invisible rain clouds had just released isolated showers upon your breasts.

I only leaked a few times, so I asked several more experienced moms about it and my unscientific poll revealed that silicone LilyPadz were recommended most often. You can mix-and-match styles and brands for different times/places (overnight, at home, with certain outfits, etc) or just stock up on one type that works for you. you can also purchase homemade breast pads on Etsy, or make your own if you happen to be so crafty.

lilypadz-single-pair

Via lilypadz.com

Things to consider when choosing breast pads:

Absorbency – Based again on my unscientific poll, the women asked swear that washables are not as absorbent as disposables (Lansinoh brand got high marks). If you’re leakiness is monsoon-like, washables may not be able to wick the moisture away as well as disposables. However, if the milky skies’ precipitation is only forecasting drizzles here and there, the comfort of washables may be worth it.

Convenience – Disposables simply get tossed (not very convenient for the environment though), and washables must be laundered. Re-usables such as silicone LilyPadz can simply be rinsed or wiped off and allowed to air-dry. Disposables can be great when traveling, or you can keep a handful in your purse “just in case.”

Cost  – If you leak frequently, you’ll be constantly buying new boxes of disposables. Washables and re-usables are a one-time fee.

Look/feel – Disposables can tend to bunch up and fold over, however when properly placed they don’t show through shirts as much as the thicker washables. However, the washable brand Bamboobies is known to give a pretty smooth, more seamless look under shirts. Also, sometimes disposables get a bit sticky from the adhesive and can feel “papery” and itchy as opposed to most washables, which are made of a softer natural material.

Other purposes – Disposables are great as a barrier between your bra and breast if you are using lanolin or a breast ointment/cream that you don’t want rubbing off. This type is also useful if you’re in the throes of thrush, as you’ll want to keep the nipple area as dry and clean as possible. LilyPadz are pretty cool because you can use them while you go swimming or feel free to go braless. Niiice!

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Low Milk Supply and/or Slow Letdown

Read my post “The Lowdown on Low Milk Supply and/or Slow Letdown.”

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Mastitis (Breast Infection)

When it comes to a breast infection, proper diagnosis is key; avoiding antibiotics is ideal. Mastitis and blocked ducts are similar enough that it can be confusing to figure out which condition you have, especially since a severely blocked duct can be as painful as mastitis and come with a fever like mastitis. The difference is that mastitis is usually treated with antibiotics (though this is not the ideal solution) because it’s caused by an infection in the breast, and a clogged duct is not. Though very rare, please be aware that Inflammatory Breast Cancer has the same symptoms as mastitis.

If you have come down with mastitis, expect sudden flu-like symptoms. There’s your first clue. Also survey your breasts for a sudden red rash, often in a triangular shape along where one or more ducts should reside. The rash may be hot to the touch with angry-looking red streaks or in a patch.

Predisposing causes of mastitis include: cracked nipple, plugged duct, ineffective drainage by the baby or a pump, tight-fitting bra, waiting too long between feedings, stress, fatigue, and anemia.

Be prepared for bad advice from health professionals in regard to breast infections. I encourage you to do your own research and learn to become hyper-vigilant and aware of what your body needs from you. At the first sign of symptoms, start treating your affected breast and inform whoever lives with you that you need to spend at least the next 24 hours doing nothing but resting and nursing and trying the treatments listed below.

Fortunately, even bad cases of mastitis can resolve on their own without a course of antibiotics. But, if your symptoms have worsened or haven’t improved after 24 of treating the affected breast, it’s time to fill that prescription. If your symptoms are improving, they should continue to lessen until you’re ship-shape again without needing any antibiotics. The lump might take a week to decrease in size enough that it’s no longer sore, but the fever usually only lasts for 24 hours. In order to avoid the risk of contracting nipple/breast thrush (yeast) from the course of drugs, you should exhaust your other options first. Luckily, simply resting and doubling-up on nursing actually goes a long way.

Here’s a few words by Dr. Jack Newman about mastitis.

Tips:

  • Nurse frequently on the affected side (don’t ignore the other side though!). If it’s too painful, you can try pumping as sometimes that’s more tolerable. Either way, you must keep your breasts in the process of draining because this will help clear the infection. Rest assured, the infection is restricted to the breast tissue and does not reach the milk, so there’s no possibility of infecting the infant. Neglecting to continuously nurse the breast can actually result in delayed recovery or an abscess, so you really want to avoid a compounding of eventually insurmountable problems. If you do mixed feedings/supplementing, you should do what you can to keep baby feeding exclusively from the breasts for now.
  • Rest. Bunk up in bed skin-to-skin with your baby and forget house chores for now. KellyMom observed that “mastitis appears to be the body’s way of telling mom to SLOW DOWN.”
  • Tips that should go without saying: stay hydrated, ditch the bra for now, eat nutrition-packed food, and take Vitamin C.
  • Cold compresses can help bring down inflammation.
  • Make a fenugreek seed poultice. KellyMom also shares instructions for a dandelion compress: Boil about an ounce of minced dandelion root in two to three cups of water until only half the liquid remains; use compresses of the resulting brew.
  • Infuse boiling water with rosemary. From KellyMom: Add 2-4 teaspoons of fresh or dried rosemary to a cup of boiling water. Infuse (steep) for 10 minutes, then strain.
  • Potato treatment (adapted by Bridget Lynch, RM):

    Cut 6 to 8 washed raw potatoes lengthwise into thin slices. Place in a large bowl of water at room temperature and leave for 15 to 20 minutes. Apply the wet potato slices to the affected area of the breast and leave for 15 to 20 minutes. Remove and discard after 15 to 20 minutes and apply new slices from the bowl. Repeat this process two more times so that you have applied potato slices 3 times in an hour. Take a break for 20 or 30 minutes and then repeat the procedure.

  • Breastfeeding Inc. warns that if you must take an antibiotic, be sure to get the right one:

“Amoxicillin, plain penicillin and some other antibiotics used frequently for mastitis do not kill the bacterium that almost always causes mastitis (Staphylococcus aureus). Some antibiotics which kill Staphylococcus aureus include: cephalexin (our usual choice), cloxacillin, dicloxacillin, flucloxacillin, amoxicillin combined with clavulinic acid, clindamycin and ciprofloxacin. Antibiotics that can be used for community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA): cotrimoxazole and tetracycline.”

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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.

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Nipple Dermatitis

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.

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Nursing Strikes

See the Nursing Strikes section in “It’s Closing Time.

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Oversupply and/or Overactive Letdown

Read all about this common issue in this post: “When Breasts Act Like Fire Hoses”.

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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. 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.

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Thrush

Read about my experience with thrush plus get more resources on symptoms, causes, prevention, and treatments here.

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Vasospasm

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.

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© The Nursaholic, © Mama’s Milk, No Chaser, 2012-2014. Unauthorized use and/or duplication of this material (including original images) is prohibited without express and written permission from the site owner and author (Holly Milkowski). Sharing/distributing content is encouraged when using direct links to the original source (mamasmilknochaser.com), but is forbidden when reproduced in part or in whole. In other words, please share — but don’t copy!

 

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