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Common Problems/Concerns

Successful breastfeeding is a combination of patience, good technique and support. As you become better at breastfeeding, it will become easier and more enjoyable. However, along the way you and your baby may experience some problems or discomforts. The following tips may help:

Going out
Sexuality
Breastfeeding in public
Inverted or flat nipples
Engorgement
Sore nipples
Thrush
Nipple preference
Decreased milk supply
Plugged ducts
Mastitis

Going out

When it is time for a much-needed night out, new challenges await you. You may find it more enjoyable to simply bring your baby along when you go out for the first three to four weeks. As newborns, babies are easily carried and do not require a lot of equipment. If you need to leave your baby with a family member or baby sitter, explore several options for feeding your baby while you are away, such as expressing your milk, so the caregiver can give it to your baby.
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Sexuality

It is important for a new mother to know that her partner still finds her desirable. Physical closeness and loving support will help ease this time. Intercourse is usually not advised until after vaginal bleeding has stopped for a few days. Remember intercourse is not the only way to maintain intimacy.

A new mother’s sex drive often may be somewhat lower after delivery due to vaginal discomfort and lowered estrogen level. Exhaustion may contribute to your lack of interest. Be patient with each other during this short transition period. Lowered estrogen levels may also cause the vagina to be drier. Water soluble lubricant may be helpful.

Try to feed your baby before making love, if possible, so your breasts will be softer, more comfortable and less likely to leak. During nipple stimulation and orgasm your milk may begin leaking. Your milk lets you know how well your breasts are functioning!

You may not begin a regular menstrual cycle for several months while breastfeeding, but you may ovulate. Some type of contraception is necessary if you do not wish to become pregnant right away. Consult with your health care provider.
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Breastfeeding in public

Many mothers have concerns about breastfeeding in public. California laws support your right to breastfeed your infant in any public area. When your baby needs to nurse, feeding can be done discreetly by placing a baby blanket or a shawl over your nursing infant. A sweater that pulls up or a blouse that can be unbuttoned from the bottom works well. Most slings also allow for discreet nursing.

Shopping malls often have large ladies’ lounges suitable for comfortable breastfeeding. Many stores provide changing tables. Take a little time to survey which stores and restaurants best meet your needs.

A support group for nursing mothers is a valuable connection for encouragement, answers, and tips on ways to manage going out with your baby. Check with your health care provider to find support groups in your area.
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Inverted or flat nipples

Babies nurse areolas, not nipples! Initial feedings may be more difficult with flat or inverted nipples, but most women manage to breastfeed successfully.

Suggestions:

After you have delivered, hand expression or pumping may help make the nipple more erect.
It is not recommended to roll, twist or pull on your nipple. These actions can hurt the nipple.
Short-term use of nipple shields may be helpful under the direction of a physician or lactation consultant.
Consult a lactation consultant for additional help

Engorgement

Breast fullness is a normal condition in which the breasts become full two to three days after birth. Engorgement is caused by increased blood supply, fluids and milk in the breast tissue. Fullness is different from engorgement and usually decreases within the first two to three weeks if your baby is nursing regularly. If enough milk is not being removed, because of a skipped feeding or limited feeding time, your breasts may become tender and engorged. An engorged breast may flatten your nipple and make it harder for your baby to latch-on.

Suggestions:

If breasts continue to be full and uncomfortable, apply cold compresses to both breasts as needed between feedings. The cold will feel good and decrease the swelling. (Baggies full of frozen peas or cold raw green cabbage leaves work well as cold compresses.)
Try a warm shower, hot washcloths on your breasts, or lean over a sink to let your breasts rest in warm water before nursing.
Massage your breasts to promote milk flow.
Use hand expression to soften the areola before latch-on.
Nurse often (8 to 12 times in 24 hours).
Do not skip feedings.
Wear a supportive bra and get in a comfortable and supported position for feedings. Avoid underwire bras.
Consult a lactation consultant for additional help.

Sore nipples

According to research, the main cause of nipple soreness is nipple trauma due to incorrect positioning of the baby on the breast. However, even with proper positioning, some women may experience short term latch-on soreness.

Suggestions:

Make sure your baby’s mouth is wide open (like a yawn) for good latch-on.
Start with your nipple opposite your baby’s nose.
If you feel pain that lasts throughout a feeding, break the suction, remove your baby, reposition, and try again.
Ensure a proper release by inserting a finger between your baby’s jaws to break the suction before removing your baby from your breast.
Make sure your baby’s lips are not turned under and that your baby is not chewing on your nipple or sucking his/her tongue. Pull down firmly on your baby’s chin to unhinge the jaw and widen the mouth and allow the lower lip to roll outward. Use your index finger cupped under your breast or your thumb on your opposite hand.
If your baby is sucking his/her tongue, you may hear a smacking sound and see your baby’s cheeks caving in. Take your baby off the breast, reposition, and try again.
Try different positions until you and your baby find a comfortable routine.
Express some breastmilk onto your nipples after a feeding and then allow your nipples to air dry completely.
Apply a warm, wet washcloth to your nipples to sooth the irritation.
Consider applying a small amount of pure anhydrous lanolin (such as Purelan or Lansinoh) to your nipples if they have sores. You don’t need to wash the lanolin off before breastfeeding.
Consult a lactation consultant for additional help.

Keep nipple area free from irritation

Avoid using drying breast creams that contain alcohol. Remember, the Montgomery Glands secrete a natural oil for lubrication and protection.
Try more frequent and shorter nursing periods, instead of longer periods, between feedings.
If you think you need a nipple shield, talk with a lactation consultant or your health care provider.
If using nursing pads, change them often. Consider using 100 percent cotton washable bra pads. Avoid pads with plastic or moisture-resistant liners.
Wear clean, supportive nursing bras. Avoid tight or poorly fitted nursing bras, bras that cause discomfort, and bras that cut into the breast.
Discontinue use of any breast pump that causes discomfort and contact a lactation consultant.

Thrush

The Candida, or yeast organism, is normally present in the mouth, gastrointestinal tract and vagina. The body also depends on our normal bacteria to prevent an overgrowth of the Candida yeast organism. This overgrowth of yeast causes a fungal infection called thrush, which grows in warm, moist conditions. This yeast overgrowth can affect any part of the body, including the breasts and nipples in breastfeeding mothers.

Breastfeeding mothers are at risk for developing thrush if they have:

Taken or are currently taking antibiotics.
Cracked nipples from poor latch-on or positioning.

Thrush symptoms

PAIN!

Especially if it continues after an initial problem with poor latch-on or positioning was corrected.
Occurs several weeks or months after successful breastfeeding.
Is a burning or shooting/stabbing pain in the nipple, breast tissue or both.
Experienced during and after feedings. Sometimes the pain in between feedings is stronger.
Experienced with pumping the breasts.

Nipple itching, flaking, redness, shininess or sometimes white patches are present.
The baby has white patches on his/her tongue or inside the mouth.
The baby has a yeast diaper rash and may be gassy and fussy.

THERE MAY BE NO VISIBLE SIGNS IN EITHER YOU OR YOUR BABY. PAIN MAY BE THE ONLY SYMPTOM.

Suggestions:

If you suspect thrush is present, contact your health care provider. It is wise to treat both you and your baby at the same time, even if there are no symptoms. If treatment is necessary, it should continue for two weeks, even if the symptoms disappear.

Home care
Caring for your environment is very important for treating thrush. Any items that come in contact with your baby’s mouth or your nipples can contain yeast. The following are highly recommended while treating and preventing the return of thrush:

Boil all items that come in contact with your baby’s mouth for 20 minutes every day, including toys, pacifiers, bottle nipples, etc.
Replace pacifiers and nipples weekly.
Any breast milk that was expressed and then frozen during a thrush outbreak may re-infect your baby at a later time. To avoid this, boil the milk to destroy the yeast.
Keep the breasts as dry as possible and exposed to air whenever possible.
Use disposable bra pads.
Use hot, soapy water when washing bra pads, bras or diapers. One cup of bleach in the wash water or one cup of vinegar in the rinse water can be effective. All items should be thoroughly dried by line drying in the sun or in a hot dryer.
During an outbreak, use paper towels for hand drying. Use bath towels only once before washing.

Nipple preference

If possible, only breastfeed your baby for the first four weeks without using bottles. Some babies reject the breast if given bottles while they are learning to breastfeed. The use of the jaw muscles and tongue during breastfeeding is very different from that used during bottle feeding. Milk flows faster during bottle feeding, and your baby gets milk instantly with little effort. More active suckling is necessary when breastfeeding.

Suggestions:
If a bottle must be given to supplement breastfeeding, offer it after breastfeeding. If using a supplement, check with a lactation consultant or your baby’s health care provider for recommendations about options other than bottles and nipples, such as finger, syringe or cup feeding.
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Decreased milk supply

Breastfeeding is a supply-and-demand system. Whatever your baby needs, your body will produce. Your milk is made fresh each feeding in response to the suckling stimulus. The more your baby nurses, the more milk you will produce. If your infant is going through a growth spurt and acts hungry, feed more often for a few days. Your supply will increase, and your baby will resume the old feeding schedule.

There usually is no need to supplement your baby’s feedings with formula or water while breastfeeding. If you are worried that your baby is not getting enough milk:

Check your baby's position at the breast.
Observe your baby's swallowing behavior. If your baby is swallowing along with sucking, then he/she is getting milk.
Count the number of wet and soiled diapers. (See section on "How will I know if my baby is getting enough milk?"
Keep track of your baby's weight gain. If your baby gains one ounce a day during the first months, then your baby is getting enough nourishment.
Observe your baby's general temperament after feeding. Does your baby appear contented?

Suggestions:

Breastfeed your baby every 1 to 3 hours per 24 hour period (8 to 12 times in 24 hours).
At first, try to do nothing but relax, sleep and breastfeed. Rest when your baby sleeps. Remember, babies are “night creatures” for the first three weeks. This is normal! You may have more opportunities for good nursing sessions at night. Try to sleep during the day when your baby sleeps.
Drink plenty of fluids.
Eat a well-balanced diet.
Limit visitors and responsibilities. Have friends, relatives or hired help do the household chores, cooking, shopping, etc.
If you continue to be concerned about your milk supply, or if your baby does not gain weight, talk to your baby’s health care provider or lactation consultant.

Plugged ducts

Sometimes milk ducts may become clogged due to incomplete emptying or continued pressure on one or more ducts. If this happens, you may feel a hard, lumpy, painful area on your breast.

Suggestions:

Apply warm, moist towels to your breasts before feeding.
Massage your breasts down toward the nipple paying special attention to the painful area.
Nurse your baby more often, as often as every 1-1/2 hours if possible.
Breastfeed in different positions, placing your baby’s chin in the direction of the plugged duct.
Breastfeed on the side with the plugged duct first. (Babies suck hardest on the first breast.)
Use a little lotion on your thumb and apply steady rolling pressure from behind the outer lump toward the nipple while your baby breastfeeds.
Get plenty of rest and enough fluids.
Avoid tight clothing. Look to see if your baby carrier or bra is rubbing the painful area.
Avoid sleeping on your stomach or the side with the plugged duct.

The area may still be tender once the plug is gone. Continue to examine your breasts daily to check for plugged ducts.

If the plug does not go away in several days, contact a lactation consultant or your health care provider. Contact your health care provider immediately if you develop fever and flu-like symptoms. The plugged duct may have turned into mastitis (see below).
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Mastitis

Mastitis is a breast infection. Fatigue is a leading cause of mastitis. Sometimes a plugged duct will become infected or bacteria will enter the breast through another route, such as an open sore on the areola or nipple.

A red, hard, hot and painful area will usually be present on the breast. You may also have a fever greater than 100.4 degrees Fahrenheit and feel as if you have the flu.

Suggestions:
Do not wait for the mastitis to go away by itself. Contact your health care provider immediately for treatment with antibiotics that are safe for you and your baby. It is very important that you continue nursing often during this time. Your milk is not infected and will not harm your baby. Also, complete the entire treatment of antibiotics (seven to 10 days) so the infection does not come back. Consider contacting a lactation consultant to teach you how to prevent mastitis from happening again.

Read more information on Mastitis from our Health Information section.
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