Breastfeeding problems

Breastfeeding isn’t always the blissful experience we’d like to imagine it will be. Mastitis, engorgement, cracked and painful nipples, poor milk supply… I could go on. But even though we can’t get out as much right now, there is help out there to keep you on your breastfeeding journey. 

Let’s look at some of the more common issues we get asked about. 

Cracked and painful nipples

Most often, the cause of cracked, sore, painful nipples is poor positioning and attachment of your baby to your breast. We discussed position and attachment in a previous blog, but the important thing is that this is easy to fix.  

Your baby will need to come to your breast with a wide open mouth. A small mouth means he will be sucking on the end of your nipple and it will be brushing the hard palate of his mouth – cue soreness and pain! It can also mean your baby can’t drain the breast correctly, which can cause poor weight gain, lower your milk supply and even blocked ducts or mastitis.  

So it’s really important to treat and heal this quickly. 

Things to help: 

• First and foremost ensure position is right. CHIN is the acronym we use to describe your baby’s position and it stands for: 
  • C – Close. Make sure your baby is tucked in really close to you. Try and move those wriggly hands and arms out of the way 
  • H – Head free. Support your baby at the shoulders rather than his head. He should be able to freely move his head into and away from the breast to remain comfortable. TIP Try taking a sip of water whilst holding the back of your head. It’s a challenge isn’t it? 
  • I – Inline. Your baby needs to be in a nice straight line with head, back and body all in the same direction TIP Try taking a drink with your head to one side and your body central… again, it’s really difficult! 
  • N – Nose to nipple. Your baby’s nose needs to be level with your nipple, he can then smell the milk and be in the right position to take a big old mouthful of breast tissue as well as your nipple 
• Ensure that you change your breast pads frequently and let the air get to your breasts 
• You can use cream or ointment especially designed for sore or cracked nipples. Or rub a little breastmilk into your nipple and areola after a feed 
• Make sure you are wearing a cotton feeding bra, without wire, as this will not restrict the breast tissue and will allow for air to circulate through your clothing 

If the pain does not improve, despite the attachment being good, please ask for help from your health visiting team or local breastfeeding support. They can look at how you’re feeding and help you to get your baby in the right position. 

Engorgement 

Engorged or really full breasts can be incredibly painful.  

Your breasts will look quite shiny, feel hot and wow - they’re painful to touch! This tends to happen in the very early days as your milk comes and may also occur when your body is not quite sure how much milk it needs to produce for your baby.  

Don’t be surprised if your baby is fussy and struggling to attach – think of it as trying to latch on to an over-inflated beach ball…..it’s not going to happen! Try to hand express a little amount off before your baby to attaches to the breast, to release some of the pressure. 

• You can hand express a little of the excess milk out while in the shower, as the warm water spray can help to relieve you. Or try a warm compress (or facecloths) on your breasts 
• Gentle breast compressions and massing while you’re feeding or expressing can help reduce engorgement 

• Make sure your bra is comfortable and not underwired as this causes restriction 

Have a look at this video on hand expression:  

 

Supply 

Sometimes we’re asked how you can tell whether your baby is getting enough and whether a mum's milk supply is enough.  

The best way to tell whether your baby is getting enough breastmilk is simple. 

They will be: 

• Happy and settled during and after a feed. Sometimes they’ll even look “milk drunk”! 
• Having lots of wet and dirty nappies throughout the day; generally 6 or more wet nappies within the first few weeks and 2 or more dirty nappies. If it’s coming out, for sure it’s going in! 
• Gaining weight – they will look chunkier and may have chubby cheeks, double chins and rolls. Their clothes will fit better too and family members may comment on “how much they’ve grown!” Numbers on the scales are just a small part 

To make sure your supply keeps up with your baby, simply feed often. The more you feed, or express, the more your body will produce for your baby. If you’re supplementing with occasional bottles of formula, please remember this will impact on your supply as each bottle is one less breastfeed and your body will produce less. Its fine to do this, if this is your plan, but early frequent access to the breast and lots of feeds in the early weeks will set up a good supply.  

Blocked ducts and mastitis 

Our breast tissue is made up of lots of little ducts and segments – it reminds me of a bunch of grapes! If you think of the grape and the branch it hangs from as being where your milk is stored, the duct is like the branch.  It can be described as the roadway to where your milk is transported from the stores to the nipple and out. So if one of these ducts becomes blocked, it causes a traffic jam! 

A blocked duct may be caused by ineffective latch and where the baby may not be fully emptying the breast at each feed. It also can be caused by restrictive clothing or underwired bras. It may feel like a little hard lump and can be sore to touch.  

When trying to relieve a blocked duct you can: 

• Aim your baby’s chin in the direction of the blockage so they help to release the milk from that area 
• Massage the area of your breast which is sore, especially when feeding or expressing – it may help to use warm or cold facecloths or massage and express in a warm shower 
• Keep feeding frequently! 

If left untreated, a blocked duct may turn to mastitis. 

Mastitis 

Mastitis is inflammation of the breast. It’s caused when a blocked duct isn’t emptied, and the milk inside causes an infection. 

You may feel: 

• Achy, run down and may have a temperature 
• Your breasts are hot and incredibly tender to touch, with a red area (sometime a triangle) that is hot and painful. This is the area of the blocked duct and infected area.  

You need to get help as mastitis can progress quickly. Always ensure that position and attachment are effective first but:  

• Continue to feed from the affected breast. This is very important as your baby will help to relieve the blockage 
• If your baby finishes his feed, hand express until your breasts feel empty 
• Use those warm facecloths again or hand express in a warm shower 
• You can take paracetamol or ibuprofen (if you are able to do so) for the aches and temperature. 
• If you don’t feel better despite these measures, please get in touch with your GP. You may need antibiotics to help clear the infection.  

Breastfeeding is a wonderful experience once you get it right, and if you're experiencing any issues and need help, we are here for you. 

There's more information on breastfeeding on our Health and Development pages. If you are struggling with breastfeeding or another issue with your baby and need support, please contact your health visitor, or get in touch via our health visitor duty lines from 9.30am-4.30pm

Bracknell: 0300 365 6000 or email dutyhvbracknell@berkshire.nhs.uk
Wokingham: 0300 365 7000 or email: DutyHVWokingham@berkshire.nhs.uk
Reading: 0118 931 2111 or email HVWBRDGDuty@berkshire.nhs.uk
West Berkshire: 0300 303 3944 or email: HVWBRDGDuty@berkshire.nhs.uk