Your Go To Manual For All Possible Breastfeeding Problems!

Have you just become a mommy? As someone who has newly attained motherhood, you certainly must have a bunch of queries and issues regarding breastfeeding newborns. And, as always, BabyChakra is here to your rescue.

Here are some awesome breastfeeding newborn tips, straight from the expert. Published below are excerpts from Dr. Mahesh Balsekar’s book – O to 2 Baby & You. Here is what the Doc has to say on the subject…

– Rotate your thumb and finger around the areola to get breastmilk from several positions.

– Transfer breastmilk into clean covered containers for storage in the refrigerator or freezer for possible later feeding for your baby. Always label the container and put a date on it.

See section on ‘Milk Storage’. For more information, view a video on manual/hand expression of breastmilk at the Stanford Children’s Hospital, breast feeding support site: newborns.standord.edu/Breastfeeding/HandExpression.html

Breast pumps

Some mothers may find it easier and faster to express milk with a breast pump. Pumps can be manual, battery-operated, or electric. Manual pumps are more reasonably priced than battery operated or electric pumps and do the job well enough. For correct use of breast pumps, please see instruction manuals regarding use and sterilization of pumps.

Common Problems In Breastfeeding Newborns

INADEQUATE BREASTMILK

Most mothers worry that they are not producing ‘enough milk’ for the baby. If mothers are not supported in the initial days, many mothers prematurely introduce supplementary milk or completely stop breast feeding. However, almost all mothers can produce enough breastmilk for their child with proper guidance and support.

How do I know the baby is getting adequate milk?

Refer to the section on ‘Getting Started’.

My baby is hungry and desperate all the time for more milk and I cannot manage. What should I do?

It’s true that a baby may occasionally need some top-up in the initial days, till breast feeding is well-established. Very large babies and very small babies are at risk for low blood sugar and may need additional feeds. Sometimes twins may need top-ups. Sometimes on the first night after a caesarean some mothers may find it difficult to cope with a baby’s demands. Occasionally despite a mother’s best efforts, need of an occasional top-up may be necessary.

If a top-up is absolutely needed try to give the smallest quantity necessary to satisfy the baby, try to give not more than 30 ml of milk. Also, avoid the bottle and give milk with a cup and spoon. Even in these instances, it is usually possible to restrict the top-ups to a few feeds. In most cases, mothers are able to phase out the top-ups and get back to exclusive breast feeds.

How can I increase my breastmilk?

Be patient: Most of the time, when a mother is anxious about ‘less milk’ it is because she is not aware that milk ’comes in’ only after 3-4 days, and that it is normal for babies to look hungry, and demand feeds frequently in the first 3-4 days. In most cases all the mother needs is reassurance and the mothers settle into a comfortable routine within 5-7 days or even 10 days.

Correct latch: Getting the right ‘latch’, feeding frequently, and avoiding top-ups in the initial days is often the only key needed to get adequate milk. Mothers who take adequate rest, adequate liquids, are patient, think positively, and feed frequently will usually do well.

Medication: Medications which ‘increase’ milk are called ‘galactgogues’ and are not recommended and are of doubtful value. The only medicine which works is a strong dose of patience!

Breast pumps: Pumping the breast mimics breast feeding. This additional stimulation increases milk production. Try to pump the breast for 10 minutes on each side after each breast feed. This expressed milk can be offered to the baby and over time you will see an increase in milk production.

I have less milk despite all my efforts. What can I do?

Feed, feed and feed: Frequent feeding is the only way to increase breastmilk. Be sure you have given a good long feed. This might mean 20-25 minutes on each side. If the baby is still hungry, you might offer 10-15 minutes again on each side. Sometimes despite best efforts, breastmilk supply may be insufficient to satisfy a baby. In such cases, top-up with formula is required.

Offer expressed breastmilk: After a full breastfeed, if possible try to offer expressed milk to the baby.

When to top-up: After a long feed if the baby still shows signs of hunger, you might need to top-up. Sometimes after a long feed, the baby might appear satisfied, but gets hungry in less than an hour. In these situations you could try to feed again but might need to top-up if the baby seems unsatisfied.

Most mothers are very motivated and very reluctant to top-up the breastfeed with formula. If you need to, it’s okay. In most cases, babies need a top-up only occasionally and often only for a few days. Most mothers get back to exclusive breastfeeding in a short while.

How to top-up: Formula is offered as a supplement with a cup and spoon. It’s best to avoid the bottle in the initial weeks after delivery. Generally, one offers the least amount of milk necessary to satisfy the baby. Try to manage with 30 ml of supplements. Offer more only if the baby is really needs it. You might find that mornings are go well and the baby seems quite satisfied. In this case don’t offer a top-up in the mornings. Or you might find that the baby is constantly hungry in the late evening or nights, in which case you can offer a top-up at these times. Most babies will be satisfied with a few top-ups in a day. Some babies might need a top-up after every feed.

Phase out supplements: Many mothers increase the breastmilk output in the second or even third feed. Once you feel the breastmilk flow has increased, try to reduce the quantity of supplements and gradually try to phase it out.

BREAST ENGORGEMENT

What is engorgement?

Normal engorgement: A certain amount of fullness and heaviness is expected and normal on the 3rd or 4th day. It indicates that the ‘let down’ reflex is working and usually settles in 3-5 days. In the initial weeks, it is not uncommon to get a sharp pulling painful sensation when you first start feeding. This usually settles in a couple of weeks.

Abnormal engorgement: Painful severe engorgement which does not settle after a feed. Breasts develop painful localised lumps. Engorgement associated with redness of the overlying skin or fever can indicate breast infection.

What causes breast engorgement?

Engorgement is one of the common problems encountered by mothers.

There can be several reasons this can happen:

Incorrect latch: ‘Incomplete emptying’ of the breast is the commonest cause of excessive engorgement. Milk is stored in ‘milk sinuses’ beneath the skin – areola junction. If the latch is not correct, the sinuses are not compressed during the feeds, the milk is not emptied and the breasts accumulate milk and get engorged and hard.

More milk production: Breast engorgement can be due to excessive ‘let down reflex’. Some mothers might get a strong let down and feel excessively engorged. With proper positioning and as the baby’s appetite increases, this usually settles down.

Blocked duct: In some cases mothers might get a localized pain or lumpish feel. This usually indicates a blocked duct.

Breast infection: If there is a localized lump with severe pain or redness of the overlying skin it might mean there is breast infection.

Breastfeeding techniques:Limited breastfeeding, too long an interval between feeds, early removal of baby from the breast can cause engorgement.

Too many top-ups

Offering the baby top-ups before breast feeding results in the baby being not hungry, not breastfeeding well resulting in breast engorgement.

How can I prevent and treat breast engorgement?

Correct positioning (latch) and frequent feeding, prevent engorgement. If there is any sign of excessive engorgement, ask for help and try to quickly reverse the problem.

Express excess milk: Babies do not get a good grip or latch on an engorged breast. Incorrect positioning on an engorged breast further reduces the emptying of the breasts, and makes the engorgement worse. Express some milk before you breastfeed, either manually or with a breast pump. This makes the breasts softer and allows a better ‘latch on’ for the baby. After the feed, if you still feel lumpy and uncomfortable, express out the excess milk again. If there are lumps, express them out. Sometimes you need to express milk from a particular segment of the breasts to open out blocked ducts. If there is a lump in the underarm, express it out. Offer the expressed milk before and after the feed to the baby with a cup and spoon to keep up the intake of milk.

Hot water soaks: Before the feed, if the engorgement is severe take a hot shower or apply a towel soaked in warm water to the breasts to improve the flow of milk.

Cold compresses: Occasionally if the breasts are severely engorged and painful, you may apply cold compresses or an ice pack to reduce the swelling and pain.

Try different feeding positions: Change the feeding position to empty different parts of the breast more effectively. Try the football position or the crossed lateral position.

Analgesics: You may use analgesics like paracetamol to reduce pain if the pain is severe.

Keep going: Feeding frequently and correct positioning is the only way to prevent and treat engorgement. Engorgement and feeding difficulties are very distressing to mothers. You need to be patient and positive. Almost always, the engorgement settles in a few days.

How do I manage engorgement of breasts when I decide to wean the child?

Weaning is a slow process where each breastfeed is substituted with milk or solids over a period of weeks to months. Most mothers therefore do not experience a problem with engorgement. If the mother does not feed the baby for several hours, her breasts are likely to feel engorged. The engorgement usually settles without any treatment.

At times the engorgement can be severe and even painful. The engorgement settles in a few days in most cases. If engorgement causes discomfort, the following steps might be helpful.

Express milk to relieve the engorgement. You should express till your discomfort is relieved. If you express all the milk that you can, the same amount of milk will form again. Gradually the need to express milk to relieve engorgement decreases.

– Apply cold compresses.

– Tablets are occasionally prescribed to decrease milk production and relieve engorgement.

SORE NIPPLES

When a mother first starts to breastfeeding it is common and normal to experience some degree of soreness. This ‘nipple sensitivity’ settles down in a few days once the breasts get used to the suckling of babies. Soreness beyond a few days is not normal. Severe soreness, pain, cracks and bleeding from the nipples is not normal.

How can I prevent nipple soreness?

Prevent dryness

– A daily bath is all that is needed. If the milk spills during a feed, wipe it with water.

– Avoid frequent use of soap because it can dry the skin.

Breast creams

– In general, it is preferable to apply the last part of the milk on the nipples, if lubrication is needed. The hind milk is rich in fats and provides natural lubrication and it also has antiseptic properties.

– Breast creams are generally lanolin based, and meant to prevent and treat nipple soreness by lubricating the breast. They are safe to use.

Get the right latch

– The prevention and treatment of soreness, is getting the positioning right.

– Soreness is usually on the nipple or at the nipple-areola junction, indicating that baby is latched on incorrectly. Correct positioning means the baby’s gums press one inch behind the nipple at the skin-areola junction. With correct positioning, nipple soreness is unusual.

How can I manage feeding with sore nipples?

Improve feeding technique  

• If you get the right latch, it is possible to feed despite the soreness. If it hurts when you feed, insert your finger under the baby’s cheeks and release the vacuum and detach yourself and again reposition correctly.
• Feed on the less sore side first. Babies suck more vigorously at the beginning of the feed.
• Change feeding positions so different parts of the skin are exposed to the baby’s sucking action.
• Engorgement prevents getting the right latch and worsens the soreness. If there is engorgement, express a little milk, make the breasts softer and then try to feed the baby.
• One need not limit the feeding time to reduce soreness. Feeding for longer duration does not cause soreness as long as the positioning is correct. Reducing the duration of feeds on breasts may lead to engorgement of breasts and further add to the problem.
• Prevent and treat dryness of nipples as discussed above

Feeding with a nipple shield

• Despite the correct positioning, feeding is sometimes difficult because of severe pain. In such situations you might need to give rest to the nipples, and feed through a nipple shield. Nipple shields are made of silicone and they are placed over the nipples for feeding.
• They need to be sterilised prior to every use.
• The nipple shield prevents direct pressure on the breasts and reduces the pain and discomfort. Once the nipples heal, usually in 24-48 hours, it is possible to get back to direct feeding.
• When you restart direct breastfeeds, one needs to make sure that you feed with the correct positioning, so that soreness does not recur.

Pumping and feeding expressed breastmilk

• Sometimes mothers might find that feeding through a nipple shield is painful. Some might find feeding through a shield ineffective, and breasts may get engorged because of incomplete emptying.
• If feeding through the nipple shield is not working, you might need to pump milk and offer that to the baby with a cup and spoon till you are able to get back to direct feeding.

BREAST PAIN

Normal breast pain

When a baby first starts suckling, many mothers get a tinge of pain or a pulling sensation. This discomfort usually disappears within a couple of minutes. This pain is because the milk ducts are empty and the sucking action of the baby creates a vacuum resulting in discomfort. Once the milk comes in, the pain settles.

If the pain is severe, or persistent, it is not normal. If the pain continues, mothers need to localise the pain. Is it in the nipple, a localised part of the breast, or is it a deep pain in the breast?

Nipple soreness

Due to an incorrect latch, some mothers get erosions and cracks on the nipples. These are usually on the nipple or the nipple-areola junction. For more information, please refer to the section on ‘sore nipples’. (p. 112) Infected nipples

The erosions or cracks sometimes get infected. Infection can be identified by redness, swelling and discharge from the skin. In the initial days, infection is usually bacterial and you might need an antiseptic cream for local application.

If the cracks come after a week or more, it could also mean a fungal (thrush or candida) infection. With fungal infections you will experience itching or burning. Sometimes nipple infections are due to a fungal infection in the baby’s mouth. Check the baby’s mouth for thrush, which appears as a curdy white deposit on the tongue, gums and inner cheeks. Antifungal creams are effective.

Breast infection or abscess

A deep rooted or localised pain can indicate a breast infection.

For more information, please see the section on ‘Breast Infection/Mastitis’. (See below)

BREAST INFECTION (MASTITIS)

Breast infection (mastitis) is an uncommon but troublesome problem seen during breastfeeding. It is important that mothers take care to prevent infection and identify signs of infection at an early stage.

Also read: All You Need to Know About Breastmilk Substitutes

To make a review based choice of a lacation support in your locality, click here

_{Source: 0 to 2 – Baby & You. A Pediatrician’s Handbook for practical parenting. Published with permission from the authors: Dr. Mahesh Balsekar and Malvika Choudhary & publisher- Vakils, Feffer and Simons Pvt. Ltd.}

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