Challenges to Breastfeeding

By OBOS Pregnancy & Birth Contributors | April 12, 2014

Sore Nipples

It started well for me—the baby latched on right away and sucked well—but then I got a cracked nipple and it was incredibly painful every time he nursed. And then the milk got stuck in some of the ducts in that same breast. So I needed him to nurse more on that side to get the milk moving, but every time he latched on it felt as if someone had set fire to my nipple. It took six weeks to get through all that. I didn’t think I’d make it, but luckily I had a lot of support from my husband, my family, the midwives, and the lactation nurse at the clinic.

Some mothers complain of sore nipples for the first days or weeks—and some limited discomfort or tenderness is normal. But if it is getting worse rather than better, or if you experience severe pain or cracked or bleeding nipples, consult with a health care professional or lactation specialist immediately. These can be signs of an incorrect latch or of something more serious, such as an infection, that should be treated promptly.

The most common cause of nipple soreness is a poor latch. Your baby may be getting milk by “chewing” on the tip of the nipple, rather than opening wide and compressing as much of the areola as possible. Pain often stems from incorrect positioning, the baby not opening his or her mouth wide enough, or tongue tie (ankyloglossia). If you have pain in your nipple every time the baby sucks, take the baby off your breast and reposition yourselves so that your nipple moves farther back in your baby’s mouth. If that does not resolve the issue and you continue to have pain, contact a lactation consultant for advice about improving the latch and ask to be checked for possible tongue-tie (which can be corrected with a simple procedure).

Another cause of nipple soreness is a yeast infection commonly known as thrush. Thrush is caused when an infection in the baby’s mouth spreads to the mother’s nipples. A newborn can get thrush if the mother had a vaginal yeast infection when giving birth or if the mother was treated with antibiotics after the birth. A thrush infection can make a woman’s nipples itchy, red, swollen, tender, and sometimes cracked.

Many mothers with thrush complain of a severe burning or cut-glass sensation while nursing. If your baby has thrush, you may see white, cheesy patches on the inside of the baby’s mouth that do not come off if you wipe them with a soft cloth or your finger. Check with your pediatric and d obstetric care providers for diagnosis and treatment of this problem. It is important that both you and your baby receive treatment; otherwise you can pass the yeast infection back and forth between you.

Engorgement (When Your Breasts Are Too Full)

Engorgement is a state of over-fullness in the breast that is accompanied by swelling, redness or shininess of the skin, increased temperature of the breast, and marked discomfort when the breast is moved or touched. Engorgement may occur in the first few days while your milk comes in or after breastfeeding is well established, particularly if you go for longer periods of time without nursing or pumping, such as when the baby sleeps for longer stretches or you return to work.

If your breast is very hard and the nipple has become flat, you may want to express a small amount of milk manually until your areola softens so that it is easier for your baby to latch on. Soaking your breasts in a basin of warm water may help your milk to flow. Cool compresses or cool packs (wrapped in a clean dishcloth) may provide comfort before and after nursing. Having the baby nurse as often as she or he wants to is the best way to prevent and treat engorgement. Pumping your engorged breasts may overstimulate them and cause your body to make more milk than is needed. If you are engorged, keep your breasts comfortably supported, use cool packs for comfort, and let the baby breastfeed, allowing him or her to determine how much milk your breasts need to make.

Plugged Ducts and Mastitis (Breast Inflammation)

A red, sore, or possibly even swollen spot on your breast may signify a plugged milk duct. To clear the blockage, try to gently massage the area while nursing, taking care to massage toward the nipple, nurse frequently from that breast, and start each feeding session from that breast. Apply moist heat or direct the shower spray to the area when bathing. Changing the infant’s positions for feedings may also help drain the area more effectively.

If the blockage does not clear, you may develop a breast infection called mastitis. A full-blown case of mastitis feels like a bad case of the flu. In addition to pain and redness on the breast, you will be achy, feverish, and shivery. You may be tired and sore and not feel the least bit like breastfeeding, but whatever you do, don’t stop. You’ve got to keep your breasts draining, or the mastitis could advance to a breast abscess, a rare but serious condition that can require surgical drainage.

If you think you have mastitis or have a temperature over 100.4°F, contact your health care provider immediately. You will likely need antibiotics, which can be taken safely by nursing mothers. Your health care provider may also recommend a non-steroidal anti-inflammatory medication, such as ibuprofen (Advil or Motrin), which is also considered safe when you are breastfeeding. While mastitis symptoms are present, try massaging your affected breast in the direction of the nipple and changing nursing positions to drain your breasts more effectively. Also get plenty of rest and plenty to drink. You should start to feel better within twenty-four hours. If you are not starting to feel better, still have a temperature, or are feeling worse after three to four doses of an antibiotic, call your health care provider.

At a well-baby checkup for my baby, I showed my doctor my cracked and swollen breasts. There were a few warm red spots on them. Other than my breasts and nipples being sore, I felt fine. My doctor gave me a prescription for antibiotics just in case I developed mastitis. I picked up the prescription immediately since we live a fair distance from the closest pharmacy and headed home. Within an hour of arriving home, I had a high fever and felt like I had been run over. I started the antibiotics immediately and lay down for a nap. By the time I woke, I was already feeling much better.

Low Milk Supply

Though the vast majority of mothers produce enough breast milk to provide all the nourishment the baby needs, a small percentage of mothers do not. This can be incredibly difficult.

I so wanted to breastfeed my baby. All through my first pregnancy, I dreamt about it. So, when my son came five weeks early, after a difficult birth followed by formula in the hospital and then jaundice, my romantic ideas about nursing quickly faded. We tried everything—nurse-ins, support, a lactation aid, constant pumping, domperidone…it​ was just crushing and completely exhausting. He was supplemental from the beginning. I really gave it all I could for five months, but my supply and his suck never got to where they needed to be. I am so glad I stuck it out with him as long as I did; I know what he got from me serves him well. But I carried a sense of sadness and loss about it. Our breastfeeding relationship was so wrapped in the experience of the struggle. I was really consumed with fear and feelings of inadequacy when I was pregnant with my second child—would it be the same? I was bracing myself against the pain and grieving for the loss of this potential beauty again. Thankfully, I had no need to worry. I am positively thrilled that his little sister, born big and term at home, has been a vigorous and committed nurser from her first latch!

Concerns about possible low milk supply usually arise several days after birth, often if a baby has lost a significant percentage of her or his birth weight and has soiled or wet only a few diapers. In many cases, the cause of this may actually be poor latch or some other common breastfeeding difficulty. Mothers are often concerned that they have low milk supply because their baby is fussy at the breast or nursing frequently, but these are generally not indicators of a low milk supply.

In rare cases, low milk production is caused by a medical condition or by the effects of previous breast surgery. In addition, certain kinds of medications, including combined hormonal birth control pills, can affect how much milk your breasts produce.

Women experiencing low milk supply can sometimes generate enough milk by pumping between feedings or using herbal supplements, teas, or prescription medications to increase the supply. Sometimes it is necessary to supplement with formula or with donated breast milk to meet the baby’s nutritional needs. Consult a breastfeeding-friendly pediatric care provider or a lactation specialist if you are experiencing low milk supply.

Medications and Breastfeeding

About one in two women take at least one prescription medication during pregnancy. Unfortunately, there are very few clinical trials that test the safety of medications in pregnancy, due to concerns about the health of the mother and child. For information on what is known about safety, see Womenshealth.gov’s Pregnancy and Medicines Fact Sheet and ToxNet’s Drugs and Lactation Database.