Difficulties with breastfeeding - engorged breasts and mastitis
Breastfeeding, like parenting, is not always uncomplicated, especially in the first few weeks after birth. It can be easy to forget at this time that, like all new skills, breastfeeding can take a while to learn and become really good at. Not all women experience true engorgement or mastitis, however, if you do it may really test your desire to breastfeed. At times you will feel that it is not worth it, and that breastfeeding is just not for you.
This article has been written to assist women who are experiencing problems with engorgement and/or mastitis. It is strongly advised that if you are experiencing difficulties with breastfeeding to seek the advice of a midwife or lactation consultant.
Engorged breasts
A few days after the birth, the milk supply comes in. In some women this happens very quickly (often overnight) and their breasts may become swollen, hard, hot and painful. This is normal.
What can you do about engorged breasts?
- feed your baby on demand until they have had enough
- if you have a strong 'let down' and milk pours from the breast during the feed, take your bra off and let it run out freely. You can catch it in a towel, cup or a sterilised container for freezing and using later
- put your baby to the more painful breast first. Try using one side for each feed rather than offering both breasts. If your baby is still hungry offer the other breast
- stand in a warm shower for five minutes before feeding. It is soothing and comfortable. Although is it generally not a good idea to express off excess milk by hand - expressing a little in the shower can make it easier for a very new baby to 'latch on' correctly
- apply a cold pack after feeding or cabbage leaves which have been stored in the refrigerator applied over the whole breast can be very soothing!
- massage your breast lumps gently towards the nipple while feeding
- do not give your baby any other fluids
- if your breasts are very painful, take some paracetamol. You may feel reluctant to do this, however, remember that being in pain makes establishing a healthy, satisfying breastfeeding pattern much more difficult.
Remember, there is no greater relief for engorged breasts than an enthusiastically feeding baby.
Mastitis - what is mastitis?
Mastitis is inflammation of the breast tissue, particularly the milk ducts and glands in a breastfeeding woman. It is caused by blocked milk ducts because the breasts are too full and the milk is not draining properly. It can also be due to a cracked nipple. Bacteria (germs) may get into the breast tissue and grow in the blocked milk ducts.
You will have a sore breast and will notice a lump which is usually red and tender. You may also have a temperature and feel unwell with 'flu-like' symptoms. Most cases of mastitis are caused because the baby is not 'latched on' or 'positioned' on the breast correctly.
What can you do about mastitis?
- see your doctor or midwife immediately if you have a fever. You may require antibiotics to cure the infection
- it is very important that you have time to rest and spend time feeding your baby properly. Seek help and support from your partner, family or whanau. If this is difficult for you ask your midwife or Plunket nurse to help you find some support
- breastfeed on demand, starting with the sore breast. Make sure the baby is latched on correctly (mouth covering almost the entire areola - not just the nipple) and drains the breast well. It is quite safe to feed your baby from the affected breast
- wear loose fitting clothes and a bra which is well fitting and does not 'dig in' anywhere (obstructing the flow of milk)
- change breast pads or bras frequently if you are 'leaking' milk
- apply warmth to the sore area just before feeding, by taking a shower or applying a warm hot water bottle wrapped in a towel or a wheat bag
- drink plenty of fluid (especially if you have a fever).
- paracetamol can be taken every four hours if necessary for the pain and fever.
Further information
Phone helplines and support
You can phone Healthline on freephone 0800 611 116 or the Plunketline on 0800 933 922 for advice about breastfeeding.
You can also talk to your midwife, doctor or Plunket nurse. Your midwife may be able to put you in touch with a lactation consultant if she feels it is appropriate. Other support options include La Leche League, and your local Parents Centre - see contact details for these organisations under 'Further information and support' below.
Related topics
Also see: Expressing breast milk and Sore and cracked nipples
Written by Anna Mickell RCpN. Reviewed by everybody, September 2008.
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