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An Introduction to Breastfeeding and Common Issues

Signs of Successful Breastfeeding

What should mums be looking for to ensure their babies are attached to the breast ('latched on') correctly and feeding well?

  • The baby has a large mouthful of breast.
  • The baby's chin is touching the breast.
  • It doesn't hurt mum to feed (although the first few sucks may feel strong).
  • If you can see the dark skin around the nipple, you should see more dark skin above the baby's top lip than below their bottom lip.
  • The baby's cheeks stay rounded during sucking.
  • The baby takes rhythmic, long sucks and swallows. It's normal for them to pause sometimes.
  • The baby finishes the feed and comes off the breast on their own.
  • The baby is wetting their nappy regularly and doing a dirty nappy at least once a day.

Common Breastfeeding Issues

Breastfeeding isn't easy, and is a skill that you and your baby need to learn together.  Although you may experience some pain or discomfort at first, it is not normal for this to last throughout the feed.  If it does, this indicates that something is wrong.  Breastfeeding should be enjoyable, so if it’s not, then it’s worth trying to establish why and make any necessary changes.

Baby Is Unsettled?
It is important to ensure your baby is latched on correctly.  If you're not sure, put your clean finger into the corner of your baby's mouth to break the seal and try again.  It may help to try different positions  if your baby doesn’t appear to be attaching to the breast as they should be.  It is wise to try to latch them on as soon as they show any signs of hunger, as it can be more difficult to do this when your baby becomes distressed.

Some babies are born with a tight piece of skin between the underside of their tongue and the floor of their mouth, known as tongue-tie.  This can affect feeding by making it hard for your baby to attach effectively at your breast.

If you are still struggling, check if your baby has any white patches on their gums or tongue that either won't come off or may bleed if you rub them? If so, these are symptoms of thrush which can cause difficulties with feeding and it is adviseable to seek medical advice, although this condition is easily treatable.  If this is the case you will also need treatment.

Painful Breasts
A few days after you have had your baby your breasts will feel very full and heavy, as the breast tissues enlarge and start fully producing your breast milk. This should ease within the first 2 or 3 weeks of breastfeeding as things become established.

If your breasts become hard again whilst you are feeding and you have a feeling that they are very heavy, hard and tender to touch then it’s likely that you have engorged breasts.

The main reason for engorgement is because you are not feeding your baby as often as your breasts need in order to empty them fully. It can also be a symptom that you have a blocked or obstructed duct.  It is important you address this situation before it leads to mastitis.

If you have mastitis you're likely to have at least two of the following symptoms:

  • breast or breasts that feels hot and tender
  • a red patch of skin that's painful to touch
  • general feeling of illness, as if you have flu
  • feeling achy, tired and tearful
  • you may have an increased temperature

The key thing to do to improve the situation is to get your baby to feed from your breasts, as stopping feeding could worsen the situation. This can be difficult if they are very hard so you might need to express a little, even the tiniest amount can make a difference. Try not to express for too long, as the aim should be for your baby to get the majority of the milk, also you want to avoid stimulating more milk production so ideally you only want to produce what your baby needs.

You can also use hot water bottles or warm flannels in a compress on the breast, try just before or when you are expressing. Some mums find that doing the expressing in the shower or in a bath also helps. Don’t overdo the heat though as this can increase the tender feelings.

Once you have expressed a little try to latch baby on and feed until the hardness disappears, sometimes you can almost see the breast change as you feed. The aim should be to feed as often as possible, about every 2 to 3 hours. You can also encourage more milk to flow by gently massaging the breast with your hands as you are feeding baby.

As your breasts are hard and tender you might find that you want to wear your nursing bra at night too, just make sure you have no seams or wires that could cause a blocked duct.
Some mums have used ice cold cabbage leaves in their bras to help with engorgement!

Mastitis may also be a sign of infection. If there's no improvement within 12 to 24 hours, or you start to feel worse, contact your GP. If necessary, they can prescribe antibiotics that can be taken while breastfeeding.

Sore or Cracked Nipples
If your nipples hurt, make sure your baby is latching correctly.  The following may help:

  • Squeeze out a drop or two of your milk at the end of a feed and gently rub it into your skin.
  • Let your nipples dry before getting dressed again.
  • Change your breast pads at each feed (if possible use pads without a plastic backing).
  • Don't use soap, as it dries out your skin.
  • Wear a cotton bra so that air can circulate.
  • Treat any cracks or bleeding with a thin smear of white soft paraffin or purified lanolin. Put the ointment on the crack (not the whole nipple) to help it heal and prevent a scab forming (There's no need to wash the ointment off before feeds.)

There's no need to stop feeding. With skilled help you should find that breastfeeding quickly becomes more comfortable again.

Inverted Nipples
Flat and inverted nipples are very common.  The baby feeds from the breast and not the nipple and in most cases is able to draw out the nipple through breastfeeding.  However, there are breast shells you can wear for a period each day from the 3rd trimester onwards that can help to draw out the nipple.

It is often recommended that you express briefly by machine before offering the baby the breast as this can help draw out the nipple.

Leaking Breasts
Your breasts may leak if they are too full of milk, or your ‘let down reflex’ is triggered. Usually your breasts only release milk when your baby suckles, but sometimes just hearing a baby cry can trigger your breasts to ‘let down’ their milk!

The more regularly you feed, the less likely your breasts are to leak. Most mums wear breast pads inside their bras in case of any leaks. You’ll hopefully find that the problem disappears almost completely after about seven to ten weeks of breastfeeding.

I Don't Think I Have Enough Milk
It is very unlikely that you won’t produce enough milk for your baby. You can increase your supply by feeding your baby more often and offering the breast as often as your baby would like. You should try to ensure your baby feeds well on each breast to reach the hind milk rather than offering a little from each breast.

Do make sure you are looking after you, as regular rest and food and drink can really help especially in the early days when you are feeding more often.

It Seems to Take Too Long
If you have a new baby, it may seem like you're spending all day feeding. Frequent feeding is very common in the early days, babies can feed up to 12 times a day and this is absolutely normal if your baby has frequent wet nappies, is gaining weight and is generally happy in themselves. Mums generally feel like it takes too long because they can’t get on with other things. In the early days it helps to have a laid back attitude to house chores, or to get someone else organised to help you.

It can also help to be organised before you start feeding: have a comfy chair, an MP3 player or the tv remote, cushions, a drink and anything else you need before you start.

My Baby Is Suddenly Feeding All The Time
This could be the sign of what is often referred to a growth spurt.  You will just have to offer your baby more time on the breast as and when he/she needs it.

My Baby Is Crying and Pulling Off
The most common reason for this is ironically too much milk, sometimes it all spurts out so that there is too much for baby to cope with. You will find that changing position will help, as well as expressing the first fast flowing milk off. If this continues you may have a condition called hyperlactation, in which case you may wish to seek some specialist support.

My Baby Isn't Gaining Enough Weight
Firstly don’t compare your baby to other babies and certainly not to their formula fed friends as breastfed babies tend to gain weight more slowly and steadily than formula fed babies. The most obvious advice is to feed your baby more often and also to make sure that your baby is getting down to the hind milk (feed until the baby wants to come off the breast of their own accord).

Breast Refusal
If your baby is refusing your breast, it’s usually their way of telling you there’s something      wrong. It might just be teething pain, or difficulty breathing from a cold.

If your baby’s gone on breast strike, try feeding them when they’re very sleepy, and keep the room quiet and distraction-free. You could also try different feeding positions, or even try feeding on the move as the rocking motion can be comforting to your baby.

If you're worried, it’s also a good idea to see your doctor to make sure there’s nothing wrong, such as an ear-infection or thrush.

Feeding From One Breast Only
Sometimes babies develop a preference for one breast. It won’t harm them, but you want to give both your breasts the chance to produce equal amounts of milk.

If your baby’s being choosy, try feeding them on the breast they don’t favour in the same position as the one they do. So if you’re cradling your baby on your left breast, just move them across to the right one, instead of turning them around. You’ll find it more comfy if you put a pillow under your supporting arm.

Biting Baby
If your baby is teething, let them have a good chew on a cold teething toy to get it out of their system and numb their gums. And if they do bite, draw them close. This makes it difficult for your baby tobreathe through their nose, forcing them to open their mouth and let go!

If your baby is biting because they think making mum yell is a great game, be firm, say ‘no!’ and take them away from the breast for a minute.

Courtesy of :
http://www.netmums.com/baby/breastfeeding
http://www.babycentre.co.uk/a263/sore-nipples#ixzz2YpkHtWJP
http://www.nhs.uk/conditions/pregnancy-and-baby/pages/breastfeeding-problems.aspx#close
http://www.cgbabyclub.co.uk/article/common-breastfeeding-problems-and-solutions

Further Reading:
www.nct.org.uk
www.laleche.org.uk
www.abm.me.uk
www.nationalbreastfeedinghelpline.org.uk

Professional Advice and Support in Harare:
Michelle Oftebro
Tel:  +263 (0)772 378679, Email:  mao@zol.co.zw