A Doula's Guide to Dealing With 4 Common Breast/Chestfeeding Challenges
Sore Nipples
Many birthing people experience nipple soreness and tenderness when they first start breast/chestfeeding.
What you can do:
Soreness due to latch/positioning: Check baby’s positioning and latch. If your nipple is pinched, flat, or a different shape than usual after you breast/chest feed, you may need to adjust baby’s latch. If you are in pain while breast/chestfeeding, gently break the latch by inserting a clean finger into the corner of your baby’s mouth, and then try again.
Soreness due to nipple trauma: make sure to release suction before removing your baby from your breast/chest by inserting a finger into the corner of their mouth, avoid harsh soaps and only wash your nipples with clean water, consult a breast/chestfeeding expert on the size of your pump flange to ensure it’s the right size and make sure not to wear clothing that isn’t too tight.
Soreness due to fungal infections: if your nipple burns, cracks, is flaky, or you have shooting pains deep in your breast/chest between feedings, you may have a fungal (yeast) infection called thrush. Thrush can also show up as white spots on your baby’s cheeks, tongue, or gums. If this is the case, you should consult your provider right away as you and your baby will likely need to be treated for thrush. If the pain persists, you may have an infection that requires antibiotics and should connect with your provider.
Video resource:
Getting a good latch to make feeding more comfortable
Clogged Ducts & Mastitis
Clogged ducts:
A plugged duct feels like a tender, sore lump in the breast/chest. It is caused by a milk duct that is not drained properly. Plugged ducts are common and can be caused by severe engorgement, regularly feeding on only one breast/chest, skipping feedings or not feeding as often as usual, or pressure against the milk ducts (diaper bag or a bra that is too tight).
What you can do:
Take a hot shower or apply warm, moist cloths over the plugged duct and the rest of your breast/chest.
Massage your breast/chest from the plugged duct down to the nipple before and during breast/chestfeeding.
Breast/chestfeed frequently and use different positions.
Empty the affected breast/chest first.
Wear a well-fitting, supportive bra that is not too tight. Consider trying a bra without an underwire.
Rely on others to help you get extra sleep or relax. This will speed healing. Sometimes a plugged duct is a sign that you are doing too much.
Mastitis:
Mastitis (inflammation of the breast/chest) can occur when a blocked duct doesn't clear, or more generally when the build-up of milk in your breast/chest causes swelling and inflammation. As well as having a tender breast/chest, you are likely to feel achy, run-down, and feverish; you may have flu-like symptoms. Delayed nipple wound healing, stress, chronic engorgement, and persistent breast/chest pain increase the risk of mastitis.
What you can do:
Follow the same tips above for clogged ducts and if you do not feel better within 24 hours, contact your provider who may want to prescribe antibiotics. Remember: it’s completely healthy for your baby to breast/chest feed when you have a breast/chest infection — the antibacterial properties of human milk are protective for your baby!
Video resource:
Best remedies for clogged milk ducts
Engorgement
Engorgement happens when milk isn’t fully removed from your breast/chest. It’s most likely to happen as your milk transitions from colostrum to mature milk or if there are sudden changes in how often you nurse (ie. skipping a few feeds or pumping sessions).
What you can do:
Preventing engorgement: breast/chestfeeding or expressing milk often in the early weeks (8-12 times in 24 hours - every 2-3 hours), ensure optimum latch so milk is removed effectively, and continue to express or pump are regular levels when you and the baby are apart.
When you are already engorged: breast/chest feed from the engorged breast/chest first, put a warm, moist washcloth on your breasts/chest or take a warm shower to encourage milk flow before feedings, massage your breasts/chest before and during feedings from the chest wall to the nipple, hand express or pump a little milk (if you do too much, you may prompt milk production and continue to get engorged) before nursing so it’s easier for baby to latch, put a cold compress on your breast/chest between feeds to reduce swelling and pain.
Video resource:
Engorgement after giving birth
Milk Supply
Many birthing people worry about low milk supply. Most of the time, your body makes exactly enough to satisfy your baby’s needs even if you don’t realize it.
How to tell if your baby is getting enough milk?
The best way to tell if your baby is getting enough milk is to keep track of wet and dirty diapers. As your milk changes, your baby's poops will too. At first, the poops will be black and tarry. Then they'll be greenish to yellowish. Then they will become yellow, loose, and seedy. Around 10-15 days after delivery, your baby may poop after every feeding or less often.
What if I have low milk supply?
By paying attention to the signs of your baby getting enough milk you should have a good idea of how they are doing. While most birthing people make plenty of milk, some do have low milk supply which may be impacted by the following:
Give your baby infant formula instead of breast/chestfeeding.
Introducing solid foods before the baby is 4-6 months old.
Take certain birth control pills or other medicine.
Not getting enough sleep.
Drinking alcohol or smoking.
Having had breast/chest surgery.
Hepatitis B or C, herpes, or diabetes.
How to increase milk supply:
Breast/chest feed every time your baby is hungry. In the early weeks, your baby will eat 8-12 times every 24 hours. It's best not to put your baby on a strict feeding schedule. Follow your baby's cues, and let your baby tell you when it's time to eat.
Make sure your baby is latching well.
Offer both breasts/chest at each feeding. Let your baby finish the first side, then offer the other side.
Empty your breasts/chest at each feeding. Hand express or pump after a feed to draw out all the milk and signal your body to make more.
Avoid bottles and pacifiers in the early weeks. Feed your baby from your breast/chest whenever you can.
Get plenty of sleep, and eat a nutrient-dense diet.
Pump or express your milk. Pumping or expressing milk frequently between nursing sessions, and consistently when you're away from your baby, can help build your milk supply.
Relax and massage. Relax, hold your baby skin-to-skin, and massage your breasts/chest before feeding to encourage your milk to let down
Video resource:
Causes of low milk supply