Troubleshooting Common Breastfeeding Problems

PHOTOGRAPHY Kirsty Stone @thesearethegoldendays

My baby is sleepy. Should I be waking them to feed?

Well, full term babies require at least eight feeds in 24 hours and, as a general rule, most babies need to feed every 3-4 hours. If your baby has a longer sleep than usual, they may feed for longer and more frequently afterwards. Some parents find that their baby has their days and nights mixed up, meaning they’re sleeping all day and waking often to feed throughout the night. In this instance, you may choose to gently wake your baby from their naps to make sure they’re having enough milk during the day.

My nipples are cracked and sore.

First of all, ask your LMC or a lactation consultant to assess your baby’s latch to make sure it is correct and to rule out a thrush infection. They will be able to offer you additional help and support to breastfeed successfully. To help with healing, it can be beneficial to express a few drops of breast milk after your baby has finished feeding to gently rub on your nipples and areola. Keep your nipples uncovered between feeds and if you are using nursing pads make sure you change them often.

My breasts are full and engorged. How can I ease the discomfort?

The number one way to relieve fullness and engorgement is to feed your baby. Beyond that, try having a warm shower to help relieve some of the pressure. Applying clean cold cabbage leaf compresses can also assist with engorgement, as can hand expressing to comfort.

I have a blocked duct. What can I do to treat it?

A blocked duct forms when a build-up of milk causes a blockage, obstructing the flow of milk. You may feel a lump in one spot on the breast which can look reddened and wedge-shaped in appearance, and feel hot or tender to the touch.

• Apply a warm compress to the breast before feeding to help loosen the milk and gently massage the plugged duct.
• It’s best to offer the affected breast for your baby to feed from first but if it hurts too much, put your baby on the affected breast straight after the let-down has occurred.
• Use breast compressions during the feed.
• Ensure the latch is correct and the breast is being emptied effectively.
• Some breastfeeding people find it helpful to dangle feed their pēpi, laying their baby down and leaning over them to feed.
• If the duct is still blocked after feeding, gently massage the affected area.

How will I know if I have mastitis? What are the treatment options?

Mastitis is an inflammation of the breast tissue caused by a blocked duct, infection or an allergy. It can occur suddenly and at any stage of a breastfeeding journey but is most common in the first few weeks. Sometimes someone can get mastitis without any sign of a blocked duct.

The symptoms are:

• A wedge-shaped area of inflammation on the breast that may be pink, red or swollen – there may be red streaks and the skin can be shiny
• A fever
• Aches and pains
• Chills
• Fatigue
• Flu-like symptoms

If you have any of the symptoms of mastitis, contact your LMC or GP as soon as possible.

To help treat the mastitis, make sure you are removing milk frequently, regularly and effectively from the breast. It’s safe to take an anti-inflammatory pain relief such as ibuprofen to help. Mastitis may or may not have a bacterial infection present, but if you do have an infection you may need antibiotics to clear it.

My let-down seems slow.

If your let-down reflex feels too slow, try to relax as much as possible. At the beginning of a feed, some breastfeeding people find deep breathing or visualising the flow of milk to be useful techniques. It can also be beneficial to apply breast compressions with a warm compress, and nurse in a quiet room or similar setting each time you breastfeed to facilitate your let-down. Caffeine, stress, excessive exercise, tiredness, smoking and alcohol can inhibit the let-down reflex.

My breasts feel empty. Has my milk supply dropped?

Usually around 6-12 weeks, milk supply begins to regulate. As a result, your breasts may feel softer, less full or even empty. This is normal and it does not mean your supply has dropped. Your body has worked out how much milk your baby needs and your breasts are adjusting accordingly. They’re no longer making too much milk, hence why they don’t feel as full or heavy as they did when your supply was being established.

My breasts feel full in the morning but emptier at night. Am I running out of milk by the end of the day?

Research suggests that milk volume tends to be greater in the morning and gradually lessens as the day continues. However, fat content typically increases as the day progresses so the number of calories your baby is receiving should not be different. It’s also important to note that your breasts not only make milk between breastfeeds but during a nursing session as well. In that respect, they’re never truly empty. The fullness of your breasts isn’t an indicator for supply and your baby will be receiving milk even if they feel soft – you aren’t running out.