Breastfeeding Problems and Solutions

Expect to be tired

• Looking after a baby is exhausting work, especially in the early days when you’re recovering from the delivery. Don’t feel bad if you feel tired and even irritable. You’re only human, after all.

Sleep

• Sleep is more important than doing dishes, laundry, and other chores, so grab some shut-eye every chance you get.
• Nap when baby naps.
• Try to sleep at least 1 ½ to 2 hours during the day for the first 2 to 3 weeks. Trust your husband, parents, or baby sitter with your baby for short periods of time, so that you have some time-out.

Night solution

• You may find it less tiring to nurse baby in bed during night feeds.

Help from husband

• Delegate some tasks to your husband, for example lulling your baby to sleep after each night fee

“Me” time

• Even if it’s just for 10 minutes, make it a point to do something purely for yourself. This private time will make you feel good and keep you from getting burnt out or overwhelmed.
• Do not put your hobbies and interests completely on the back-burner. You really should not feel guilty for spending a time away from baby, as this “me” time helps recharge your batteries, and be a good parent.

At least 95% of mothers can make plenty of milk for their babies, but many are concerned about not having enough. Checking your baby’s weight and growth is the best way to know if he’s getting enough milk.

Often, although mums think that their milk supply is low, it’s actually just fine.

What you can do:

• Eat a well-balanced diet and drink enough fluids.
• Make sure your baby is latched on and positioned well
• Breastfeed often and let your baby decide when to end the feeding
• Offer both breasts at each feeding. Have your baby stay at the first breast as long as he is still sucking and swallowing. Offer the second breast when the baby slows down or stops
• Avoid giving your baby formula or cereal as it may lead to less interest in breast milk. Your baby doesn’t need solid foods until he has reached 6 months old.
• Limit or stop pacifier use as your baby may fall asleep while sucking on this even when he is hungry.
• Let your doctor know if you think your baby isn’t getting enough milk.

Is Galactagogue necessary?

• Galactagogues are foods, herbs or medications that are thought to enhance milk supply.
• Taking these foods may only work if accompanied by sufficiently stimulating breast milk production, either through frequent feeds or expressing milk.
• While there are many substances that mothers claim to help them make more breast milk, there is limited scientific evidence to prove their effectiveness.
• Many cultures have special foods that are thought to enhance milk production. These vary and may contain active ingredients to fulfil this purpose. However, they have not been formally studied.
• Prolactin is the main hormone responsible for the production of breastmilk. Most medications that act as galactagogues work by increasing prolactin levels.
• The most common galactagogues are Fenugreek seed, Domperidone and Metoclopramide.
• Always speak to your doctor or lactation consultant if you plan to take any galactagogues.

The main cause of sore and cracked nipples is poor attachment by baby when feeding. This may be due to baby pulling the nipple in and out as he suckles, and rubbing the skin against his mouth. It may also be due to the strong pressure on the nipple from incorrect suckling.

Improving breastfeeding positions and latch-on is usually all it takes to solve this problem. Often, as soon as the baby is well attached, the pain will lessen and the baby can continue breastfeeding normally.

There is no need to rest the breast as the nipple will heal quickly when it’s no longer being damaged.

Symptoms

• Inverted nipples do not protrude from the level of the areola but are retracted inwards instead. Sometimes, an inverted nipple is non-protractile and does not stretch out when pulled; instead the tip goes in. This makes it difficult for baby to latch on. Protractility often improves during pregnancy and in the first week or so after baby is born.

Causes

• Different nipple shapes are a natural physical feature of the breast. An inverted nipple is held by tight connective tissue that may loosen after a baby suckles from it for a time.

Management

• Talk to your doctor or lactation consultant if you are concerned about your nipples.
• Continue breastfeeding, remember that baby has to latch on to both nipple and breast, so even inverted nipples can work just fine. Baby is more likely to attach and feed well if he becomes used to breastfeeding very early on. It is best to avoid bottles and teats this time, as these are very different in shape compared to the inverted nipple.
• Often, inverted nipples will protrude over time, as the baby sucks more. Trying different breastfeeding positions may also help baby to attach.
• If baby cannot attach in the first week or two, mother can express her breast milk and feed it by cup.
• Mothers can gently stimulate her nipple using a breast pump or another mild suction device such as a syringe.
• There is also a special device designed to pull out inverted nipples. It is a non-surgical method for inverted nipples that uses suction to stretch the lactiferous ducts gently in a manner similar to tissue expansion.

Symptoms

• The breasts are swollen, and the skin looks shiny and red.
• Usually the whole of both breasts are affected, and are painful.
• You may have a fever that usually subsides in 24 hours.
• The nipples may become stretched tight and flat, which makes it difficult for the baby to attach and remove the milk.
• The milk does not flow well.

Cause

• Failure to remove breast milk may cause congestion, especially in the first few days after delivery when milk comes in filling the breast and at the same time, blood flow to the breasts increases.
• The common reasons why milk is not removed adequately are delayed initiation of breastfeeding, infrequent feeds, poor attachment and ineffective suckling.

Management

• You must remove the breast milk. If the baby can attach well and suckle, then you should breastfeed as frequently as the baby is willing.
• If the baby is not able to attach and suckle effectively, you should express milk by hand or with a pump until the breasts are softer, so that the baby can attach better. Once this is achieved, get baby to breastfeed frequently.
• You can apply warm compresses to the breast or take a warm shower before expressing. This will help the milk to flow.
• You can also use cold compresses after feeding or expressing, as this will help to reduce swelling or fluid retention

Mastitis is an infection of the breast tissue.

Symptoms

• There is a hard swelling in the breast, with redness of the overlying skin and severe pain.
• Usually only a part of one breast is affected, which is different from engorgement, when the whole of both breasts are affected.
• You may have fever and feel ill.
• Mastitis is most common in the first 2 to 3 weeks after delivery, but can occur at any time.

Causes

• Usually due to long gaps between feeds.
• Other causes include poor attachment, with incomplete removal of milk.
• Unrelieved engorgement.
• Frequent pressure on one part of the breast from fingers or tight clothing, and trauma.

• Management
• Improve the removal of milk and try to correct any specific cause that is identified.
• Rest and breastfeed the baby frequently and avoid leaving long gaps between feeds. If working, take sick leave to rest in bed and feed the baby. (Mums with mastitis should not stop breastfeeding)
• Apply warm compresses.
• Start breastfeeding the baby with the unaffected breast, to stimulate the oxytocin reflex and milk flow.
• Vary the position of the baby.
• If symptoms are severe, if there is an infected nipple crack, or if no improvement is seen after 24 hours of improved milk removal, the treatment should then include some antibiotics. However, antibiotics will not be effective without improved removal of milk. Always speak to your doctor if this happens.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.