Hesperian Health Guides
Common difficulties while breastfeeding
HealthWiki > A Book for Midwives > Chapter 16: Breastfeeding > Common difficulties while breastfeeding
Fear of not having enough milk
Some women are afraid that they do not have enough breast milk. Health workers or family members may even tell them they do not have enough. Assure the mother that this is almost never true. The more a baby suckles, the more milk a mother's breasts will make.
| If the baby does not seem satisfied, | do not give solid food or a bottle. | Help him breastfeed more! | |||
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| long nipple | flat nipple |
Flat or inverted nipples
Some women's nipples are flat or inverted (sink into the breast). Even so, the baby can usually breastfeed without a problem. But the mother and baby may need some help in the first few days.
Breastfeeding with flat nipples
- Start breastfeeding right after birth — before the breasts become full.
- If the breasts are very full, remove some milk by hand to make them softer.
- Gently roll the nipple to make it stand out.
- Cup a hand around the breast and pull back. The nipple will pop out.
| Take the breast like this: | and pull back towards the chest. The nipple will stand up. |
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Engorged (swollen) breasts
Sometimes a mother's breasts get very full and hard, especially during the first few days after the birth. This can be painful for the mother and also makes her more likely to develop a breast infection. It can also make it hard for the baby to suck the breast. If the mother begins breastfeeding the baby very soon after the birth, and feeds often, she may avoid this problem.
But if a mother's breasts do get swollen, she can try the following:
- Breastfeed the baby more often, both day and night (every 1 or 2 hours, and on both breasts).
- Place hot, wet cloths on the breasts for 15 to 20 minutes before each feeding.
- Put ice, cool cloths, or fresh cabbage leaves on the breasts between feedings. Let the milk leak freely and support the breasts with a bra or cloth.
- If the baby has trouble getting onto the breast because it is swollen, remove a little milk by hand until the breast is soft enough for the baby to take.
Encourage the mother and remind her that this problem will go away soon.
Painful lump in the breast (abscess)
If a painful lump forms in the breast, the milk is probably getting stuck in one part of the breast. If the lump is not treated, the breast can easily become infected.
If a mother has a painful lump, she should:
- breastfeed frequently (every 1 or 2 hours), giving the baby the sore breast first. If for some reason the mother cannot breastfeed, she must remove the milk by hand.
- stay in bed and keep the baby with her so he can feed often.
- drink lots of liquid.
- place hot, wet cloths on the sore breast for 15 to 20 minutes before each feeding.
- use ice or cold cloths between feedings to lessen the pain.
- gently massage the lump as the baby feeds.
Some women have gotten rid of an abscess by drinking 1 tablespoon of
vinegar in a cup of water every hour. Putting cabbage leaves on the abscess
also might help.
Breast infection (mastitis)
Infection inside the breast can occur if the mother has sore, cracked nipples or full, engorged breasts, if she wears a very tight bra or binding clothing, or if she is very tired or in poor health. Preventing these situations will help prevent breast infection.
Signs of breast infection:
- abscess (painful lump in the breast)
- hot, red, sore area on the breast
- body aches and pains
- fever of 38°C (100.4°F) or higher
| For breast infection |  | ||||
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by mouth, 4 times a day for 7 days | ||||
| or | |||||
| If you cannot find this medicine, or if the woman is allergic to penicillin | |||||
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by mouth, 2 times a day for 7 days | ||||
| For fever and pain | |||||
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by mouth, every 4-6 hours as needed (do not take more than 4000 mg in a day) | ||||
| If there is no improvement after 2 days, the woman should be treated in a hospital. | |||||
If a breast infection is not treated early, it will get worse. If an abscess develops and antibiotics do not make it go away, the woman should see a health worker who has been trained to drain an abscess using sterile equipment.
The mother can keep breastfeeding, but try to keep the baby’s mouth and hands from touching the abscess or its drainage. Cover the abscess with a clean, dry cloth.
Sore or cracked nipples
If a woman feels pain in her nipples while breastfeeding, the baby is probably not in a good position. If the baby keeps breastfeeding in a bad position, the mother's nipples may crack. Cracked nipples can become infected.
To treat sore or cracked nipples:
- Help the mother hold the baby in a position that allows the baby to get a large mouthful of breast.
- The mother can rub breast milk into her nipple. This will prevent infection in the cracks and keep the nipples soft so they will not crack more.
- Encourage the mother to leave her breasts open to air and sunlight when she is not breastfeeding.
- Encourage the mother to keep feeding from both breasts — but she can start with the less sore breast and switch to the cracked one once the milk starts flowing.
- If the pain is too great to breastfeed, the mother can remove her milk by hand and feed the baby with a cup and spoon for a few days.
Thrush
If a baby is in a good position while suckling and the mother still has pain in the nipples that lasts for more than a week, it may be caused by thrush (a yeast infection on the nipple or in the baby's mouth). The mother may feel an itch on her nipples or a stabbing burning pain. The baby may have white spots or redness in her mouth.
How to treat thrush
Cover the white spots in the baby's mouth with nystatin drops. Use 2 full droppers (0.5 ml of nystatin per dropper) 4 times a day. Continue giving this medicine for 2 days after the patches are gone, or they may come back.
If the mother has itching or pain on her nipples, she should treat her nipples the same way she treats the baby’s mouth, with nystatin drops.
The mother should keep breastfeeding. If the thrush does not get better in 3 days, get medical advice
The baby has gas pains (colic)
If a baby starts to cry and pull his legs up soon after he starts to suck, he may have gas — too much air in the belly. Some babies swallow air when they breastfeed. It may help to let the baby burp.
| Lay the baby on your shoulder and rub or pat his back. |  |
or | Lay the baby across your knees and rub or pat his back. |  |
or | Sit the baby up leaning forward and rub or pat his back. |  |
Sometimes a baby seems to get gas pains when the mother eats a certain food or spice. The mother can try eating food without spices, or stop eating a food that may be causing gas for 2 or 3 days (if she is getting enough nutrition from other foods). There is no particular food that should be avoided, because each baby is different.
Gas pains usually stop when the baby is about 4 months old.