Hesperian Health Guides
Common Concerns and Problems
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Fear that there is not enough milk, or that milk is not good enough
Many women think they do not have enough milk. This is almost never true. Even mothers who do not have enough to eat can generally make enough milk for their babies.
The amount of milk your breasts make (your milk supply) depends on how much the baby suckles. The more the baby suckles, the more milk you will make. If you skip a feeding and give a bottle instead of breast milk, your body will make less milk.
Some days it may seem like the baby is always wanting to breastfeed. If you feed your baby whenever it is hungry, your milk supply will increase. In a few days the baby will probably seem satisfied again. Night feeding helps to build up a mother’s milk supply. Try not to believe anyone—even a health worker—who says that you do not have enough milk.
Breasts do not have to feel full to make milk. The more babies a woman has breastfed, the less full her breasts will feel. Small breasts can make as much milk as large breasts.
A baby older than 2 weeks may not pass stool every day. If the baby is feeding well, wetting, and seems content, the stool will come.
A baby is getting enough milk if:
- it is growing well, and seems happy and healthy.
- it wets 6 or more times and dirties the diaper (nappy) about 1 to 3 times in a day and night. You can usually tell this after the baby is 5 days old, when the baby will start to pass urine and stool more regularly.
Because breast milk looks different from other milks, some women fear that it is not good milk. But breast milk gives babies everything they need.
Nipple concerns and problems
Flat or pushed-in (inverted) nipples
Most women with nipples that are flat or pushed-in can breastfeed without a problem. This is because the baby suckles on the breast, not just the nipple. You do not need to do anything to prepare your nipples during pregnancy.
The size and shape of your nipple is not important—the baby suckles from the breast, not just the nipple.
|average nipple||flat nipple||long nipple||inverted nipple|
These ideas may make it easier for your baby to suckle:
|Offer the whole breast. This helps the baby get a good mouthful of the breast.|
- Start breastfeeding right after birth, before your breasts become full. Make sure your baby takes a good mouthful of breast.
- If your breasts become too full, remove some milk by hand to make them softer. This will make it easier for the baby to get more breast in its mouth.
- Lightly touch or roll your nipple before you feed. Do not squeeze it.
- Try cupping your hand around the breast and pushing back to make your nipple stick out as much as possible.
Sore or cracked nipples
If you feel pain from breastfeeding, the baby probably does not have enough of your breast in its mouth. If the baby suckles only on the nipples, they will soon become painful or cracked. A cracked nipple makes it easier for a woman to get a breast infection. You can teach your baby to take more breast in his mouth. Here are some suggestions.
Prevention and treatment:
- Be sure to hold the baby so it can get a good mouthful of the breast.
- Do not pull your breast out of the baby’s mouth. Let the baby feed as long as it wants. When it is done, it will let go of the breast itself. If you need to stop before the baby is ready, pull down on its chin or gently put the tip of a clean finger into its mouth.
- Soothe sore nipples with breast milk at the end of a feed. When the baby has stopped feeding, squeeze out a few drops of milk and rub them on the sore places. Do not use soap or cream on your breasts. The body makes a natural oil that keeps the nipples clean and soft.
- Avoid rough or tight clothing.
- To help sore nipples heal, leave your breasts open to the air and sun, if possible.
- Continue to feed from both breasts. If a nipple is very sore or cracked, start on the less painful breast and then switch to the other breast when the milk is flowing.
- If the pain is too great when the baby suckles, remove the milk by hand and feed the baby with a cup or spoon. A crack should heal in 2 days.
Pain and Swelling in the Breasts
A woman’s breasts are too full (engorgement)
When the milk first comes in, the breasts often feel swollen and hard. This can make it difficult for the baby to suckle, and the nipples may get sore. If you breastfeed less because of the pain, your milk supply will be less.
Prevention and treatment:
- Start breastfeeding within the first hour after birth.
- Make sure you are holding the baby well.
- Feed the baby often, at least every 1 to 3 hours, and on both breasts. Sleep with the baby nearby so you can breastfeed easily during the night.
- If the baby cannot suckle well, remove some milk by hand—just enough to soften the breast—and then let the baby suckle.
- After feeding, apply fresh cabbage leaves or cool wet cloths to the breasts. After 2 or 3 days, the swelling should go down. Engorgement that does not improve can become mastitis (a hot, painful swelling of the breast).
Blocked duct, mastitis
If a painful lump forms in the breast, it may mean that a duct is blocked by thick milk. When milk flow stops in part of the breast, it can also cause mastitis. If a woman has a fever and part of her breast is hot, swollen and painful, she probably has mastitis. It is important to continue breastfeeding so that the duct can empty and the breast does not get infected. The milk is still safe for the baby.
Breast infection (mastitis with infection)
|Warm, wet cloths can help with blocked ducts or mastitis.|
If you have had signs of mastitis with no improvement after 24 hours, or severe pain, or a crack in the skin where germs can enter, you must get treatment for breast infection right away.
The most important part of treatment is to continue breastfeeding often. Your milk is still safe for the baby. Medicines and rest are necessary too. If you can, take time off from work and get help with your household work. Also follow the treatment for blocked duct and mastitis. If needed to keep the milk flowing, you can milk your breast by hand or use the warm bottle method.
|Medicine for Breast Infection|
|Medicine||How much to take||When and how to take|
|For infection take:|
|dicloxacillin||500 mg||4 times a day for 7 days.|
|If you cannot find this or |
are allergic to penicillin, take:
|erythromycin||500 mg||4 times a day for 7 days.|
|Before taking medicines, see the “Green Pages.”|
|For fever and pain, take:|
|paracetamol (acetaminophen) 500 to 1000 mg until the pain goes away.|
IMPORTANT! If a breast infection is not treated early, it will get worse. The hot and painful swelling will feel as if it is filled with liquid (abscess). If this happens, follow the treatment described here AND see a health worker who has been trained to drain an abscess using sterile equipment.
|How to mix gentian violet with clean water to make a 0.25% solution
If your gentian violet says...||Use|
|0.5%.........||1 part gentian violet plus 1 part water|
|1%............||1 part gentian violet plus 3 parts water|
|2%............||1 part gentian violet plus 7 parts water|
If you are holding the baby so it is comfortable and feeding well, and the pain in your nipples lasts for more than a week, it may be caused by thrush in the baby’s mouth. Thrush can feel like an itchy, stabbing or burning pain, moving through the breast. You may see white spots or redness on your nipple and in the baby’s mouth.
Mix gentian violet with clean water to a strength of 0.25% and paint on the nipples and on the white patches in the baby’s mouth once every day for 5 days, or until 3 days after healing is complete. Use a clean cloth or finger to apply. If it does not get better, see the “Green Pages” for other medicines. You can continue to breastfeed. The medicine will not hurt you, your milk or the baby.