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Breast milk is the best food for your baby, but sometimes in spite of your best efforts, problems can arise. Don’t give up! Here is what to do about the most common difficulties.
Swollen, hard breasts
Two or three days after delivery, your breasts usually become engorged, or temporarily swollen and uncomfortable. The increased flow of blood to the breast and the start of milk production cause this. Some women feel their breasts are only slightly fuller, but others feel their breasts are very swollen, tender, lumpy and throbbing, and sometimes the swelling may extend to the armpits. This swelling usually lessens within 24 to 48 hours, but may get worse if you nurse your baby too briefly or infrequently.
What to do
Breastfeed only. Avoid giving baby water or formula.
Breastfeed often, 8 to 12 times in 24 hours, and make sure your baby nurses at least 10 minutes on each breast at every feeding.
Avoid having baby start sucking when the areola (dark area surrounding the nipple) is too hard or your nipple is flatter than usual because of the fullness of your breasts. Try taking a warm shower. It helps the “let-down reflex” or the free flow of milk from your breasts, and the areola will soften to allow baby to latch on without damaging your nipple. Or, express some milk with a breast pump or by hand. Express only until your baby can latch on comfortably. (Pumping a lot of milk will increase your milk production and make your breasts feel even more uncomfortable.) Before nursing, you can also try gently massaging your breasts. Once the milk starts to flow, allow your baby to nurse. You can also massage your breast gently while baby is nursing to help milk flow.
To ease the swelling and pain of engorgement, put an ice pack or cold towel on your breasts after nursing.
Express your milk if you miss a feeding.
Wear a supportive nursing bra, even during the night, making sure it is not too tight.
Baby’s low weight gain or your low milk supply
If you milk doesn’t come in after three or four days from the birth, or if you nurse infrequently, or if your baby is sick, he may lose a lot of weight. Also, if you are very tired, or if you are nursing twins, your milk supply may decrease.
What to do
Breastfeeding is based on the law of supply and demand: the more your baby feeds, the more milk you will produce, so increase the frequency of the feedings, to one feed at least every two to three hours. Measure the time from the start of one feeding to the start of the next.
Nurse your baby while lying in bed, because your relaxed state helps you with the “let-down reflex,” or flow of milk.
Massage your breasts while nursing.
Cuddle your baby while he feeds, as these movements stimulate milk production.
Undress the baby’s legs before feeding, since skin to skin contact or being partially undressed will wake a sleepy baby and help him to nurse better.
Feed on one breast, burp him and put him on the other breast, repeating the action so that baby nurses twice on each breast.
If necessary, use a breast pump to increase your milk production. Pump immediately after a nursing to stimulate additional milk supply, and then feed the milk you pump to the baby.
Fenugreek (helba) can help in increasing milk supply. By drinking several fenugreek teas a day, mothers usually notice an increase in their milk supply after a few days.
Small, tender lumps in your breast
Tender lumps in your breast may signify that your milk ducts are clogged or that you have mastitis, an infection of the breast.
What to do
Take a warm shower or bath, or apply warm, damp towels to your breasts right before nursing. Don’t use a hot water bottle because its weight might hamper milk flow.
Massage your breast from behind the lump forward to your nipple.
Breastfeed frequently, starting with the affected breast.
Change the baby’s nursing position a few times during each feeding, to make sure that all ducts are emptied.
After a feed, hand express to empty the breast completely if baby doesn’t.
Clean dried milk off your nipples with sterile cotton and boiled, cooled water.
If you have fever or pain, or if the affected breast has red spots, you must call your doctor. You might have mastitis, in which case you may have to take antibiotics.