Common Breastfeeding Challenges

Every woman's breastfeeding journey is different, so you may experience some or none of these problems.

Breastfeeding can be challenging, especially in the early days.

1.Sore Nipples

 In the early days of breastfeeding, sore nipples are almost always the result of incorrect positioning & latching of the baby.

The best prevention for sore nipple is latching the baby on properly from the first day!

Management

• Ensure proper positioning and attachment.The baby should be nursing from most of the areola (the darker colored area around the nipple) and the nipple.Your baby should not be suckling from just the nipple
• Express some milk at the end of a feed, spread it on your nipples & air-dry them.
• Use purified lanolin cream or ointment that is especially made for breastfeeding.
• Let your nipples air dry after feeding, or wear a soft cotton Bra.
• Get help from a lactation consultant.
• Get help from your doctor or lactation consultant before using creams, hydrogel pads or a nipple shield.Creams or lotions are usually not necessary in some cases.
• Avoid harsh soaps or ointments that contain astringents (like a toner) on your nipples. Washing with clean water is all that is needed to keep your nipples and breasts clean.

2.Inverted and Flat Nipples

Some women have nipples that turn inward instead of pointing outward or are flat and do not protrude.

Inverted or flat nipples can sometimes make it harder to breastfeed. 

Often, flat and inverted nipples will protrude more over time as the baby sucks more.

What you can do

• Rolling your nipple between your thumb and forefinger to encourage it to stick out
• Compressing your breast just behind your areola with your fingers in a ‘V’ or ‘C’ shape to push your nipple outwards
• Touching your nipple briefly with a cold compress or ice cube to make it erect
• Hand expressing or using a breast pump for a couple of minutes before a feed to pull your nipple out more.
• Talk to your doctor or a lactation consultant if you are concerned about your nipples.You can ask about using a device that gently suctions or pulls out inverted or temporarily flattened nipples.
  

3.Engorgement

Breast fullness is a normal part of lactation which nearly all women experience when their milk comes after birth.

This feeling of fullness is often accompanied by a feeling of heaviness,
tenderness and warmth.

The swelling will likely last for 2 or 3 days.

Your breasts will adjust over time and start making the exact amount of milk your baby needs.

When breast fullness and swelling becomes severe,it is called“engorgement”.

This can be caused when the baby is not nursing frequently enough or not latching properly.

Not enough milk is being removed from the breast.

When breasts are severely engorged, they become hard,and the skin is taut and shiny.They become extremely tender and painful, and you may run a low‐grade fever and become achy.

The nipple and areola
(the ring of darker skin around your nipple) may flatten out so that the baby has difficulty latching.

Preventing Engorgement:

• To prevent engorgement,feed your baby frequently, at least 8‐12 times in 24 hrs.
• Make sure your baby latches-on well.
• Do not skip feedings or give formula feedings during the first several weeks. 
• As your breasts fill with milk, feed every 1 ½ to 2 ½ hours during the day and 3 hours at night to lessen the chance that your breasts will become severely engorged.
• Do not use a pacifier since you might miss your baby’s feeding cues.
• Do not time or limit feeds. Allow your baby to end the feed himself when he is done.
• Applying ice to your breasts, as your “milk comes in”(after feeds for 15 to 20 minutes) will reduce the swelling.
• Use gentle massage to help your milk flow..
• Stand in the shower and let warm water run over your breasts. This will feel good and encourage leaking. 

4.Breast Infections

Mastitis is soreness or a lump in the breast. It can cause symptoms such as:

• Fever and/or flu-like symptoms, such as feeling run down or very achy
• Nausea
• Vomiting
• Yellowish discharge from the nipple that looks like colostrum.
• Breasts that feel warm or hot to the touch and appear pink or red

It usually happens in only one breast. Some breast infections that do not get better on their own need to be treated with prescription medicine from a doctor. 

What you can do

• Breastfeed on the infected side every two hours or more often. This will keep the milk moving freely and your breast from becoming too full.
• Massage the area, starting behind the sore spot. Move your fingers in a circular motion and massage toward the nipple.
• Apply heat to the sore area with a warm, wet cloth.
• Rely on others to help you get extra sleep, or relax with your feet up to help speed healing. Often a breast infection is a sign that you are doing too much and becoming overly tired.
• Wear a well-fitting, supportive bra that is not too tight, since a tight bra can constrict milk ducts.

Ask your doctor for help if you do not feel better within 24 hours of trying these tips, if you have a fever, or if your symptoms get worse like,

• You have a breast infection in which both breasts look affected
• There is pus or blood in your breastmilk
• You have red streaks near the affected area of the breast
• Your symptoms came on severely and suddenly.

5.NURSING STRIKE

A nursing "strike" is when your baby has been breastfeeding well for months and then suddenly begins to refuse the breast. 

Not all babies will react the same way to the different things that can cause a nursing strike. Some babies will continue to breastfeed without a problem. Other babies may just become fussy at the breast. And other babies will refuse the breast entirely.

Some of the major causes of a nursing strike include:

• Having mouth pain from teething, a fungal infection like thrush, or a cold sore
• Having an ear infection, which causes pain while sucking or pressure while lying on one side
• Feeling pain from a certain breastfeeding position, perhaps from an injury on the baby's body or from soreness from an immunization
• Being upset about a long separation from the mother or a major change in routine
• Being distracted while breastfeeding, such as becoming interested in other things going on around the baby
• Having a cold or stuffy nose that makes breathing while breastfeeding difficult
• Getting less milk from the mother after supplementing breastmilk with bottles or overuse of a pacifier
• Responding to the mother's strong reaction if the baby has bitten her while breastfeeding
• Being upset by hearing arguing or people talking in a harsh voice while breastfeeding
• Reacting to stress, overstimulation, or having been repeatedly put off when wanting to breastfeed

If your baby is on a nursing strike, it is normal to feel frustrated and upset, especially if your baby is unhappy. Be patient with your baby and keep trying to offer your breasts. You may also want to pump your breastmilk to offer during the strike and to make sure you do not get engorged.

What you can do

• Try to hand express or pump your milk as often as the baby used to breastfeed, to prevent engorement.
• Try another feeding method temporarily to give your baby your breastmilk, such as using a cup, dropper, or spoon.
• Keep track of your baby's wet and dirty diapers to make sure he or she is getting enough milk.
• Keep offering your breast to your baby. If your baby is frustrated, stop and try again later. You can also try offering your breast when your baby is very sleepy or is sleeping.
• Try breastfeeding positions where your bare skin is pressed next to your baby's bare skin.
• Focus on your baby, and comfort him or her with extra touching and cuddling.
• Try breastfeeding your baby in a quiet room without distractions.

Reference:womenshealth.gov