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When Breastfeeding Becomes Hard


Engorgement is simply a case of too much of a good thing when your cups runneth over, as it were - your breasts just too full of milk. This can result in granite hard breasts which, as one can imagine, can be so throbbingly uncomfortable they hurt right up to the armpits. Sometimes, they're caused by an over-supply of milk, or an irregular feeding schedule.

A blockage in the duct can also cause a build up of milk behind it. For the nursing mum, especially a firsttimer who is still grappling with other problems like sore nipples and sleep deprivation, engorged breasts may be particularly frustrating, not to mention painful. Says lactation consultant Betty: "It can be a frightening experience for a mother.

Engorgement is a serious condition but it is temporary and with proper treatment, it is usually resolved within 12 to 24 hours." Since this condition is most common when your milk first comes in, it is advisable to start breastfeeding as soon as possible to establish a well-coordinated system of Mum's milk supply and baby's feeding demands.

"Eighty percent of my clients experience mild to severe engorgement usually in the first week after delivery. During this time, babies can be sleeping too much to feed regularly or are not latching on correctly. "This in turn can lead to sore nipples and infrequent feeding," says Betty. To head off the problem, it's best to nurse as frequently and regularly as possible.

"Allow your baby to nurse as long as he needs to, at least eight times in 24 hours," she advises. "If breast feeding does not reduce engorgement, Mum may need to express between feeds." Sometimes, mothers suffer from engorgement when they return to work after maternity leave, or when they wean their babies off the breast at six months to a year.

If left untreated, engorgement can affect milk supply and let down, the trigger that releases milk from the ducts during feeds, warns Betty. "The increase in pressure within the duct systems restricts blood and lymph flow, which carry nutrients to make milk. Engorgement may even harm breast tissue. The increase in milk pressure can cause some alveoli cells to shrink and die off, thus affecting milk supply."

What's more, the flattened nipples of engorged breasts are more difficult for baby's mouth to grasp on to. "Nerves within the nipple and aureola are not stimulated and let down may not occur," she says. More serious complications involve infection of the milk ducts, leading to a painful condition known as mastitis. "Bacteria that is not effectively removed by the lymphatic system may cause infection," she warns.

She notes that you should see your doctor if you have a fever of more than 38.5 deg C or any redness, accompanied by a reduction of milk flow. "You can see any lactation consultants either in private practice or at the hospitals. There, they can massage your affected breast directly to relieve the pressure.

Alternatively, consult your gynaecologist if he or she is pro-breastfeeding and has adequate knowledge on lactation," she says. As a freelance lactation consultant, she prefers house calls. "I feel that it is better for me to visit the mother at home where she is more comfortable. 1 can even show the hubby or care giver who is with her to assist her in feeding and expression."

If the engorgement has progressed to such a degree that baby is unable to latch on to the breasts, you will first need to express milk before a feed to soften the aureola. "You can hand express in a warm shower - water spraying on the back and shoulders can help you relax. You can also have a warm drink before expression as warmth improves the circulation of the body," she says.

Alternatively, use a pump before nursing to soften an aureola hardened by breast engorgement. Her advice: "Pump till your aureola is just soft enough for baby to latch on and nurse. Following the feed, you should pump the breast again if needed, or until milk flows out easily." But the best relief, according to Betty comes in a dimpled, chubby form of your baby:

"I believe that baby is the best pump to relieve engorgement, and many mums whom I've seen totally agree with me. "A good latch enables the baby to take large amount of breast tissue into his mouth so that his lips are positioned behind the milk sinuses in the aureola and strip the milk from them." 

She adds: "Removing the milk relieves the pressure in the breasts while maintaining milk production." The best way to do this yourself is to experiment with nursing your baby in different holds, for example switching from cradle hold to football so that you can position your baby's mouth over the affected milk sinus.

What A Re-Leaf!

Applying chilled cabbage leaves to engorged breasts provides relief: Fact or fiction? Apparently fact is stranger than fiction. Bizarre as it may look, cool cabbage leaves applied between feeds help decrease discomfort, although why they work is still unknown. Says lactation consultant Betty: "Cabbage reduces the oedema, or swelling in breasts' engorgement, and even the inflammation caused by plugged ducts and mastitis." But avoid prolonged use -the leaves may reduce milk production. Alternatively, use a cold compress after a feed.

Engorgment

It is results from mismanagement of breast fullness caused by delay or infrequency of breastfeeding. It usually occurs three to four days after delivery. In most cases, it affects both breasts. Swelling is generalised, accompanied with increased warmth and pain, the aureole may be rather hard and you may have a low-grade fever. The milk building up in your breasts signals the body to decrease milk production. If not relieved, prolonged engorgement can contribute to insufficient milk supply.

Blocked Ducts Or Plugged Ducts

They are usually found in mothers who have abundant milk supply. The cause is incomplete milk removal or pressure on a specific area of the breast from wearing a tight bra, the underwire in a bra or a bad sleeping position. These can hinder the flow of milk in the ducts. It is characterised by tenderness, heat, swelling, lumpiness or possibly redness in one area of breast or slight pain. Because the plugged duct is localised, there are no flu-like symptoms or fever, but perhaps a low-grade fever usually below 38 deg C. Sometimes, a tiny white plug can be seen at the opening of the duct in the nipple.

Mastitis

It is an infection of the breasts tissue resulting from untreated plugged ducts or engorgement, sore or cracked nipples, an infection or trauma to the breast. Usually, only one breast is infected. Most times, the breast is infected by bacteria from the baby's mouth. Mums with mastitis complain of fatigue, localised breast tenderness, flu-like symptoms, headache and muscular aches. The breasts are red, hot and tender to touch. Treatments include efficient milk removal by frequent feeding or expression, a warm moist compress to the inflamed area and anti-inflammation medication or antibiotics. The mother will also need total rest to help her fight the infection. With proper treatment, the condition will resolve within two to three days.

Prevention Tips

Initiate Breast Feeding Within The First Hour Of Life

When mother and baby are kept together 24 hours a day, she becomes familiar with her baby's feeding cues.

Breast Feed According To Baby's Cue

Or if the fullness is increasing, don't be afraid to gently wake baby and put him to the breast for a feed.

Ensure Correct Latch And Positioning

The right latch means maximum suction power.

 

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