Engorgement

In the first few days after birth your breasts produce colostrum, a thick, yellowish substance, rich in proteins and antibodies. This colostrum has been in your breasts since before birth. It is the perfect food for your baby these first few days and he doesn't need anything else.
Your milk will "come in" around the third or fourth day after birth. When it does, you may experience a fullness and tightness in your breasts.
After delivery, the hormones that stimulate milk production, also cause increased amounts of blood and lymph in the breast. These fluids together with the milk volume itself; cause your breasts to become full, heavy and tender. This fullness is a normal condition, which subsides at about ten days after delivery if the baby is nursing frequently.

This breast fullness may however develop into engorgement when the breast is not emptied frequently or adequately. When breastfeeding is delayed or interrupted or the time that baby nurses at the breast is restricted the breasts can become overfull or engorged.

Symptoms of engorgement include:

* Breasts feel extremely full and painful
* Breasts are warm, hard, skin can be shiny and transparent
* You may have low-grade fever
* Your nipples may be difficult to grasp due to engorgement of the areola.

Prompt treatment of engorgement will prevent possible complications as:

* Feeding problems or slow weight gain if baby is unable to latch on well to the breast
* Sore nipples due to the inability of baby to grasp the nipple and latch on properly to the   breast.
* Increased risk of plugged ducts and breast infections due to inadequate milk flow and   pressure within the breast.

MEASURES FOR IMMEDIATE RELIEF OF ENGORGEMENT 

* Use warm compresses or heating pads on your breasts or take a warm shower about 15   minutes prior to   nursing, to promote letdown and milk flow,
* You can accompany this with some gentle massage with your finger tips, massaging
  from the chest wall toward the nipple area in a circular motion
* Use cold compresses on your breast in between feedings to relieve pain and swelling   (crushed ice in a plastic bag, or a bag of frozen vegetables work well).
* Nurse frequently, at least every 1 ½ to 2 hours, you may have to wake up a sleepy baby
  for a feed.
* Nurse from both breasts and don't restrict feeding time
* If baby is too sleepy to nurse or hasn't nursed long enough to soften the breast, hand   express the milk or use a breast pump.
* If your baby has difficulty latching on to your engorged breast, hand express or pump
  some milk until your areola has softened and it is easier for your baby to latch on.
* Take a pain medication that is compatible with breastfeeding (such as Paracetamol ).
* Avoid use of supplementary bottles and pacifiers, all baby's nursing should be at the
  breast
* Wear a well fitting, non-binding bra for support

When you follow carefully the above measures you will feel more comfortable, your engorgement will subside soon and further difficulties will be prevented.

 

Plugged Ducts

If you notice a tender spot, redness or sore lump in your breast you may have a plugged duct.
A plugged duct usually occurs when a milk duct is not properly drained. Milk or cast off cells accumulating within the duct may form a plug, causing milk to back up behind it. This can cause inflammation in the surrounding tissues.
Plugged ducts don't go accompanied with fever and flu-like symptoms like a breast infection, but if not treated properly and quickly they may develop into a breast infection.

ACTIONS

* Apply heat to the affected area (hot compress, heating pad, warm shower) prior to   nursing.
* While nursing from the affected side use massage to encourage proper draining,
  starting behind the sore spot, working towards the nipple in firm, circular motion.
* Nurse frequently, at least every 2 hours, always starting with the affected breast first.
* Take adequate rest. Plugged ducts are often a first sign that you are doing too much.
* Try different nursing positions, make sure the baby is positioned and latched on well.
* If baby does not empty breast or doesn't want to nurse, pump or express milk.
* Make sure you don't wear constrictive clothing, especially your bra.

By following these measures you will usually feel better after a day or two. If after a week of careful treatment the symptoms are still present or have worsened, contact your doctor.

Knowing the reason for the plugged duct can be reassuring and can help prevent it from happening again.

The most common causes are:
* Missed or shortened feedings, so your breasts become overfull. For example when
  your baby suddenly sleeps through the night, when your baby uses a pacifier for long
  periods of time or when you give supplementary bottles. In these cases the answer is:
  avoid skipping feedings or  pump breasts so they don't become overfull.
* External pressure on the breast can restrict the flow of milk and cause inflammation,
  for example: a tight bra or constrictive clothing, pressure on the breast from sleeping
  on your stomach or baby resting on your breast, wearing breast shells for long periods
  of time.
* Poor positioning or latch-on so milk ducts are not properly drained. Check the
  positioning and latch on of your baby carefully.

Breast infection

A breast infection, also called mastitis, can develop from a plugged duct gone unnoticed or untreated, or can be the result of a crack in the nipple skin, providing a pathway into the breast for bacteria.
The affected area of the breast becomes red, hot and painful, you have fever of 38 C or higher and flu-like symptoms ( tired, achy, run-down).

Breast infections most commonly occur:

* In the newborn period when mother is tired and breast is not emptied properly.
* After abrupt weaning or when there is a change in nursing pattern. For example if
  your baby suddenly sleeps through the night or missed feedings because of
  mother-baby separation etc.
* When mother is over tired, stressed, and overworked.

Treatment for mastitis is the same as treatment for plugged ducts.
If you develop symptoms of a breast infection you should contact your doctor as soon as possible; you may need to take antibiotics. Ask for the type that is compatible with breastfeeding. Be sure to take it for the whole course of treatment. Start immediately with the measures below and continue these as long as the symptoms persist. Taking action now will prevent you from further complications.

ACTION
* Apply heat (warm compresses, or heating pad) before and
  between feedings.
* Rest: go to bed and stay there for several days; get help with all tasks.
* Empty breast; nurse frequently on the affected side.
* Maintain fluid intake, water and fruit juices are preferable.

When you follow these actions, in addition to possible antibiotics prescribed by your doctor, you will soon feel much better and able to enjoy your wonderful nursing relationship with your baby.

In a few cases, breast infections tend to recur. If you get a breast infection a few weeks after a previous one, it is possible that the original infection was not cured.
Always make sure you finish the whole course of treatment as prescribed by your doctor. Don't stop the treatment as soon as your symptoms have disappeared.
Certain mothers with recurrent mastitis may be prone to infections; these mothers may want to evaluate their overall health and other factors that may have contributed to mastitis, like poor diet, inadequate rest or fatigue.

Sore Nipples

Under normal circumstances breastfeeding doesn't hurt. In the first days after birth you may experience some nipple tenderness, but this usually subsides in a few days and after that breastfeeding shouldn't hurt. If it does, it is a sign that something is wrong.

THE PRIMARY CAUSE of nipple soreness in the early weeks is poor positioning and latch on of the baby. Please go back to the section on POSITIONING and check
every step carefully. You may experience immediate relief from nipple soreness when you begin positioning your baby correctly. If you are sure that your baby is positioned and latched on correctly, have a look at some other possible causes of sore nipples described below. SOME OTHER CAUSES OF NIPPLE SORENESS

* Sometimes engorgement can cause sore nipples. If the breast is overfull the nipple may flatten, making it difficult for the baby to latch on to the breast properly. In this case you can pump or hand express some milk prior to nursing to soften the areola and bring out the nipple so your baby can latch on easier.

* Giving bottles or pacifiers in the early weeks of breastfeeding can cause your baby to become nipple confused. Sucking from a bottle nipple is different than from a breast and some babies start sucking incorrectly from the breast, causing the nipples to become sore.. If you suspect your baby is nipple confused consider stopping the use of pacifiers until the baby is older. If you're giving supplemental bottles to your baby consider reducing them gradually and start increasing your milk supply by nursing more often. Supplements can also be given to your baby by cup, spoon, plastic eyedropper, feeding syringe or baby cup. These feeding methods will take some practice but they don't cause nipple confusion.

* The use of soaps, alcohol, deodorant, body lotion or certain nipple creams can cause irritation to the skin of your nipples and result in sore nipples. If you suspect this can be the cause of your sore nipples, for example if you have a history of sensitive skin, eliminate these products or choose hypo-allergic ones. It is best to avoid using soap or alcohol on your breasts because they can dry your skin and remove the natural protective oils and can also cause irritation.

* Damp breastpads, especially the ones with a plastic lining, can cause the nipples to become sore because they create a moist environment with no air circulation. Use breastpads without plastic lining and change them very often, alternately you can use folded cotton handkerchiefs.

* Taking the baby from the breast without breaking the suction can cause sore nipples. When your baby is finished nursing and you want to take him from the breast, insert your finger in the corner of baby's mouth to break the suction, this way your nipples will not be hurt.

* A tight bra can cause your nipples to become sore. Make sure you are wearing a well fitting bra with some room for expansion for when your breasts become full.

* Improper use of a breastpump can cause sore nipples. Check the instructions of your breastpump carefully and try a lower setting, make sure your nipple doesn't touch the inside of the flange when you pump.

* When your baby is older and eating solids your nipple soreness may be caused by irritation from food particles in baby's mouth. In this case wipe baby's mouth with a moist cloth or give him a sip of water before nursing.

* If you have sore or cracked nipples that don't respond to standard sore nipple treatment (see below) while your baby is positioned and latched on correctly you may have contracted thrush on your nipples

Below you will find some suggestions that will make nursing more comfortable while your nipples are healing.

* Pay extra attention to the positioning and latch on of your baby especially in the period that your nipples are sore. Make sure your nipple goes deeply in baby's mouth, this will protect the nipple from further damage.

* Before every feeding you can pump or hand express some milk to start the letdown, this way your baby doesn't have to suck too vigorously.

* Apply some ice, wrapped in a wet cloth, on your nipple immediately before nursing to numb the nipple.

* Nurse on the least sore side first as baby usually nurses more vigorously on the first breast.

* Breastfeed often, don't hold feedings off for fear of pain because this will make your baby more hungry and he will nurse more aggressively.

* Try different nursing positions, so the pressure of baby's gums and tongue are not constantly on the sore spot.

* Change breastpads frequently, avoid the ones with plastic lining. Wear a cotton bra. If dried milk causes your nipple to stick to your bra or breastpad, moisten it with some water before taking it off.

* If your nipples are so sore that you can not tolerate wearing your bra or clothes, you may want to consider wearing breast shells. Breast shells are two piece plastic or silicone devices worn inside your bra over the nipple and areola during the day to protect your nipples and promote healing by allowing air circulation.

* Be careful when choosing a cream or ointment for the treatment of sore nipples. Some may not be safe for your baby to ingest; others may be drying to the skin or cause irritation. Modified lanolin reportedly has excellent healing properties, maintains internal moisture, which hastens the healing process and does not need to be removed before feeding. Apply the lanolin before every feeding.

* If your nipples are so sore that you can not tolerate your baby nursing at your breast you may want to choose to temporarily pump your milk and feed it to your baby. If your baby is younger than 6 weeks it is better to avoid the use of bottles because your baby can become nipple confused at such an early stage, in this case it is better to feed him with a cup, spoon, plastic eye dropper or feeding syringe. As soon as your nipples have healed you can put your baby back to the breast.

Most sore or cracked nipples will heal quickly in a few days with the ideas given above and you'll be back to problem free nursing your baby!