Disclaimer – The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein.
Pharmamum’s Ultimate Guide: Breastfeeding
When I think back to when I first breastfed my eldest daughter, the first thought that comes to mind was, ‘I really had no idea what I was doing’. I remember when my beautiful baby girl was placed on my chest and then moments later, the midwife said, ‘Ok let’s give her a feed’. At that point, I thought, ‘I’ve been pregnant for 9 months and I didn’t even think once, to do any research on breastfeeding’. My plan was to get through the birth and then worry about breast feeding. And that’s exactly what I did, I worried a lot about breastfeeding for at least the first 6 weeks, because for me, it didn’t come naturally. I needed a lot of education.
I think it took approximately 5 to 6 weeks to feel comfortable breastfeeding. From dealing with attachment issues, bleeding and cracked nipples to mastitis, nipple thrush and vasospasm, looking back I think I had it all. The following post will deal with many breast feeding challenges, how I dealt with these issues personally and as a pharmacist, I want to share with you, the products that can help with treating these common problems.
From the minute I started breastfeeding, I struggled with attachment. For the first couple of weeks, I constantly had to place my daughter Sophie on the breast, and then take her off, as she often, would not have enough of the nipple in her mouth and nor was she getting enough breast milk whilst attaching poorly. Whenever Sophie would start suckling, I was in pain, it felt like she was just clamping down on the nipple, so I had to gently break the seal with my pinky finger and take her off the breast and try again. I would often see the tip of my nipple with a red line down it, illustrating that she was not positioned correctly. On the positive, I was in hospital and had the constant support of the midwives watching over and helping me to become confident with attaching Sophie correctly to the breast. Every midwife that observed, had an extra tip and this really helped. However, by the third day, my nipples were starting to bleed and I was in so much pain I was advised just to give the nipples a break and express for a day, to allow them to heal.
What I learnt:
- The baby’s mouth needs to cover as much of the areola as possible ( more so on the baby’s lower jaw side) to drain the breast well.
- The chin should be pressed into the breast and ensure the nose is clear to breathe freely.
- The babies head should be tilted slightly back, at the same level as your breast.
- Their nose should be level with your nipple.
- The babies lips should be flanged out.
- The baby’s upper lip should be touched by your nipple as you begin to breastfeed. When baby opens the mouth wide, place on the breast, and aim the nipple towards the roof of their mouth.
- Keep your breast compressed in your hand until the baby is actively suckling.
By ensuring all of the above is performed whilst breastfeeding, there should be no pain.
Treating sore, cracked and bleeding nipples:
Once you address the problem of attachment and correct positioning with the help of a lactation consultant or midwife, the nipples will begin to heal. There are products that can be used in the meantime to soothe and speed up the healing:
- I found the best treatment for my sore nipples was hand expressing a few drops of breast milk and spreading it over the sore nipples. Breast milk has wonderful healing properties as well as anti-bacterial properties and works really well to soothe sore cracked nipples. Just allow them to air dry before putting the bra back on.
- Lanolin eg Lansinoh is a an ultra purified grade of Lanolin. It soothes and protects sore cracked nipples and provides a moist wound healing environment. Applying Lansinoh on the nipples when they are cracked and sore can be difficult as the Lansinoh is a thick waxy substance and at room temperature can be difficult to spread. With clean hands, warm a pea size amount by moving it around between your fingers, this will make it easier to apply. Lansinoh does not have a smell or taste to it and can be applied after a breastfeed. It is not necessary to wipe it away before a breastfeed. A small percentage of people using lanolin may have a reaction. It will occur if you are sensitive or allergic to wool. I always recommend doing a skin test and applying a small amount to the skin, even if it is on your hand just to test that you are not sensitive to it. However Lansinoh’s lanolin formulation have removed the part of lanolin that most people are sensitive to.
- Hydrogel soothing pads provide cool soothing relief to sore nipples. They help heal damaged nipples and are placed directly on the nipples in between feeds. You can place them in the fridge before applying them to the nipple and that will provide cooling comfort and reduce inflammation. They also provide a barrier to the nipple, so that the nipple is cushioned and not rubbing against the bra when sore and irritated. The pads can be reused and rinsed with warm water in between use. There are a few different brands available eg Mother’s mates, Dr Brown’s hydrogel soothing pads and Rite Aid. I found them to be really soothing in between feeds.
When I got home from hospital with my baby daughter, my milk had not come in yet. I had my daughter on a Tuesday and by Sunday my milk finally came in. My breasts that evening suddenly became engorged, they were red, felt lumpy and I had a fever. I rang my obstetrician and he mentioned to me that a fever can occur when the milk is coming in, but come to his rooms the next morning and he will check for mastitis. My obstetrician confirmed it was mastitis and gave me a prescription for an antibiotic. He said, it is important to start the antibiotics straight away. Mastitis often comes on quickly and it can feel like you are coming down with the flu, feeling feverish and unwell. It is an infection caused by a blocked duct that has not cleared properly. The milk is banking up and going in to the breast tissue causing inflammation which gives the breast a red appearance and often the skin can appear shiny. The breast becomes hot, very sore and inflamed.
- It is imperative to get treated for the infection with antibiotics as soon as possible, within 12 hours.
- Often one’s first reaction is to want to leave the breast alone, because it is so painful, however that will only make the infection worse. The milk ducts needs to be cleared and by getting your baby to breastfeed on the infected side will help drain the breast best. It is perfectly safe for your baby to drink from the infected side. To clarify, the baby cannot catch the infection as any bacteria in the milk will get killed by the digestive juices in the babies tummy.
- It is important to breastfeed more often (approximately every 2 hours) alternating breasts with each feed but do try and feed from the infected side first because often the babies suck will be stronger initially before the baby gets tired.
- Your baby may be hesitant to drink from the affected breast just because it feels different eg harder and lumpier, and may be a little more difficult to feed from, but not because the milk tastes differently.
- The breast must be drained often and the baby is best at draining the milk from the breast, however if the breast is too painful to feed from, express with an electric pump for less pain and feed baby using a bottle until feeling better and more comfortable.
- Keep massaging the breast in the direction of the nipple to encourage the clearing of the blockage and ensure the milk flows in the right direction. Gentle pressure behind the lumpy area may help clear the blockage too.
- In terms of whether to use ice or heat:
Heat: Apply a heat pack about 10 minutes prior to breastfeeding to help the flow of milk. You can use a hot water bottle, a wheat pack, or even sit in a warm/hot bath.
Ice: Apply ice immediately after a feed, for pain relief. Don’t place ice directly on to breast, ensure you wrap an ice pack in a tea towel and place it on the affected area. A cabbage leaf can be placed in the bra to also give some pain relief.
- It is worth waking your baby to feed from the breast, however if your baby is too tired or not interested, then express as often as you need, until you feel comfortable.
Drink plenty of water and rest as much as possible to recover quickly.
Paracetamol and Ibuprofen can be taken when needed for pain relief. They are both safe to use whilst breastfeeding.
Some breastfeeding mothers may not experience a fever or flu like symptoms when they notice a clogged or blocked duct in their breast. They may feel an area that is tender or a knotty hard lump in the breast where the milk duct is not draining well. It can become sore and inflamed. The blocked ducts do need to be addressed quickly to avoid developing mastitis, which is where the above symptoms are accompanied with fever, nausea, and flu like symptoms. If the milk flows freely and the bacteria is flushed out, then the bacteria doesn’t have the opportunity to multiply. However if the milk stagnates, the growth of bacteria can occur in the ducts. Hence, the above dot point treatment plan for mastitis apply here as well, feeding frequently and draining the breast completely along with massage and heat to ensure those hard lumps/areas do not progress to mastitis. Women’s health physiotherapists also offer an effective treatment using ultrasound which can relieve the symptoms of breast engorgement, blocked ducts and mastitis.
I was recommended by a GP who was also a lactation consultant to give my new born baby probiotics after my course of antibiotics as a small amount of the antibiotics would pass through my breast milk to the baby. Occasionally, a rash and disruption of the baby’s good bacteria in their digestive tract can result in diarrhoea or thrush. Bioceuticals make a probiotic that can be given to infants including ‘premmies’ called Baby Biotics and Inner health make a probiotic powder that can be given from three months. They contain the most common bacteria present in the gastrointestinal tract of healthy breastfed newborns and infants. Both can be mixed with a small amount of breastmilk and made into a paste and tiny amounts placed in their mouths, or on the mother’s nipple for the baby to consume whilst breastfeeding. Obviously be mindful of the risk of choking and only place it in their mouths when they are awake and in an upright position.
When you hear the word ‘thrush’ most people think of itching and discharge. However, those symptoms are not present in nipple thrush and the symptoms are completely different to vaginal thrush. Nipple thrush is a fungal infection and extremely painful. Nipple thrush can occur after a course of antibiotics or after nipple damage, ie where cracks in the nipple and/or bleeding occur. The warm, moist environment is a good breeding ground for a fungal infection. I remember personally suffering with nipple thrush, however due to the trouble I was having with attachment and pain when breastfeeding, I remember thinking, ‘what’s this stinging feeling? Is this normal?’ I thought maybe it’s my body reacting to the constant breast feeding followed by expressing to try and increase my milk supply. That stinging sensation became worse, and I felt it more so after I finished each breastfeed. I made an appointment with a lactation consultant who happened to be a doctor as well, and she diagnosed nipple thrush but thought I may also be suffering with nipple vasospasm.
Symptoms of nipple thrush include cracked nipples which don’t heal, Nipples can be pink/red and shiny, with or without white areas on the folds and there can be a burning sensation as well. Thrush on the nipples can enter the milk ducts which can cause deep breast pain. Thrush pain lasts while your baby is feeding and usually gets worse after feeds. I remember in the middle of the night feeds, going back to bed and lying there in agony because the stinging sensation after feeding was unbearable, and I could feel the sting all the way to the top of the breast.
Nipple thrush includes treating:
1)the surface of the nipple
2)the baby’s mouth
3)Oral treatment for the mother (if the pain is deep within the breast.)
In order to get pain relief the above three areas need to be treated at the same time, to avoid passing it back and forth, from mother to baby.
The surface of the nipple– Can be treated with an anti-fungal cream e.g. Miconazole 2% (Daktarin, Resolve). Apply a thin smear of the cream to the whole nipple after each feed. Before a feed, just wipe away any excess cream but it is not necessary to wash the nipple before breast feeding.
The baby’s mouth- There are anti-fungals that can be given to infants to treat oral thrush, eg. an oral gel (Daktarin oral gel) or drops (Nilstat or Mycostatin oral drops). They both have to be used four times a day and after a feed. I prefer to recommend the oral gel to a baby as the gel can be applied to the affected area and stays around in the mouth for a longer period of time. The drops can miss the affected areas and just be swallowed. It is safe to swallow both products. The manufacturer of Daktarin gel states, it can be used from 4 months up and that is because it comes with a measuring spoon and the concern is the risk of choking. It is recommended to measure the dose on the measuring spoon but not to put the spoon in the baby’s mouth, rather using a clean finger apply a small amount on the affected areas of the mouth, usually the tongue or you may see plaques along the inside of the cheeks. It is recommended to treat the baby until the symptoms are gone and for two days after.
Oral treatment for the mother- Your doctor will write a prescription for an oral anti-fungal tablet to take which is safe whilst breastfeeding. Complete the course and by the end of the course the pain should have subsided. If it has not, obviously speak to your doctor.
Thrush grows in a moist warm environment so try as much as possible to keep the nipples dry, by changing breast pads often. Wash bras and towels in hot water. Canestan also make an anti-fungal wash that you can purchase from any supermarket. You can put 1-2 capfuls in the washing machine to kill any fungal species.
Vasospasm is when the blood vessels in the nipple constricts and spasms causing an intense pain in the nipple and often the tip of the nipple can turn white from pink. Nipple thrush and nipple vasospasm can often be difficult to differentiate. They both cause a burning sharp stinging pain in the nipple and often an infection or nipple damage can trigger vasospasm. Often the vasospasm is first treated as Nipple thrush to ensure there is no infection and then if the vasospasm continues to occur, it is recommended to ensure the nipples are not exposed to cold air which is the main trigger. Often after the baby finishes breastfeeding and the nipple is exposed to the cold air, vasospasm will occur so breast warmers can help. They can sit in the bra and the heat will just relax the blood vessels and stop the pain. They can be purchased through the breastfeeding association of Australia. Rubbing olive oil directly onto the nipples has also been shown to help. It can reduce the frequency of the nipple spasms and can also settle the pain quickly. Supplements like fish oil or evening primrose oil and magnesium (eg 300mg twice daily) are also recommended to help relax the blood vessels. If the above methods are not helping, last resort, your doctor can prescribe medication which stop the vasospasms from occurring.
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also if you tried a remedy that worked well for your children that was or wasn’t mentioned above, let me know. I hope this information does help.