Your breastfeeding concerns sorted with Eilis Mackie, Lead for Lactation and Infant feeding at The Portland Hospital, part of HCA Healthcare UK
We asked Eilis to help us solve your breastfeeding questions.
Soreness and discomfort
You may hear about sore nipples but in an ideal world, this shouldn’t really happen because you should be shown how to get a good latch very early on. If the latch is too shallow, where your baby is on the nipple, rather than a deep latch that takes in the areola and some of the breast tissue too, you may have problems. Other problems that might cause difficulties would be something mechanical, such as a tongue tie, or being unable to latch, or something else that’s going on.
If this happens, you need some support and your midwife may suggest different positions – not all breasts and babies fit together in the same way. A lactation expert will look at mummies and babies as individuals; mummies with larger breasts wouldn’t necessary position their baby in the same way as mummies with smaller breasts. They will also look at your baby’s mouth to check for any problems such as a cleft palate.
If your baby’s latch was too shallow, the best treatment would be moist wound healing – using a lanolin-based cream on the nipple to help the skin heal between feeds. You can also try air drying to help.
You may have heard about a condition called a tongue tie or read about it. It’s quite uncommon, though we don’t really know the prevalence of this condition. There’s plenty of over-diagnosis, mis-diagnosis and also under-diagnosis! At The Portland, most newborns will be seen early on by a Paediatric Consultant, so a problem like this will be picked up. If there is a feeding problem, your baby can’t latch, keeps coming off the breast and can’t maintain a latch, if there are any noises like clicking, then it’s something that needs to be looked at by a lactation expert. If there is a tongue tie, it can be rectified quite simply. Find out more here.
Two or three days after the birth, your milk will ‘come in’ – and you will really feel the difference! But there’s a difference between this and engorgement, which is something else entirely.
When your milk comes in, your baby feeds, the breast empties and then softens. Engorgement is when there’s excess fluid in the tissues of the breast, not just milk in the ducts. This can happen if a woman has had a long labour or a Caesarean section and has been given intravenous fluids that can be stored in the tissues. It can also happen if a mummy has been advised to pump too soon. The signs that you have engorgement are that the breasts are painful and look like bowling balls! They are shiny and round and the milk doesn’t move well.
What we advise in this case is to reduce swelling while keeping the milk flowing – you can take paracetamol or ibuprofen and should feed every two to three hours. It’s important to let your baby finish on the first breast before switching to the second. You can also apply ice packs or frozen peas wrapped in a towel or cloth between feeds for 15-20 mins to reduce swelling. Just before feeding, put a warm (not hot) flannel on the breast, which helps open the blood vessels and release the milk down.
If your baby has trouble latching on to such a full breast, express first (by hand at first). You can also use reverse pressure softening, which is a technique that pushes fluid back into lymph glands. To do this, apply pressure with two fingers either side of the nipple, pushing towards the chest wall and hold this position a while until you see the milk coming. Then rotate your fingers 360 and do it again. You can find a video showing this technique here. It would really help you to have a session with a lactation consultant before doing this.
Lack of supply or too much milk
Occasionally we will see a woman who seems unable to make sufficient milk for her baby and if this happens, you need to try to find the underlying reasons. Sometimes there will be an underlying medical condition or hormonal problem or the baby may not be stimulated enough. Again, we check the latch and ensure that Mummy and baby relax, skin to skin, as much as possible. Then we would asses how the baby is transferring milk – make sure baby is swallowing properly and if not, help the mummy to hand express.
Once a mummy has created a good feeding routine and her supply is well established, she may want to try expressing to have some milk for daddy or a carer to give to the baby in the night. Don’t pump too early as you run the risk of engorgement. Sometimes mummies are disappointed that they can’t pump a large amount of milk but you should realise that your baby can empty your breast more effectively than a pump, so they will be getting more out of a breast from sucking.