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Breastfeeding: Troubleshooting

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Early on in our breastfeeding journey, we struggled with using nipple shields (Charlotte had some trouble getting a latch on leftie) and cracked, bleeding nipples. Aside from those issues, the first ten seconds of nursing hurt for about six weeks. It was like little needles in my nipples. After about two weeks of things finally working correctly, I started having shooting pain through my breasts. (Just in time to go back to work! Awesome. . .) The pain was intense enough to wake me from a dead sleep, and lasted about month before it was corrected. I would lie in bed crying, and trying really hard to be quiet about it so I wouldn’t wake the baby.

Here’s the kicker – No one knew what it was. There is nothing worse than having pain during the breastfeeding process, and not knowing what is wrong. It is terribly isolating. We thought it was clogged ducts, then thrush, and then vasospasms. It turned out to be a milk bleb, with clogged ducts behind it causing shooting pain through my breast. It was finally caught by the lactation consultant at the county health department.

I’m not sharing this because I want sympathy or a pat on the back.
I’m sharing because I want any breastfeeding mother out there who is having unexplained pain to know that
                        you are not alone!
                                   Don’t give up!

There are so many things to learn and worry about when you’re breastfeeding! Here are a few common issues, including some of the difficulties that I had personal experience with:

Cluster Feedings – It’s normal for babies to eat more often in the evenings. Often, this helps them to sleep better.

Growth Spurts – Babies will be fussy and eat like crazy for a few days at a time. This is to help the baby through the growth spurt and also to tell your body to make more milk. These tend to occur at one week, 2-3 weeks, 4-6 weeks, and 3, 4, 6, and 9 months.

Sore Nipples – When you’re getting used to nursing, it’s not uncommon to have sore, or even cracked, bleeding nipples. Put Lanolin on them after every feeding. I alternated between Lanolin and Earth Mama Angel Baby Nipple Butter.  You can put Neosporin on them, if you wipe it off before feedings.  It also helps to put some breast milk on the nipples and let it air dry. That stuff is magic!!  They say that the pain shouldn’t last longer than a week, but it was about six weeks before Charlotte really understood how to latch, and it stopped hurting. Normally, the pain is worse at the beginning of the feedings, and then gets better.
EDIT: I want to make certain that my readers understand that, while my experience was painful, this is not the norm. If you are having pain, get help. If the pain persists (like mine did), then you persist in getting help!

Yeast/Thrush – If your nipples are itchy, try wiping them clean and putting Monistat or Lotrimin lotion on them after every feeding. If you have shooting pains, cracked nipples that won’t heal, your baby starts to eat and pulls away, and/or your baby has white spots in his mouth, call your ob and pediatrician. You have a yeast infection (thrush), and both of you need treatment.

If you have thrush, your doctor will probably give you Diflucan. You and your baby can also take acidophilus, which your can get at your local health food store. Your pedi will likely give you little one medicine as well, such as gentian violet or Nystatin. It may help to put a mixture of 1/3 hydrocortisone cream, 1/3 Monistat cream, and 1/3 Neosporin on your nipples after each feeding. Wear cloth nipple pads to soak up excess, and then you don’t need to worry about wiping off the nipples before the next feeding. You can also rinse your nipples with diluted vinegar, and give them lots of time to air out. Yes, it’s awkward to walk around your house topless, but your hubby probably won’t mind. Just close the blinds! If you have thrush, you’ll also need to wash your clothes, blankets, and spit cloths in really hot water to keep it from spreading through the laundry.

We didn’t have the terrible, full blown thrush. We did have the beginnings of some yeast – aka, “itchy nipples.”  I used Lotrimin cream, boiled my breast pads for a while, and washed everything in H-O-T water. Ahhh, motherhood. . . Nothing makes you feel sexier than putting athlete’s foot cream on your nipples. . .

Clogged Ducts and Mastitis – If you start to feel a hard, tender spot on your breast, you may be getting a clogged duct. To help this, apply hot, wet washcloths to the painful area before feeding. Put the baby on that breast first, and aim the chin at the painful area. This may require some acrobatic skills, such as dangling a boob upside down over a baby laying on the floor. I swear it works though!

Nurse often, massage the breast while you nurse, and drink plenty of water. Hot showers, and hand expressing milk in the shower while massaging the painful area, can also help. Lecithin, a supplement, can help clogged ducts and prevent them in some people. If you’re having recurrent clogged ducts, take one pill, four times daily.

Hand Expressing – This isn’t as hard as it sounds. Make a “C” with your hand, put it behind your areola, and pull back to the chest wall. Then, gently roll your fingers forward and through the nipple. Moo, right? If you need more information, here’s a link to Dr. Sears’s instructions. And if you want to see someone doing this, here’s a link for that too. You will see some boobies, so you may not want to click on that one if you’re at work!

Milk Bleb – If you notice a white spot at the end or your nipple, you may have a “milk bleb” or “milk blister.” It may lead to clogged ducts behind the blockage, which can create shooting pains in the breasts. A milk blister can be opened with a sterile needle by your ob. In the early stages, you might be able to scrape it open in a hot shower. It’s worth a shot.

Mastitis – Clogged ducts can sometimes lead to mastitis. If you have a fever or flu-like symptoms, call your doctor. Mastitis is an infection and requires antibiotics to get better.

Nipple Confusion – If you hold a full baby bottle upside down, you can see how quickly milk comes out. It is very different from nursing, which requires work. If bottles are introduced too early, babies may prefer them and reject the breast. Sources vary on when it’s okay to introduce artificial nipples. Most sources say four to six weeks. We introduced a bottle at five weeks, but weren’t giving it to her on a regular basis until twelve weeks.

Bottle feeding – When you start giving bottles, hold them horizontally, so that the baby has to work for it (rather than laying the baby back). If a baby slams down bottles too quickly, this can also lead to rejecting the breast. We had trouble with this when beginning day care. Sometimes after day care – when Charlotte was getting bottles much quicker than she does at home – she would get frustrated and cry at the breast. Alternating breasts until she calmed down seemed to help. It was so tempting to give her a bottle when she cried like that! However, it would teach her a bad habit (screaming for bottles, rather than bf). Babies learn quickly!

Leaking – I leaked a lot early on, though it rarely happens anymore. Nursing pads are your friends. When things are leaky, change them out at every feeding. I toss dirty ones in a lingerie bag, so they don’t get lost in the wash. (These bags are also good for baby socks.) Early on, I leaked so much that I would put a folded baby washcloths and nipple pads in my bra.

Low Supply – First, it’s important to know that many women have an oversupply for the first few weeks – until your body figures out how much to make. After that, it’s normal for your supply to lower a bit. If you think that you’re not making enough, first look at your habits. Are you taking any medicines? Are you stressed? Sick? Eating enough protein? Are you drinking 120 ounces of water per day? Are you getting enough calories? (Dieting seriously tanks my supply!)

Here are some suggestions for helping a low supply:
♦ Nurse and pump frequently.
♦ Try “power pumping.” (I love that term – it sounds like you should do it while wearing a cape!) This involves pumping 10 minutes and resting 10 minutes for an hour or two.  After a few evenings of this, many women have an increased supply.  If you exclusively pump, “power pumping” through your baby’s growth spurts might help you to keep your supply up with their demands.
♦ Eat oatmeal.
♦ Take Fenugreek (an herbal supplement). You can start with 3 pills, 3 times a day.  Normally, you will start to smell sweet – like maple syrup – and that means the Fenugreek is working.  Mmm, pancakes. . .
♦ Drink Mother’s Milk Tea.
♦ If all else fails, your doctor can prescribe medications, such as domperidone, to increase your supply.

Teething – If the baby gets teeth and bites you, immediately unlatch, say “No bite” firmly, and stop nursing for a few minutes.  Charlotte has done this a few times so far, but I think (hope!!) she got the message last time.  Normally this isn’t an issue until they’re at least six months old, unless you’re lucky like me. She got her first two teeth at four months! This child now has eight of the suckers. . .

Vasospasms – Before investigating my own mystery pain, I had never heard of this. It’s also known as Raynaud’s Syndrome, and is pretty uncommon. It can happen in response to a trauma to the nipple, such as really working on a clogged duct. I had some symptoms of this before getting my milk bleb fixed. I’m still not certain if the symptoms were because of the milk bleb, or if I was having vasospasms related to what was happening.

Vasospasms of the nipples occur when the blood vessels suddenly constrict, and you don’t get blood flow. The end of the nipple will turn white, and there is pain. The symptoms are worse when going from a warm to a cold environment, such as getting out of a hot shower or your baby unlatching at the end of a nursing session. Stress can make it worse. Ibuprofen and vitamins, such as Calcium, Magnesium, and B6 can help. When I was trying to rule out vasospasms, I was taking four tablets of a 333 mg combo of Calcium, Magnesium, and Zinc. It’s a combo pill, so I was getting 1332 mg calcium, 532 mg Magnesium, and 20 mg zinc per day. I also took two 100 mg tablets of B-6 per day (200 mg total per day).  Kellymom is a great resource if you think you’re experiencing these symptoms.

For more information and tips, check out my article on Breastfeeding: The Early Weeks.

So, here are some common problems associated with breastfeeding. I hope that this article was helpful to you. I feel the need to again state that I am not a medical professional. I am a nursing mother, sharing what I’ve learned so far. If you are having pain or have questions, call your doctor and a lactation consultant. Be an advocate for yourself – even if no one knows what is wrong!    

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5 responses »

  1. Hi, thanks for commenting on my blog post about breastfeeding myths. Now I get to comment on yours. Please let your readers know it is NEVER acceptable to have pain with breastfeeding. It means that something is wrong and it can be fixed! Also, please don’t use neosporin on your nipples! If you have open wounds on your nipples, an antibiotic ointment may be necessary, but check with an IBCLC or your Dr. for the appropriate treatment. Thanks for sharing this important information and good for you for being so determined even tho you experienced challenges.

    Renee Beebe, M.Ed., IBCLC

  2. Hi, Renee!
    Thanks so much for commenting! It was actually a lactation consultant that told me to use that mix that involved 1/3 neosporin. I would definitely not have put anything on my nipples (other than lanolin) without talking to a lactation consultant first. And I will edit the post, so that it’s clear that pain is not normal, but was just my experience.
    Thank you so much for the comments – and for all that you do! I would have been lost without the support of a couple of fabulous lactation consultants!

  3. Pingback: Breastfeeding: The Freezer Stash « sooobig

  4. Pingback: Breastfeeding: The Freezer Stash « sooobig

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