Breastfeeding problems

You may have sore nipples as you and your pēpi learn to breastfeed. The most common cause is latching problems. If breastfeeding is uncomfortable, ask your midwife, lactation consultant or breastfeeding support worker for help with positioning and latching your pēpi.

If you notice cracked, grazed or damaged nipples at any time, ask your midwife or lactation consultant for help. Sore and cracked nipples can be caused by a range of things but are most often caused by latching problems. Your midwife or lactation consultant can help you to position your pēpi more comfortably, or explore other reasons for your sore nipples such as tongue tie or sensitive skin.

Tongue tie

Self care for sore nipples

It is important to care for your nipples when breastfeeding, this includes:

• changing breast pads often if you are using them
• using a thin layer of nipple balm to help keep the right amount of moisture in the skin
• only using nipple protectors such as silverette cups for a short period of time — these can cause swelling of the areola (area around your nipple) and leave your skin soggy leading to nipple damage
• if you have sensitive skin or get eczema, use a colour and fragrance-free moisturiser on your nipples for healing and to avoid skin irritation
• use pain relief such as paracetamol or ibuprofen as needed.

It is normal for your breasts to start to feel full, and sometimes sore and firm, as your milk supply increases (the milk 'comes in'). This feeling is most common 3 to 5 days after baby’s birth, and can last for 24 to 48 hours. If your pēpi is feeding well and often, your body should adjust your supply to the amount of milk your pēpi needs.

Engorgement happens when your breasts are too full and this may cause the areas around your nipples (areolas) to become so firm that your pēpi finds it hard to latch. Engorgement can be very distressing and painful.

If your breasts are becoming engorged, they may feel:

• hard and the skin may look stretched or shiny
• warm and tender to touch
• throbbing
• lumpy.

Self care for engorged breasts

Feeding your pēpi frequently on demand can help relieve the discomfort you feel with your engorged breasts. Avoid spacing your baby's feeds too far apart or limiting baby's time at your breast.

If your pēpi struggles to latch because your breasts are too full, you can try the following.

• Hand express a small amount of milk first — just enough to make the nipple area soft enough for your pēpi to latch.
• Reverse pressure softening to remove fluid from around your nipple area. This involves using your fingers to apply firm pressure on the areola on either side of the nipple. Press toward your chest, moving position every 30 seconds or so, and continue for a few minutes until your areolas have softened.   

Reverse pressure softening for breast engorgement — YouTubeexternal link

Expressing breastmilk

If you continue to have discomfort after feeding your pēpi, try these techniques:

• apply cold compresses to your breasts for 20 minutes after feeding
• wear a good fitting, supportive bra
• use pain relief such as paracetamol or ibuprofen as needed
• express a small amount of milk after a feed for comfort — this may help but avoid doing it regularly as it can increase milk supply to more than what your pēpi needs
• gentle stroking toward the armpit can be helpful.

If you continue to have difficulty with engorgement or your pēpi is not feeding well after trying these techniques, contact your midwife, lactation consultant or other health professional for advice.

Preventing engorged breasts

• Make sure your pēpi is latching at your breast correctly and is drinking well. Ask your midwife or lactation consultant to check your technique.
• Feed your pēpi when they are hungry by following their cues or signs. Nuzzling, hand-sucking or mouthing (when they open their mouth and turn their head) are all signs they want to feed. Crying is usually a late cue for feeding.
• If your breasts are feeling full and uncomfortable, it is okay to wake your pēpi up to feed. If they are too sleepy to feed, you can try expressing a small amount of milk by hand.
• Avoid giving your pēpi formula top-ups (unless advised by your midwife or lactation consultant), as they might not remove enough milk when they next breastfeed.
• Do not use a breast pump unless you have spoken to your midwife or lactation consultant about it. Using a breast pump without a good reason can cause you to make too much milk or other problems leading to damaged nipples and mastitis.

If your breasts become engorged and this is not managed well and gets worse, it can develop into mastitis. This is when an area of your breast can become inflamed, red and painful. Sometimes this inflamed area can become infected with bugs (bacteria). This sometimes needs to be treated with antibiotics.

The symptoms of mastitis can include:

• breast pain or tenderness
• a red, hot, swollen area in one or both breasts
• fever, chills, a headache or feeling like you are getting the flu.

If you have mastitis, it is best for you and your pēpi if you continue breastfeeding.

Self care for mastitis

It is important that you rest and drink plenty of fluids.

There are several things you can do to relieve the discomfort and reduce inflammation.

• Keep feeding your pēpi as normal. 
• If you are expressing to feed your baby, only pump what your baby needs. You do not need to try to empty the breast.
• Take pain relief such as paracetamol and ibuprofen.
• Apply a cold pack to your breast for 10 minutes every 30 minutes between feedings. This can reduce pain and inflammation. Avoid heat as this can make inflammation worse.
• Wear a supportive bra that does not cause painful pressure.
• Try gently stroking your breast using light touch. Use a pressure similar to what you would use to stroke a cat. Stroke your breast from your nipple to your armpit and collarbone. You can do this as often as you like, and especially before feeding or pumping. Deeply massaging your breasts is not helpful and can make the inflammation worse. This video shows how it is done.

Massage and lymphatic drainage for engorgement and mastitis — YouTubeexternal link

If you develop a fever (a temperature over 38 degrees Celsius) or your symptoms are not getting better in 24 hours, talk to your midwife or healthcare provider.

Your healthcare provider may prescribe an antibiotic if there is an infection. Usually the strategies above will ease your mastitis and reduce your chances of infection.  

Preventing mastitis

To prevent getting breast inflammation and mastitis, follow the advice for preventing engorged breasts above. 

Preventing engorged breasts

Some breastfeeding problems may be caused by a tongue tie. To make sure that you and your pēpi receive support with this, your midwife or Lead Maternity Carer can offer to refer you to a health professional who is an expert in breastfeeding. This is usually a Lactation Consultant, who can also provide support and advice with latching and maintaining breast feeding.

Tongue tie

Sometimes you may feel as if you do not have enough milk. This may be because your pēpi is breastfeeding frequently, with feeds close together (this is called cluster feeding). They also breastfeed more often when they are going through a growth spurt. Sometimes they are fussy and unsettled, but that is just because they are new babies and going through normal newborn unsettled periods.

Remember that the more often that breast milk is removed from the breast by your pēpi, the more milk will be produced.

You can be reassured your pēpi is getting enough milk if breastfeeding is comfortable for you, and your pēpi:

• has plenty of wet and dirty nappies in a 24 hour period
• has a good deep latch
• is gaining weight.

If you are concerned that your pēpi is not getting enough milk, talk to your midwife, lactation consultant or doctor.

Poos and wees — a short guide about what to expect — New Zealand College of Midwivesexternal link

You need to look after yourself while breastfeeding, which might mean asking others to help you too.

Make sure that you eat a well balanced diet and drink plenty of fluids — mostly water.

Avoid alcohol, caffeine and smoking, as these can affect your milk supply and your baby’s health.

Your health after birth