Breastfeeding problems

You may have sore nipples as you and your pēpi learn to breastfeed. Nipples are usually most sore in the first week after baby’s birth. They should feel better 7 to 10 days after baby’s birth.

During that first week the initial soreness should wear off 15 to 30 seconds after your pēpi has latched. If it does not, ask your midwife, lactation consultant or breastfeeding support worker for help with positioning and latching your pēpi.

If nipple soreness continues into the second week, or you have cracked, grazed or damaged nipples, seek help from your midwife or lactation consultant. Sore and cracked nipples can be caused by a variety 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, for example, tongue tie or sensitive skin.

Care for your nipples by putting some expressed breastmilk on them and letting it dry after feeds. Change breast pads often if you are using them. Before using nipple creams, talk with your midwife or lactation consultant as breastmilk may be all you need. Use pain relief such as paracetamol or ibuprofen as needed.

Your breasts might start to feel full, sore and hard as the 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 breasts are really sore and hard, and feel too full, try putting something cool on them after a feed for 20 minutes and in between feeds as needed. This can reduce the hot, swelling feeling. Avoid applying heat as this can increase inflammation in the breasts.

If your pēpi is finding it tricky to get a good latch, you can hand express a little milk first. This will soften the areola (the darker area around the nipple) so that it is easier for pēpi to latch — and less painful for you.

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

Talk to your midwife, lactation consultant or doctor straight away if:

• you feel unwell (sometimes mastitis feels like getting the flu)
• part of your breast is red or feels sore, hot or lumpy.

You may have a local inflammation caused by a narrowed milk duct or a more general breast infection (mastitis). It is better for you and pēpi if you continue breastfeeding.

Continue to feed your pēpi as normal by following baby's cues. If you are expressing breast milk to feed your pēpi, only pump what they need. There is no need to try and 'empty the breast'. Try offering the sore breast first. If this is too hard to begin with, feed from the other side until the sore side 'lets down'.

Try gently stroking your breast using a light touch, with 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. Note that 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 — YouTube

It is important that you have bed rest for at least 24 hours and that you drink plenty of fluid. 

Applying a cold pack to the sore area on the breast can help. This can be done after and between feedings for relief. You can also take paracetamol or anti-inflammatories like ibuprofen to feel more comfortable. Avoid putting head on the breast as this can increase inflammation.

If you have a fever (a temperature over 38.5 degrees Celsius) or your symptoms are not getting better in 24 hours, talk to your midwife or doctor. They may prescribe an antibiotic to reduce the inflammation, but if caught early this is not usually necessary. Wear a supportive bra that does not cause painful pressure.

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.

What goes in must come out. A pēpi who is breastfeeding well will also have plenty of wet and dirty nappies in a 24 hour period. If you are concerned that they are not having enough wet and dirty nappies, talk to your midwife, lactation consultant or doctor.

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

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

Your health after birth