Thursday November 14th 2019

Boobs Behaving Badly

BREASTFEEDING  is a real pain when something goes wrong. Every mother has a tale to tell about cracked nipples, blocked ducts or alarming lumps the size of kiwi fruit.

Nursing your child isn’t rocket science, but it doesn’t always come naturally.

“With my first baby, I made a serious and common mistake,” says Marie Beytell, 40, a Johannesburg educational drama producer and artist.

“In the first two weeks, you should feed baby as much as possible to prevent engorged breasts. But too many guests arrived and too much time lapsed between feeds, so by evening I had rock-hard breasts and my nipples were gone!”

Knowledge is key

The hard truth is that there isn’t enough support and information for breastfeeding mothers in South Africa. It’s no surprise that many moms reach for a formula bottle and run screaming at the first sight of bumps or bleeding nipples.

“Women are not well-prepared for breastfeeding and mothering,” says medical doctor and lactation consultant Nan Jolly. “They go to childbirth classes which might give them a little information, but not much else.

“Health professionals are also rarely good sources. They get no training in breastfeeding and rely on the same old wives’ tales that the rest of us do.”

Prevention is better than cure, says Jolly, a La Leche League leader. Arm yourself with support – lactation consultants, midwives and female relatives who’ve lived to tell the tale – and go to classes or read appropriate books on the subject.

Troubleshooting

Common – and not so common – ailments are not the end of the world and can be cured.

PROBLEM : Sore or damaged nipples

This oh-so-delicate area is prone to soreness, pain and cracks, especially in the early weeks. The most common cause of nipple niggles is incorrect latching.

Cause : If nipples are red, inflamed, cracked or painful to touch, your baby’s probably latched incorrectly.

Prevention : Ignore ridiculous advice about scouring with a face cloth to “toughen” them up. Use a softening protective cream before and after nursing (Lansinoh is excellent and doesn’t need to be washed off). Get expert help with latching – babies should have a good deal of breast in their mouths, including the areola. The pinch you feel with incorrect latching is the nipple being tweaked by baby’s tongue and mouth. Ouch.

Cure : Use Lansinoh liberally and avoid soap – wash with plain water. Rubbing breast milk onto the area and letting it air dry also helps. Beytell advocates “baking” your nipples for a few minutes daily in non-midday sun, though fair-skinned women should be extra-careful of burning. If you’re in agony, ask your caregiver to prescribe a safe pain reliever.

PROBLEM : Engorged breasts

Milk-clogged mammary glands are a nightmare for nursing moms. Engorgement is a cheap, instant breast enlargement gone painfully wrong.

Cause : Insufficient emptying of breasts. It occurs easily in the early days, when your milk “comes in” and you’re in flood!

Prevention : Do not time feeds. Nurse baby on demand and for as long as she likes – this prevents excess milk build-up. The rule is simple : more feeds equals less engorgement.

Cure : Rocks on your chest demand instant relief. Apart from frequent feeding, cabbage leaves are a traditional stand-by – dunk two leaves in hot water, wring out excess moisture and place the leaves inside your bra. Also hand express by massaging the blocked milk down towards the nipple (be careful not to injure  sensitive tissue) and alternate between cold and warm compresses. This too shall pass.

PROBLEM : Thrush

Yeast infections are usually more annoying than painful. Symptoms are white patches inside your baby’s cheeks or tender, sore nipples with shooting pains during or after feeding.

Cause : Yeast occurs in the body and causes thrush when it grows out of control. It thrives in warm, moist conditions, making milk an ideal “carrier”. Antibiotics, the pill, diet, pregnancy, diabetes, tight clothing, perfumes and deodorants and weakened immune systems can contribute.

Prevention : Yoghurt or supplements containing lactobacillus acidophilus help and also avoid tight clothing, douching and antibiotics if possible. Wear cotton panties, wipe from front to back after visiting the loo and don’t use perfumed soaps or bath products. Wash nipples regularly with warm water and eat a balanced diet high in fruit, vegetables, whole grains, nuts and seeds.

Cure : See you caregiver promptly for diagnosis and treatment. Both you and your baby need medication, as you can easily pass the thrush between you. Continue breastfeeding.

PROBLEM : Painful lumps

Sensitive, sore masses on your breasts may be quite harmless or indicate serious infection. The lumps are usually blocked milk ducts.

Cause : Blocked milk ducts can result from engorgement and must be treated early to prevent infection, which could lead to mastitis or abscesses.

Prevention : Demand feeding ensures adequate emptying of the breasts. If engorged, hand or pump express between feeds to prevent blockages.

Cure : Continue breastfeeding despite the pain and hand or pump express if necessary. Massage to unplug ducts and apply warm, moist compresses, alternating with cold compresses if preferred.

PROBLEM : Mastitis

An infection with symptoms ranging from red, shiny and hot or painful breasts, a fever, fatigue, nausea or chills. You’ll need to see your caregiver. If untreated, an abscess may occur. Abscess symptoms include a closed pus-containing lump, pain, tenderness and red skin over the lump.

Cause : Usually caused by engorgement, blocked milk ducts or broken, damaged skin around the nipple.

Prevention : Breastfeed regularly and treat engorgement and blocked ducts promptly.

Cure : For mastitis, preventative measures help, while antibiotics may be prescribed. Lactation experts suggest feeding from the non-infected breast first until let-down (milk ejection reflex), then feed from the infected breast. A pain reliever may be prescribed. Abscesses must be drained with a needle by a doctor, but also speak to a lactation consultant for breastfeeding support and information.

Problem : Mystery bumps

Less common masses include montgomery gland infections, milk blisters and galastoceles.

Cause : Montgomery glands – situated in the areola – may become infected from a cut or pressure and are quite painful. Milk blisters are “milk under the skin”, caused by milk collecting beneath skin growing over a milk duct. These blisters are characterised by white, yellowish or clear dots. Galastoceles are nodules resulting from blocked ducts and usually occur when you wean.

Prevention : Stop Montgomery infections by breastfeeding regularly and taking care of your nipple and areola areas. Galastoceles can’t be prevented, but aren’t serious and are aspirated by a doctor or spontaneously disappear. Correct latching and regular emptying of breasts prevents milk blisters.

Cure : Manage your Montgomery problem by soaking the area in warm water before feeding, massage above the lump gently and feed often. Milk blisters benefit from an Epsom-salt soak followed by a very hot compress before feeding. If this doesn’t burst the blister, try gently scraping the skin with a clean fingernail before feeding. Use healing medication on the blister area after feeds (wash off before the next feed).

RESOURCES :

  • La Leche League International has branches virtually everywhere. Visit www.lalecheleague.org
  • The websites www.kellymom.com and www.breastfeeding.com have support and information on breastfeeding and troubleshooting.
  • The LLL manual “The Womanly Art of Breastfeeding” is most useful and encouraging, says Jolly. Get it at Amazon (www.amazon.com) or your local LLL group.

© Beth Cooper, 2010. First published in Femina magazine.

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