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Breastfeeding Challenges Reduced Breast Milk Supply Not Having Breastfeeding Challenges Reduced breast milk supply Not having enough milk is one of the most common reasons mums give up on breastfeeding, but with the right support almost everyone will be able to feed for as long as they want. What are the symptoms? Some mums worry they're not making enough milk because they're not sure if their baby has gained enough weight. Occasionally mums don't produce enough milk for their baby, breasts never really feel full, baby's weight gain is slow and they seem unsatisfied or distressed. Additional support can be provided by Breastfeeding Helpline advisor (0300 100 0212) on how to increase milk supply. What causes it? There are a number of possible causes, including: Formula: Some mums introduce formula not realising this will reduce milk supply even further. Attachment issues: if a baby isn't well attached this will impact on effective milk transfer. Not feeding at early feeding cues: timing feeds, scheduling, missing night feeds or finishing feeds too early may reduce milk supply. Medical and birth problems: some serious conditions can delay lactation but these are very rare. What's the solution? Watch the video below for advice on how to increase lactation and read our top tips. https://youtu.be/i0tqQfTpVDc Top tips Feed as often as possible rather than introducing alternatives Skin-to-skin contact and breastfeeding as soon as possible after birth is key in getting the supply off to a good start. Keeping baby close and avoiding supplements of formula milk, teats and dummies will also help. Making sure baby is attached and feeding properly is vital. If the baby isn't attached correctly, milk transfer will be compromised leading to a reduction in supply Ensure responsive feeding offering both breasts each feed and overnight as feeding establishes Expressing after breastfeeds can increase supply. Expressing 8 times in 24 hours including once overnight will optimise supply. Sore and cracked nipples Painful, cracked and fissured nipples is mainly due to poor positioning and attachment. What are the symptoms? Your nipples will be painful and they may be very red, blistered or even bleeding. The nipples will most probably be sore to touch and the pain will be at its worst when feeding. What causes it? Incorrect attachment is the cause of the problem. When sub optimally attached, the nipple will be compressed against the hard palate and may become painful or damaged. In the video below an Infant Feeding Advisor helps mum overcome sore and cracked nipples by showing her how to correctly attach her baby to the breast. https://youtu.be/FQhwTzTwBFA What's the solution? Optimal positioning and attachment is normally the answer, although tongue tie might also be impacting on maintaining good attachment. A thorough breastfeeding assessment is essential to care planning. Encourage as much skin to skin contact and responsive breasting form both breasts at earliest feeding cues Optimise positioning and attachment If nipples are cracked promote moist wound healing using a licensed nipple cream to affected area after feeds. If nipples are fissured then use Actiform Cool hydrogel dressing 5cm X 6.5cm. Ensure contact with fissured area, take off for feeding then replace. One dressing can be used for a 24 hour period unless breasts are leaking when it should be replaced earlier. Consider use of analgesia if required. Thrush Thrush is a common fungal infection that can be passed between mum and baby. What are the symptoms? Symptoms of thrush vary, but sore, red, pale, shiny or itchy nipples are the most common signs. Mums may also experience a burning sensation or a sharp, shooting pain in the breast during or after feeds. A white coating may also appear on baby's tongue, gums and inner cheeks. Watch this video to hear mum, Lisa, talk about how she spotted her little one had thrush. https://youtu.be/QPx3cq34IZc What causes it? Thrush can happen at any time. It thrives on broken skin; warm, moist conditions and seems to be more common after taking antibiotics. Breastfeeding mums with cracked nipples who are taking antibiotics for mastitis have a higher risk of thrush. What's the solution? Thrush needs antifungal treatment prescribed by the G.P. Both mum and baby need to be treated at the same time because thrush passes very easily between mum and baby. To avoid re-infection make sure to: Full breastfeeding assessment Optimise positioning and attachment Skin to skin contact Use of anti fungal treatments as prescribed by the GP Consider analgesia if required. Discard any stored expressed breast milk as the thrush infection will be present in the milk. Freshly expressed milk can be given to the baby however. Wash bras and towels at 60 degrees to help kill the thrush and dry in the sun if possible. Avoid using breast pads Consider wash solution of acidic or alkaline base. Either one teaspoon of vinegar or lemon juice to a pint of cooled, boiled water or a teaspoon of sodium bicarbonate to a pint of cooled, boiled water. Use wash solution after breastfeeds which helps alter the acid mantle of the skin, reducing fungal growth. How can I stop it happening again? Thrush can happen at any time, but if it's linked to taking antibiotics make sure to completely drain your breast after each feed by expressing any leftover milk. Please visit www.feedgood.scot website for further information and advice on breastfeeding challenges for both mums and babies. Mastitis This is when breast tissue becomes inflamed or infected. What are the symptoms? The breast(s) will likely be hot and painful and may have a sore lump or red area. The Mother may also be suffering from flu-like symptoms. Similar to engorgement, mastitis is caused by a build-up of milk and typically happens 2-3 weeks after the birth while breastfeeding is establishing. What causes it? Mastitis happens when milk can't flow along a duct. Milk then 'builds up' and can cause breast tissue to become inflamed, causing pain, lump or red area. Mastitis can happen due to missed or shorter than normal feeds or too much pressure on the breast from a bra or clothing. However, the most common cause is incorrect positioning and attachment. What's the solution? A thorough breastfeeding assessment Optimise positioning and attachment Encourage skin to skin contact and responsive breastfeeding offering both breasts each feed A warm compress before feeding will soothe the pain, but the most important thing is to optimise positioning and attachment with the baby’s chin indenting the affected area. Hand expressing aided by postural drainage will also be helpful A cool compress or chilled, green Savoy cabbage leaves on the breast after feeds and/or hand expressing will help reduce inflammation. Anti-inflammatory tablets may also be helpful. If the Mastitis has become infected, (more likely if nipples also cracked), then a GP prescription for an antibiotic may be required. Using antibiotics can make thrush more likely so try to make sure the breasts are effectively drained when feeding. Frequent breastfeeding during a bout of mastitis - emptying the breast is the only solution. Watch this next video to hear a mum's story on how she overcame mastitis. https://youtu.be/IlLbV9udwOI .
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