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Common Problems Encountered by Breastfeeding Women

This article addresses the problems commonly faced by breastfeeding mothers.

Low milk supply; flat and inverted nipples

Common Problems Encountered by Breastfeeding Women

Breastfeeding is the way women have fed their babies from the beginning of time, so you should expect the process to proceed uneventfully, right? After all, it seems only fair that a woman who makes the positive choice to breastfeed her baby would be able to nurse as long as she desires. The surprising and disappointing truth is that lactation problems do occur, even among women with the best of intentions and the highest motivation to succeed at breastfeeding. Sometimes problems involve the mother's breasts and nipples or relate to her overall health. At other times, breastfeeding problems involve the baby or impact the baby's well-being. Some problems are due to circumstances beyond our control, while others are the direct result of lack of knowledge or lack of confidence, improper technique, or bad advice. Most problems that cause women to discontinue breastfeeding before they had wanted arise within the first few weeks, but a breastfeeding complaint can present at any point in the course of lactation. Whether breastfeeding problems begin in the hospital or surface months later, they can be the source of great stress and threaten long-term breastfeeding.

The Importance of Getting Help Early
The early recognition and treatment of a breastfeeding problem offers the best chance that the difficulty can be resolved successfully. The chief message is: Get help as quickly as possible so you can resolve your problem before it becomes complicated by insufficient milk. Unfortunately, many health professionals practice a wait-and-see approach to breastfeeding complaints, hoping that any difficulties automatically will self-correct between office visits. This nonintervention approach is understandable considering how little training most health professionals receive about the management of breastfeeding problems. Without corrective measures, however, many problems are compounded by low milk or an underweight baby, making a bad situation worse.

Why Breastfeeding Problems Are Readily Complicated by Low Milk Supply
Breastfeeding difficulties can cause physical discomfort, exhaustion and frustration, as well as infant fussiness and poor infant growth. Furthermore, many breastfeeding problems readily become complicated by low milk supply. Often, complaints in breastfeeding women are linked to ineffective or infrequent emptying of milk. If milk is not removed from the breasts regularly, a chemical inhibitor in residual milk accumulates and decreases further milk production. In addition, excessive pressure from unemptied milk can cause damage to the milk-producing glands. Thus, milk left in the breast acts to decrease further milk production. Problems that impair milk removal-infrequent or short feedings, inverted nipples, breast infections, sore nipples, breast engorgement-can quickly result in diminished milk production.

Flat and Inverted Nipples
A flat nipple is one that cannot be made to protrude with stimulation. An inverted nipple retracts inward instead of becoming erect when the areola is compressed. Both flat and inverted nipples can make it difficult for an infant to grasp the breast correctly. They also are more prone to trauma from early breastfeeding efforts, which can result in painful cracks and damaged skin. When flat or inverted nipples are discovered prenatally, several treatment options are available to draw the nipples out. The most popular of these is the wearing of breast shells, also known as milk cups, over the nipples inside the maternity bra. These dome-shaped devices have an inner ring that is worn over the nipple. When a breast shell is situated over a flat or inverted nipple, it applies steady pressure at the base of the nipple which causes it to protrude through the central opening.

When prenatal treatment isn't possible or when the problem isn't detected until after delivery, mothers may need extra help with getting started breastfeeding. Whether or not your flat or inverted nipple(s) was treated prenatally, the most important thing you can do when your baby is born is to get skilled help with proper breastfeeding technique and expert guidance in helping your baby attach to your breast correctly.

Flat nipples can range from those that are only slightly less protuberant than normal, to nipples that are almost indistinguishable from the surrounding areola. Inverted nipples range from those with a slight central crease or dimple to deep central inversions that interfere with infant latch-on and prevent milk from flowing normally. Depending on the characteristics of your particular nipples, your baby may be able to latch on and draw your nipples out without any special treatment. If your baby is having trouble grasping your flat or inverted nipples, you can try the following strategies:

  • Gently compress and roll your nipple between your thumb and index finger for a minute to try to make it more erect before attempting to feed your baby. With patience and persistence, your baby can probably attach to your breast and nurse effectively even if you have flat or inverted nipples.
  • Use a breast pump to draw your nipple(s) out immediately before breastfeeding your baby. A hospital-grade electric pump may be available on the postpartum floor for your convenient use. If an electric pump is not available, a hand pump can be used to create steady, gentle suction for about thirty seconds.
  • If one nipple is more protuberant than the other, begin your breastfeeding attempts using that nipple. Once your baby learns to nurse from one breast, he may be better able to draw the nipple out on the other side. You can build on this initial success as you offer the more difficult side.
  • Wear breast shells for about thirty minutes before each feeding to help pull your nipples out. Obviously, the devices must be removed prior to breastfeeding. Some women can tolerate longer periods of wear, but overuse of breast shells can make nipples sore by trapping moisture. They can also cause plugged ducts by pressing against swollen breast tissues once milk comes in. (Any leaking milk that collects in the shells should be discarded.)
  • If your baby has not learned to latch on well to both breasts and nurse effectively within twenty-four hours of birth, I recommend that you begin regular milk expression. Use the most effective pump you can obtain, preferably a hospital-grade electric breast pump with a dual collection system. Pump your breasts for approximately ten minutes after each feeding attempt. Pumping serves several purposes. It draws your nipples out with each pump cycle, and it provides effective draining of your breasts to assure you continue to produce a plentiful milk supply. Pumping also obtains expressed breast milk to use to supplement your baby until she learns to nurse effectively.
  • While your baby is learning to breastfeed correctly, some experts believe it is preferable not to use a bottle to give the required supplemental milk. They argue that a preference for bottle-feeding can easily develop in babies who haven't learned to nurse effectively. These advocates recommend cup feeding or another alternative method of giving the extra milk. Other breastfeeding proponents insist that using bottles doesn't necessarily interfere with learning to nurse, so long as the mother's milk supply is kept plentiful by frequent pumping, and the baby is guided in correct breastfeeding technique. When a baby is having trouble learning to nurse due to flat or inverted nipples, I suggest temporarily avoiding bottle-feeding, if possible, and choosing an alternative method of feeding supplemental milk, at least during the period you are in the hospital.
Most importantly, keep first things first. Your top priorities are assuring your baby receives sufficient milk and preserving a generous breast-milk supply. With regular pumping and persistent attempts at the breast, your baby will probably be able to eventually breastfeed well. Rarely, a woman might have to pump several weeks until her nipples have been drawn out sufficiently for her baby to learn to nurse effectively. But such extra effort is well worth the benefits gained by breastfeeding.

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