10/16/2016

One of the troubles that nursing mothers face is lactostasis, that is, blockage of the milk duct. When milk in any one lobe of the mammary gland stops being removed. Ksenia Solovei, Head of the National Movement in Support of Breastfeeding "Milk Rivers of Ukraine", UNICEF partner in the Breastfeeding Support Program in Crisis Situations, talks about the first signs of lactostasis, its treatment and prevention.

“The main causes of lactostasis are ineffective suckling of the mother’s breast by the child, long breaks in feeding, limitation of the duration of suckling, overwork of the mother, etc. breast, he sucks milk poorly, and therefore it can stagnate. A logical conclusion follows from this: the best prevention of lactostasis during breastfeeding is the correct attachment of the crumbs to the breast and the absence of pacifiers and nipples in care, ”says Ksenia Solovey.

How lactostasis manifests itself during breastfeeding:

• a painful induration is felt in one part of the breast, it can be as large as a bean or even as a quail egg;
• there may be slight redness over the induration;
• the temperature may rise.

White spot on nipple. Examine the nipple for a white spot. It happens that the opening of the duct overgrows due to improper attachment, and a white film forms on the nipple, which prevents the milk from flowing freely, and it stagnates. To get rid of it, warm the nipple, rub it with a hard towel to break the integrity of the film, and start feeding.

What to do if you have lactose intolerance:

• Keep breastfeeding! During this period, you should feed more often than usual, at least every 1.5-2 hours. Always start breastfeeding with the breast that hurts, and end with healthy breasts.
• Check attachment. The child's mouth is wide open when sucking, the chin rests on the chest, most of the areola has entered the child's mouth from below, the lower lip is turned inside out. Swallowing is heard when sucking. After feeding, the nipple comes out of the baby's mouth in an even cylinder (a beveled nipple is like a new lipstick - indicates improper attachment).
• Get plenty of rest and don't limit your sucking! You should focus on yourself and your health. Stay in bed with the baby and feed until you feel better.
• Use cold treatment . In most cases, lactostasis is accompanied by swelling of the breast tissue and this can aggravate the situation. Therefore, 3 times a day, apply cold to the seal area for 10-15 minutes. It can even be a leaf of white cabbage from the refrigerator, pre-soften it with a rolling pin or beat it off.
• Drinking mode. It is very important to continue to drink enough without reducing fluid volumes. If a nursing woman stops drinking during lactostasis, her milk becomes more viscous and it becomes more difficult to cope with lactostasis.
• Express breast milk. If for some reason you do not feed your baby directly from the breast, but feed with expressed milk, it is important to regularly and effectively express milk manually or with a breast pump.

Signs of improvement:

1. If your temperature returned to normal in a day, this indicates that you are acting correctly.
2. Breast tenderness will go away.
3. Compaction will gradually decrease. All this happens gradually, within 3-7 days.

Signs of deterioration:

• The temperature persists for several days.
• There are cracks on the nipple.
• No temperature, but the seal does not change during the week.

In this case, you should contact your doctor to prescribe medication. Tell your doctor that you plan to continue breastfeeding and they will prescribe medications that are compatible with breastfeeding.

If you have a situation of lactostasis and you feel that you cannot cope on your own, it is best to seek help from specialists so that they can accurately determine at what stage of the disease you are and give more detailed recommendations for solving the problem.

As part of the Let's Help the Children program, the Rinat Akhmetov Humanitarian Center, in cooperation with UNICEF, provides information support to mothers affected by the conflict in Donbas. You can ask a lactation consultant online at at .

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Solve nine breastfeeding problems in the first month

Expert advice on how to deal with major breastfeeding problems in the first month.

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Cathy Garbin, child health nurse, midwife and lactation consultant:
Cathy, a mother of two, was a research fellow at the renowned Human Lactation Research Institute, founded by Peter Hartmann, for seven years, providing support to breastfeeding mothers in clinics and at home. Today, she still works as a family counselor, and also conducts seminars for attending physicians and speaks at international conferences.

Breastfeeding is as much a skill as driving a car, and in the first month mother and baby may encounter some obstacles along the way. It takes time and experience to make it familiar to both of you. Solving breastfeeding problems in the first month helps to establish good milk production and increase the duration of breastfeeding in the future. Below you will find tips on how to overcome the main breastfeeding challenges that mothers often face from the end of the first week to the end of the first month after giving birth.

Problem #1. A painful lump appeared in the breast

Lumps and bumps in the breast of a breastfeeding woman can appear for various reasons. One of the most common is blockage of the milk ducts, which results in a hard and painful lump that can become inflamed.

Solutions ^1–3

• Massage the inflamed area, especially while breastfeeding or expressing, to clear the blockage.
• Gently apply warm flannel to your breasts or take a warm shower before feeding to relieve discomfort.
• Continue breastfeeding as usual to avoid milk accumulation that can cause mastitis.
• Try to express milk from the inflamed breast after feeding to ensure that it is completely emptied. This will help to remove the blockage and restore the patency of the duct. See what breast pumps* Medela has to offer and choose the right one for you.
• Try ultrasound therapy. If you have repeated clogged ducts, your lactation consultant or healthcare professional may suggest this procedure to help restore milk flow. The procedure is performed by a physiotherapist.
• Call your healthcare provider, if you notice signs of infection (breast redness and tenderness or flu-like symptoms such as fever, aches, malaise and headache) or if you think the lump is not related to breastfeeding .

Problem #2. The breast is red and sore

If one or both mammary glands are red and sore, and this is not due to blockage of the ducts, mastitis, that is, inflammation of the breast tissue, is not excluded. Mastitis is characterized by redness, burning, and soreness of the breasts, combined with flu-like symptoms: You feel hot and cold, your joints ache, and your temperature rises above 38.5 °C (101.3 °F). Seek medical attention immediately if you experience these symptoms. Mastitis needs to be treated as soon as possible, as your condition can worsen in just a few hours. ³

Mastitis can be caused by the following causes:

• untreated blocked ducts,
• Bacteria entering the breast through cracked and damaged nipples,
• incorrect attachment of the child to the breast,
• long periods between feedings,
• breasts too full,
• wearing a bra that is too tight or that cuts into the skin,
• Abrupt weaning,
• excess milk.

Solutions ³
In addition to seeking medical attention:

• Continue to breastfeed or express milk frequently. Your milk is still safe for your baby. Its release will help eliminate blockage of the ducts and prevent painful accumulation of milk. Sudden cessation of feeding or pumping may exacerbate symptoms. After feeding, it is advisable to express any remaining milk.
• Give the child the inflamed breast first. This way the child can empty it completely. If it hurts too much, start feeding on the healthy breast, and when milk begins to flow, go back to the first one.
• Rest well, drink and eat. You need to get enough fluids and good nutrition.
• Massage the sore area under a warm shower or apply a warm flannel or warm pack to clear the blockage and relieve symptoms before feeding or pumping.
• Apply a cooling pack after feeding, , to reduce inflammation.

Problem #3. My strength is running out

Breastfeeding in the first weeks can be very tiring and seem endless. The baby will ask for a breast every few hours, day and night, and you have not yet grown stronger after giving birth.

Solutions

• Take care of yourself. This may be easier said than done when you have a newborn in your arms, but still try to get as much rest as possible, eat healthy and regular meals, and drink plenty of water. Do not refuse the help of your partner, relatives and friends, or even hire an assistant if you can afford it.
• Feed lying down. This will allow you to relax and reduce stress on sore spots, stitches or c-section scars.
• Don't skip feedings. Your partner may offer to bottle feed your baby while you are resting. However, despite this temptation, it should be remembered that milk production is best established in the first four weeks through breastfeeding. When breastfeeding is well established, you can give your baby expressed milk, but before that, ask family or friends to help you with other things so you can fully focus on breastfeeding.

Problem #4. How can I increase breast milk production?

It's easy to question whether you're making enough breastmilk, especially when your baby has developmental spikes between the third and fourth weeks. It may seem to you that the child asks for breasts more often because he does not have enough milk. However, if the number of wet and soiled diapers doesn't change—see Breastfeeding: What to Expect in the First Month—the baby is likely to breastfeed more often to calm down. The baby is surrounded by many new sounds and images that are easy to get tired of, and at the breast he feels safe. ⁴

Solutions ^4.5

• Do not try to supplement your baby with formula, unless doctors are worried about weight gain or fluid loss. Continue breastfeeding your baby. This will help naturally increase breast milk production.
• Do not feed on a schedule. Feed your baby on demand. Thus, the production of breast milk will adapt to his needs.
• Use the breast pump, , to help increase breast milk production while continuing to breastfeed.

Problem #5. I have too much milk

Hyperlactation, or too much milk, can also be difficult for you and your baby. You may experience discomfort from swollen and leaking breasts, and your baby may have difficulty latch-on, choke on the milk flowing too fast, and be unable to empty the breast properly. ⁶

Solutions

• Express some breast milk at the start of a feed to reduce the force of the flush. Don't pump too much as this can aggravate the situation - pump only as much as needed to ease the discomfort. Try hand pumping or use a breast pump (check out the Medela* breast pump range and choose the right one for you).
• Use the towel or pad to soak up excess milk, or place the milk collection pad** on the other breast while you breastfeed first.
• The child must feel supported. Hold him firmly (this gives a sense of security) and in a comfortable position so that he can turn his head. Talk to the baby during the first rapid flush, then he will not be frightened by surprise and will not push the breast.
• Contact a lactation consultant or health care professional who will monitor you and suggest single-sided feedings or hourly breast changes (“breast duty”) to normalize your milk supply.
• Be patient . Problems with milk production usually go away after a few weeks.

Problem #6. I have different breasts!

You have noticed that the baby prefers one breast, or that one breast produces more milk than the other, and as a result, the mammary glands have acquired different sizes and shapes. This happens quite often and does not pose any problems for breastfeeding. If this does not bother you or your baby, you can leave everything as it is. If this makes you uncomfortable, try the following tricks.

Solutions

• When feeding, offer the less demanded breast first because babies usually breastfeed more vigorously at the start of a feed.
• Use the breast pump to increase breast milk production in the smaller breast.
• Don't give up on bigger breasts. Breastfeeding should continue with fuller breasts to avoid blockage of ducts and mastitis.
• See a doctor. Sometimes an ear infection is the cause of a baby lating on only one side. However, some positions may cause him discomfort, so try to keep the child more upright. In addition, a breast infection can change the taste of milk and cause milk to be rejected as well.

Problem #7.

With frequent feeding, sometimes painful friction occurs, and a blood bubble may appear on the breast,
nipple or areola. ⁷

Solutions

• Ask a lactation consultant or specialist to check the baby's latch on. A shallow grip can cause blistering of the nipples and areolas.
• Talk to your doctor about what medication you can take to relieve pain if needed.
• Try other feeding positions to avoid putting pressure on the painful area.
• Lubricate inflammation with pure lanolin.
• Use Breast Pads** to avoid rubbing your blister with clothing and help it heal faster with air circulation, or try cooling hydrogel pads** to help relieve pain and promote healing.
• Try expressing milk. Using a breast pump can be an alternative way to get breast milk without bladder irritation. Choose the correct funnel size so that the nipple can move freely and the bubble does not rub against the walls of the tunnel.
• Do not pierce the vial as this may lead to infection.
• Seek medical attention, if the problem persists and causes you pain.

Problem #8. Painful white spot on nipple

When the opening of the milk duct is blocked by milk or a thin layer of skin grows over it, a small white or yellowish spot may appear on the tip of the nipple. For some, these blocked ducts, sometimes called milk vesicles or blisters, cause pinpoint pain, especially during feeding or pumping. Others do not experience any discomfort. White blisters may persist for several days or weeks until the skin breaks and hardened milk comes out. ⁸

Solutions

• Follow the tips above to solve friction bubble problems.
• Remove the blockage, if you see that the milk cork is starting to bulge. Try to squeeze it out very gently with clean nails.
• Continue breastfeeding or pumping, to clear the milk duct. If the milk duct clears during feeding, it will not harm the baby in any way.
• Apply hot wet flannel to the vial just before feeding or pumping. This will help open the blocked duct. You can also try rubbing the area quickly with a clean, damp cloth.
• Manually express some milk before feeding, trying to push out hardened milk clots. If this does not help, feed the baby or express milk as usual. Repeat several times a day.
• Soak a cotton swab with olive oil and put it in the bra, pressing it against the bubble nipple. This will help soften the skin.
• Seek medical attention, if problem persists. Your doctor may remove the plug with a sterile needle. This should be done immediately after feeding, when the bubble is as inflated as possible.

Problem #9. My nipples hurt while breastfeeding

At the start of breastfeeding, my nipples may become more tender, sore, and even inflamed, but this usually goes away after a few days. If your baby's latch is checked by a specialist and the inflammation persists or the nipples hurt with every feeding, you may need medical attention to resolve this problem. ^2.7

The following symptoms and signs that appear on one or both breasts during or after feeding may indicate a bacterial infection or thrush:

• burning, itching or moderate to severe pain in the nipples,
• pain in nipples aggravated by contact with clothing,
• nipple pain persists despite attempts to attach baby differently,
• nipples hurt to touch,
• stitching, shooting, burning or deep aching pain,
• chest pain during feeding and almost an hour after,
• hot pink nipples,
• discoloration and texture of the areola (hot pink, darkening, dryness or peeling),
• white rash on chest or areola.

Also check if your child has the following symptoms and signs:

• thick white patches or coating on the tongue,
• white indelible spots on the cheeks,
• bright red spotted rash on buttocks not helped by diaper rash creams.

Solutions ⁷

• Seek medical attention. He will most likely suggest testing for infections to make a diagnosis. Bacterial and fungal (yeast) infections are treated differently, so appropriate treatment should be started as soon as possible. There are other reasons that can cause similar nipple pain, such as eczema, psoriasis or vasospasm (narrowing of the blood vessels) in the mother and problems with latch or tongue frenulum in the child. Therefore, it is very important to make an accurate diagnosis.
• Practice good hygiene. Wash hands before and after feeding and applying any medication, and after changing diapers. Change bra pads regularly, wash bras, tank tops and towels in high temperature water, thoroughly wash breast cups and anything your baby puts in her mouth, such as nipples.
• Let the nipples dry after feeding, as all infections love a warm and humid environment.
• See your doctor again if there is no improvement after a few days. Do not let the problem run its course, otherwise the situation may worsen.

Materials on the topic. Breastfeeding: what to expect in the first month

Breastfeeding: what to expect after the first month

Breastfeeding problems after the first month

Literature

Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol # 20: Engorgement. Breastfeed Med. 2009;4(2):111-113.- Breastfeeding Academy Protocol Committee, "AVM Clinical Protocol #20: Breast engorgement." Brestfeed Med (Breastfeeding Medicine). 2009;4(2):111-113.

2 Jacobs A et al. S3-guidelines for the treatment of inflammatory breast disease during the lactation period. Geburtshilfe and Frauenheilkunde . 2013;73(12):1202-1208. - Jacobs A. et al., "Recommendations S -3 for the treatment of inflammatory diseases of the breast during breastfeeding. Geburtskhilfe und Frauenheilkünde. ABM Clinical Protocol# 4: Mastitis , Revized MARCH 2014. . 23: 50099 Med (5) H., Academy of Breastfeeding Protocol Committee, AVM Clinical Protocol #4: Mastitis, March 2014 edition of Brestfeed Med (Breastfeeding Medicine). 2014;9(5):239-243.

4 Kent JC et al. Principles for maintaining or increasing breast milk production. J Obstet , Gynecol , & Neonatal Nurs . 2012;41(1):114-121. - Kent J.S. et al., "Principles for Maintaining and Increasing Milk Production". F Obstet Ginecol Neoneutal Nurs. 2012;41(1):114-121.

5 Amir L. Breastfeeding managing ‘supply’ difficulties. Aust fam physician . 2006;35(9):686. - - Amir L., "Breastfeeding: problems of 'supply'. Aust fam physical. 2006;35(9):686.

6 Trimeloni L, Spencer J. Diagnosis and management of breast milk oversupply Journal Am Board Fam Med . 2016;29(1):139-142. - Trimeloni L., Spencer J., "Diagnosis and correction of excess breast milk production." Journal Am Bord Fam Med. 2016;29(1):139-142.

7 Berens P et al. Academy of Breastfeeding Medicine. ABM Clinical Protocol# 26: Persistent pain with breastfeeding. Breastfeed Med.

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