Common Breastfeeding Questions and Problems - Article Five

Engorgement

What happens if I have too much milk and become engorged?
Engorgement, a pronounced filling and swelling of your breasts that causes them to become very hard and painful, is your body's signal that the supply-and-demand mechanism is out of balance. Engorgement is a problem for both mother and baby. For mother, it can be very painful, and, if left untreated, can progress into a debilitating breast infection.

This condition is also uncomfortable for baby. If your breasts are engorged, the nipple angle flattens, preventing baby from properly latching on. When this happens, your baby sucks your nipple but cannot get enough of the areolar tissue into her mouth to compress the k sinuses. As a result, the baby stimulates more milk to enter the breast but is unable to empty it, further aggravating engorgement and setting up a vicious circle. As the breast tissue swells, the milk cannot flow freely. Baby gets less milk and needs to feed more frequently; mother gets more engorged, and the breastfeeding pair is in trouble. You can prevent engorgement by following the right-start tips for breastfeeding; feeding on cue rather than on schedule and using correct positioning and latch-on techniques.

If engorgement occurs while you are still in the hospital, use an electric breast pump to release some of the extra milk in order to soften the areola, so that baby can latch on and more effectively empty your breasts. Usually, in the first week, your breasts slowly and steadily build up milk, and baby should drain your breasts at the same rate as the milk is produced. Some fullness is common as your milk increases during the first week, but it should subside with proper positioning and latch-on, frequent feeding, and lots of rest. Sometimes milk increases suddenly around the third or fourth day, causing mothers to exclaim, "I awakened with these two painful boulders on my chest." Use a breast pump, preferably electric, immediately to relieve this engorgement before it progresses. In the past, warm compresses were recommended, but now that engorgement is better understood, it is realized that heat can actually do more harm by increasing tissue swelling. You will need to apply cold compresses or packs of crushed ice (use a thin cloth between your skin and the ice pack to prevent frostbite) until the swelling subsides enough for the milk to flow. This cool therapy will also relieve the heat and pain in your breasts.

You can keep fullness from developing into engorgement once you are home by standing in a warm shower, soaking your breasts in warm water in a basin, or applying warm compresses for ten minutes before expressing or feeding. This helps trigger your milk-ejection reflex so baby will get milk flowing sooner and empty your breasts better. If your areola is too full for your baby to latch on correctly, then express some milk before feeding to soften your areola enough so that your baby can grasp the areola and not only your nipple.

If fullness progresses to engorgement, do not sit patiently and wait for engorgement to subside. Use continuous ice packs between feedings to alleviate your pain and reduce swelling, and if possible rent an electric breast pump until you can reach a lactation consultant for help with your breastfeeding technique. If your baby is nursing well, pump only enough milk to relieve the fullness and soften the areola so that baby can latch on. If your newborn is not yet nursing effectively at the breast, you will need to pump every two to three hours to keep the milk flowing and to stimulate a good milk supply. Acetaminophen and a well-fitting bra that is not too tight for support are helpful, and rest is a must.

Above all, don't stop breastfeeding! The breasts must be drained. Unrelieved engorgement often leads to a breast infection called mastitis. The symptoms resemble the flu: fatigue, fever, chills, and aches. Your breasts may be generally engorged or you may feel a localized swollen, tender, red, warm area. To treat apply moist heat (warm towel or jet of warm water in shower) to the sore area for ten minutes at least four times daily, take acetaminophen for fever and pain and a doctor-prescribed antibiotic (both safe while breastfeeding), and rest. Unless you advised not to by your lactation consultant, it is helpful to continue breastfeeding. The breast must be emptied (either by aby or by pumping) for the infection to heal.

If you have enjoyed uncomplicated breastfeeding and suddenly you are becoming engorged, take inventory of your feeding techniques, or take this as a signal that your nest or you schedule is too busy. Listen to your body; it is trying to tell you something.

Needs To Relax

I'm a tense person. How can I better relax during breastfeeding?
The hormone prolactin has a calming effect, yet emotional stress or physical stress (exhaustion, pain, illness) can actually interfere with the milk-releasing hormone, oxytocin, inhibiting the MER. Then if your milk doesn't flow, baby comes unglued, Babies are quick to pick up on mother's tension, so relaxation is a valuable skill to cultivate. Try the following tips.

Think baby. Before beginning to breastfeed, set the tone for the time ahead by focusing on the activity at hand -- put aside conflicting concerns and think baby. Imagine yourself breastfeeding; imagine the movements and facial expressions of your baby that you enjoy most. Massage your baby. Stoke and cuddle your baby using a lot of skint-to-skin contact. All these images and activities get the relaxing hormones flowing, helping you to unwind before beginning to feed.

Minimize distractions. Prior to feeding eat a healthful snack and drink some water or juice. A hot shower, warm bath, or brief nap before feeding time is good relaxation therapy. Try the relaxation techniques and breathing exercises you learned during childbirth class. Play relaxing music prior to and during breastfeeding. Visualize a fountain flowing from your breasts. Ask someone to stand behind your chair and massage your neck, shoulders, and upper back. As you accomplish latch-on, with all your pillows in place, take a deep abdominal breath and exhale slowly, just as you learned for childbirth, letting all the tension flow away from your neck, back, and arms.

Feed in a warm bath. Water therapy helps if you are extremely tense. Sit in a warm bath with the water level just below your breasts. Breastfeed baby (who is also half-immersed in warm water) as you recline in the tub. A safety tip: Don't try to step into a filled tub while holding baby. You may slip. Place baby on a towel next to the tub until you are comfortably settled, or have someone else hand your baby to you after you are reclining in the tub.

Prepare a breastfeeding station. This idea has helped other mothers relax while feeding their babies amid all the activities of a busy family. This station is an area in your home especially set up as a nest for mother and baby, containing your favorite chair (preferably an armchair or a rocking chair with arms at a comfortable height to support your arms while holding baby), plenty of pillows, a footstool, soothing music, a relaxing book, nutritious nibbles such as fruit bits or trail mix, and juice or water. If you don't take the phone off the hook, a cordless phone or a long extension wire is a real help. You will be spending a lot of time in this next, so make it inviting and functional. Anticipate your needs for the hour or so you ay be spending there -- for instance, extra diapering supplies and baby clothes, a burping cloth, a waste can. If you have a toddler and/or preschooler, include snacks for him and some favorite activities you save just for feeding time. You may need to have one feeding station located where you can keep him contained in a safe area. It's hard to relax if you have to worry about what he's getting into. Some toddlers tolerate new baby feeding time better if you actual set up you station on the floor. This gives the message that you are accessible. Breastfeeding itself is a self-relaxing cycle. The more you breastfeed, the more relaxing hormones you produce, which help you breastfeed better.

There will be more articles to come on Common Breastfeeding Questions and Problems.