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When Breastfeeding Isn't As Glamorous As Everyone Says

A conversation about engorgement, a plugged duct and mastitis:

New mother Lisa… is engorged. Her baby Oliver, is 4 days old. She tells me that both her breasts are so hard and swollen that the nipple sticks straight out...“Like a nipple on a bowling ball?” I ask, “Exactly. Olly can’t get latched on, he keeps trying and comes away crying.” she responds, verging on tears. With a flat, taut nipple it’s no wonder Olly can’t latch on and get milk… he can’t compress any breast tissue behind the nipple.

I offer the reassurance that this uncomfortable, painful, throbbing feeling -without fever - will begin to subside in as little as 12 hours if managed properly and promptly.

Engorgement: it’s not just too much milk. Your new postpartum breasts have milk, sure, but they’ve also got an increased blood supply and your cells are retaining fluids in an effort to make more breastmilk for your just born.

Call it normal breast fullness or call it engorgement, it can turn really painful if you aren't breastfeeding your baby often enough or if the feedings aren’t thorough.

FIX IT: First Lisa needs to express milk to soften her breast. Olly has to be able to take breast tissue into his mouth along with the nipple to get the milk. Prepare to breastfeed before Olly starts showing signs of hunger. Manual expression is easier on the nipple than a suction pump. When Lisa has softened her breast and is able to use her fingers to compress the breast tissue behind her areola, milk will appear in the pores of her nipple. Olly should be offered her breast at this time. Feed him on one breast for the entire feeding as long he will keep up his sucking and swallowing. Switch to the other side if he still shows signs of hunger and won’t resettle on the first breast. Pump or manually express the unused breast just to relieve the pressure and then stop. That breast will likely have been leaking during the feeding and has softened somewhat on its own. Keep Olly skin to skin to stimulate him to eat more often, at least every 2 hours. Next feeding? Start on the other breast. Use cold compresses over a layer of cloth between feedings; 20 minutes on, 20 minutes off and you can place slightly crushed cabbage leaves inside a bra against your skin for 20 minutes once in the morning and once in the evening. AND REST!!!

Lisa will likely feel the uncomfortable fullness subside with improved milk removal and the cooling of inflamed tissues. She can be assured that mild engorgement is part of the normal, natural sequence of adjustments during her early postpartum period.

Magdalena, is the mother of an exclusively breastfed 3 month old daughter, Genevieve. Magdalena has recently returned to work outside of her home… now she has a plugged duct. “My left breast has a lump that I can feel, below my armpit.” I ask if it feels hard and tender. “It sure does, and that shoulder is sore too.” I ask, “Are you carrying something heavy on that side?” suspecting a shoulder bag clutched close to her body. “Yes, my briefcase and breast pump during my long commutes.” Bingo. Magdalena didn’t know that milk ducts in the breast may become blocked when the breastmilk flow is impeded by pressure on the ducts from a tight bra or clothing or carrying a heavy shoulder bag or 2. Working for long hours outside of the home can also lead to hurried feedings, limiting Genevieve’s time at the breast.

FIX IT: I advise Magdalena to begin every feeding or pumping session on the affected breast after an application of moist heat and a gentle tapping, patting massage around the lump. A vibrating massager works well in this instance to, very simply put,  ‘loosen’ milk that has been ‘stuck’ in the ducts which can accumulate stringy, semi-solid particles. Breastfeed Genevieve as often as possible when at home and pump more often and for longer when away, to move more milk through, freeing the clog. Be sure to hold Genevieve in a football type hold, up against the left side of your ribcage with Gen’s chin toward the lump. Magdalena did not know that Genevieve would drain milk most fully from the portion of the breast closest to her chin.

CAUTION: Call your healthcare provider for any signs of infection:

Increased pain, swelling, redness, or warmth in an area on a breast.

Red streaks extending from a breast.

Drainage of pus coming from a breast.

Flu-like symptoms, such as fever of 101°F (38.5°C) or higher, chills, and fatigue.

Paula Zindler
RN IBCLC

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