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Common Concerns During the Early Weeks of Breastfeeding

My Breasts Are Swollen and Painful
One of the most frequent early difficulties encountered by breastfeeding women occurs when their milk comes in abundantly and their breasts get larger, firmer, and tender. These breast changes that coincide with the beginning of copious milk production are known as postpartum breast engorgement. Engorgement results from hormone fluctuations after delivery that cause a sudden increase in milk volume. Tissue swelling, lymph drainage, and increased blood flow to the breasts also contribute to the dramatic breast changes.

It is generally believed that frequent, unrestricted nursing during the first days postpartum will relieve milk congestion and prevent severe engorgement. In my experience, however, the severity of engorgement cannot always be explained by a woman's early feeding practices. Some women begin nursing right away and feed often, yet still experience excessive engorgement, while others don't start breastfeeding for a day or so without getting severely engorged. Most experts agree that engorgement is more remarkable in first-time mothers than those having subsequent babies. In addition, I have observed that engorgement is often greater in women whose breast size increased dramatically during pregnancy.

Fortunately, postpartum breast engorgement is a temporary condition, usually lasting only a few days until your body adjusts to the process of making and releasing milk. By the end of the first week after delivery, milk flow is usually well established and breast engorgement has subsided. In the meantime, it is very important that your baby be helped to latch on correctly and to nurse often (at least every two to three hours) while your breasts are engorged. You may need to express some milk to soften your nipple and areola and make it easier for your baby to latch on. Frequent milk emptying will make you more comfortable, keep your baby well fed, and assure continued generous milk production.

For specific strategies to help your baby nurse well when your breasts are swollen, to relieve uncomfortable engorgement, and to improve milk flow, see this article.

My Nipples Hurt
Sore nipples are one of the most frequent complaints of breastfeeding women. Early, mild nipple tenderness, beginning on the second day, is so common as to be considered normal. Usually the first minute after your baby latches on is the most uncomfortable. Try your Lamaze breathing techniques to help you relax prior to nursings, so you won't tense up in anticipation of pain.

First and foremost, pay attention to proper nursing position and the infant's attachment to the breast. Early sore nipples are usually due to improper infant latch-on. Another helpful strategy is to begin feedings on the least sore side, since your baby suckles more vigorously at the beginning of a feeding until the milk ejection reflex has been triggered. Once your milk begins to flow and nursing is more comfortable, you can move your infant to the more painful side. However, try to assure that both breasts get equal stimulation and emptying. Frequent, shorter feedings are preferable to long nursings at wider intervals. Most mothers find that a soothing emollient applied to their nipples promotes healing. I recommend USP Modified Lanolin (medical grade), such as Lansinoh for Breastfeeding Mothers or PureLan. These products can be obtained from breast pump manufacturers, La Leche League, lactation consultants, maternity shops, and other locations. Pat your nipples dry and apply a thin coating of lanolin after each nursing. You do not have to remove medical grade lanolin before feeding your infant.

Because the volume of colostrum is low, some babies create a strong vacuum when sucking during the first few days and cause nipple soreness. Once abundant milk production begins, the baby generates less negative pressure during nursing, and nipple pain usually starts to subside. By the end of the first week, you should have little, if any, discomfort with feedings.

Severe or persistent nipple pain is not normal. If your nipples are so painful that you dread feedings, if discomfort persists throughout a nursing, if you have open cracks or fissues, or if your pain does not improve after your milk comes in, you need to seek assistance. Notify your own and your baby's doctor and request to be referred to a lactation consultant.

Can I Feed My Baby on Schedule Instead of by Demand?
The vast majority of breastfeeding proponents strongly attest to the importance of round-the-clock demand feedings for young breastfed infants. However, some parent educators emphasize the value of creating structure and order in a young baby's life by the early establishment of predictable patterns of feeding and sleeping. Other parenting experts consider this philosophy of ordering a baby's life to be somewhat controversial. In my opinion, parents should make every effort to meet their infant's needs promptly in order to help their baby feel loved, safe, and secure and to build trust in the world. Meeting your baby's individual needs as quickly and effectively as possible forms the basis for a strong love bond with your infant. A baby's emotional development can be harmed when her needs go unmet because her parents adhere to an arbitrary feeding schedule. Those who advocate the desirability of regular routines in infant care make attractive claims of successfully feeding babies on predictable schedules and getting them to sleep through the night at an early age.

Obviously, a wide range of parenting styles can be effective in raising healthy, happy children. However, some babies develop regularity in their feeding and sleeping patterns more easily than others. I strongly believe that the unique needs of an infant take priority over parents' desires for predictability and order. While some breastfed babies can thrive well with a regular schedule, it is my impression that the great majority do best on a demand schedule. Breastfeeding is most successful when infants remain in close contact with their mothers and are allowed to nurse in an unrestricted fashion. In some instances, rigid scheduling of feedings has resulted in an infant's failure to thrive.



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From Dr. Mom's Guide to Breastfeeding by Marianne R. Neifert. Copyright © 1998 by Marianne R. Neifert. Used by arrangement with Plume, a member of Penguin Group (USA) Inc.

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