Blocked milk duct
A small hard lump in the breast may be a blocked milk duct. If it remains after you massage it and bathe it in warm water, see your doctor, as it may also be an abscess, a breast infection, or in very rare cases a cancer.
A common complaint, especially in first-time mothers, is a cracked nipple. It usually starts a few days after the baby starts feeding and can be excruciatingly painful. Preparing your nipples for breastfeeding should lessen the likelihood of this problem. If a crack does appear, soothing creams are available from chemists or doctors to settle the problem, and often the baby will have to be fed from the other breast for a few days until the worst of the discomfort passes.
Excess breast milk and engorged breasts
One of the most common breast problems is engorgement, which is not only uncomfortable but may lead to difficulty in feeding and to infection. If the breasts are swollen and overfilled with milk, expressing the excess milk usually relieves the discomfort. This can be done by hand under a shower or into a container, or with the assistance of a breast pump. At other times, expressed milk may be kept and given to the baby by a carer while the mother is out or at work. Breastfeeding need not tie the mother to the home.
The infant may find it difficult to suckle on an overfilled breast, so expressing a little milk before the feed may be helpful. A well fitted, supportive bra is essential for the mother's comfort. Mild analgesics such as aspirin may be necessary, particularly before feeds, so that the feeding itself is less painful. Heat, in the form of a warm cloth or hot shower, will help with the expression of milk and with releasing milk from blocked areas of the breast.
Engorgement usually settles down after a few days or a week, but if the problem persists, fluid tablets can be used to reduce the amount of total fluid in the body and make it more difficult for the body to produce milk. In severe cases, partial suppression of the milk supply may be necessary.
Inadequate breast milk supply
Breastfeeding may be started immediately after birth in the labor ward. Babies have an instinct that enables them to turn towards the nipple when it is brushed against their cheek, and the suckling at this early stage gives comfort to both mother and child. In the next few days, relatively frequent feeds should be the rule to give stimulation to the breast and build up the milk supply. The breast milk is initially called colostrum and is relatively weak and watery. It slowly becomes thicker and heavier over the next week, naturally compensating for the infant's increasing demands.
After the first week, the frequency of feeding should be determined by the mother and child's needs, not laid down by any arbitrary authority. Each will work out what is best for them, with the number of feeds varying between five and ten a day.
If the milk supply appears to be inadequate, increasing the frequency of feeds will increase the breast stimulation, and the reflex between the breast and the pituitary gland in the brain is also stimulated. This gland then increases the supply of hormones that cause the production of milk. Sometimes, medications that stimulate the pituitary gland can be used to increase milk production, or even induce milk production in mothers who adopt a baby.
A mother who is tense and anxious about her new baby may have trouble breastfeeding. The mother should be allowed plenty of time for feeding and relaxation so that she becomes more relaxed and never feels rushed. A lack of privacy can sometimes be a hindrance to successful breastfeeding. Lots of reassurance, support from family, and advice from doctors, health center nurses or the Nursing Mothers Association can help her through this difficult time.
The best way to determine if the baby is receiving adequate milk is regular weighing at a child welfare clinic or doctor's surgery. Provided the weight is steadily increasing, there is no need for concern. If the weight gain is very slight, or static, and increasing the frequency of feeds fails to improve the breast milk supply, then as a last resort supplementation of the breast feeds may be required. It is best to offer the breast first, and once they appear to be empty of milk, a bottle of suitable formula can be given to finish the feed.
Some women have flat or inverted nipples. Your nipple is also inverted if it retreats when you try to express milk by hand. If you intend to breastfeed, the doctor will examine your breasts, and if your nipples are flat or inverted, a nipple shield may be worn to correct the problem. The shield fits over the nipple drawing it out gently, making it protrude enough for the baby to feed. Stimulating the nipple by rolling it between finger and thumb, and exposing the breasts to fresh air (but not direct sunlight) may also help.
Suppression of breast milk
If a mother desires not to feed her new baby, cannot feed because of disease or drug treatment, or the baby cannot be breastfed because of prematurity or other disease, it is necessary to suppress milk production. A firm bra should be worn and nipple stimulation should be avoided. Fluid tablets can assist reducing engorgement, and occasionally estrogens may be prescribed. The best medication to stop the production of breast milk is bromocriptine which will dry up most women's milk in three or four days, but it must be taken for at least ten days to stop it from recurring. It may cause some nausea in the first few days, but this settles with time.
Infection of the breast most often arises during breast-feeding. Germs (staphylococci) gain entrance by the milk ducts and set up inflammation which often ends in suppuration. A small abscess may form in the sebaceous glands of the areola, but more often infection goes deep into the substance of the breast and the pus may track in various directions- with a tendency to reach the surface and discharge. There is a diffuse redness of the breast and a swelling which feels firm and tense. There is much throbbing pain with temperature and the patient feels sick and ill. In treatment, hot fomentations should be applied and when pus has formed it is necessary for the abscess to be opened by a surgeon and drainage established. Penicillin both locally and systemically is a valuable aid to treatment. As a rule, the breast heals both quickly and cleanly, and breast feeding may be resumed.
This is a condition of over-growth of the connective tissue of the breast occurring in women about the change of life. There is a feeling of dullness in the breast with stinging pains. The breast has a knotty feel and is tender to touch. It is important that the diagnosis of mastitis be confirmed by expert examination. The application of a belladonna plaster and a supporting bandage is helpful in treatment. In some cases, if the mastitis is localised, an operation may be advised. Testosterone, the testicular hormone, has recently been advocated in treatment of mastitis.
cyst may form in the breast in a pregnant or lactating woman as a result of blocking of a milk duct with subsequent dilatation. A soft elastic swelling appears which often disappears when breast-feeding ceases. If the cyst does not spontaneously disappear, it should be removed surgically. Cysts may arise during the change of life. Sometimes they are multiple. Removal by operation is necessary.
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