Breastfeeding: the difficulties and advice of the midwife
Breastfeeding while it is one of the most natural things there is is not one of the easiest. There may be difficulties that can discourage mothers enough to stop breastfeeding. To make breastfeeding successful, therefore, it is necessary to know the various difficulties that can be encountered and to surround oneself with a support network made up of mothers with good experience, and experts such as midwives and breastfeeding consultants.
If there were difficulties with the first child, they do not necessarily persist with the second child. Breastfeeding depends on how the birth went, the skills of the baby, how the mother is at the time and the assistance the mother receives and the support she can get from family and friends.
What are the difficulties?
One of the first difficulties that a woman may encounter is the pain in the nipples which does not disappear after a few seconds from the beginning of the feed and which can often turn into small cuts called fissures . The only cause for this is the wrong or not very good attachment of the baby to the breast . The wrong attack may depend on the wrong position or maybe because the baby is small and can’t take a good part of the breast. Yes, because the baby has to take the breast and not the nipple!! This thing therefore means that flat nipples are not worrying because the baby feeds the breast and not the nipple!
Correct position to breastfeed well
The classic cradle position… the baby must be placed under the breasts, belly to belly and it is the baby who must meet the nipple. The position of the baby’s face must be such that the nipple, with the breast free and not supported or raised, touches the area between the baby’s nose and lips.
If you then leave the baby the autonomy to open his mouth, throw his head back a little and take the breast, the attachment will be very good because the baby knows how to do it. If, on the other hand, the baby is “centered” by the nipple that is moved by the mother’s hand, she may not take that good part of the breast and the nipple could rub on the baby’s palate, leading to fissures. In this position it is important that the baby’s belly touches the upper part of the mother’s belly well and that the ear is aligned with the shoulder and hip. This means that the baby is aligned and therefore that the suction is not disturbed. To better understand imagine yourself drinking from a bottle, it is very difficult to drink if you bend your face forward or too sideways. It’s the same for a child, if the position is the most comfortable he will eat more serenely without breaking away. One thing that helps is containment. If the child is contained, i.e. the little legs,
Some remedies for breast pain while breastfeeding
If your nipples hurt or if you have fissures, you need to check the attachment and position, perhaps going to an expert, if the expert says that the attachment is good but you continue to have pain, change experts, unfortunately not all know how to recognize a good attack!
Aluminum teats, various creams and nipple shields should be used when there are no other remedies and the attachment has been checked and adjusted. A good cream to use is lanolin which helps healing but there is no scientific evidence on its use.
For the nipple shield it is very important to choose the one with the right size. It must be able to cover the nipple well and the length of the teat must be a hair shorter than the baby’s palate, to measure it, insert a finger into the baby’s mouth and see where the end of the palate is, the teat must be a little shorter . To wear it, immerse it in hot water so that it softens but does not burn on the skin, stretch it and then put it on, centering the nipple with the teat. The heated silicone will stick like tape to the skin so you don’t have to hold the nipple shield for the duration of the feed and the heat will let out some milk which will fill the space between the nipple and the tip of the teat which will help the baby with the first feedings.
Before trying the various creams on the market for which there is no scientific evidence, as well as for the silver cups, the woman can express some of her own milk and sprinkle it on the areola. Breast milk is very rich in vitamins, antibodies and many other substances that can help the nipples heal. It can be spread before, to soften, and after feeding. If there are cuts it is important to clean the breasts and the soaps that are used, some soaps can be too aggressive and make the situation worse, in these cases using only water for when the woman decides to wash is perfectly fine! The most important thing to wash are your hands!!
The breasts must stay in the air as much as possible, do not stay in contact with wet breast pads and it is suggested not to wear underwear with lace but prefer cotton to avoid further rubbing and worsening.
Breast engorgement
Another difficulty that can be encountered in the first few days during the milk supply or after is breast engorgement. An engorgement is when there is a lot of milk production compared to what the baby eats. In the early days, the breast must calibrate its production based on the baby’s requests and this may take time. Therefore, too much milk equals stagnation of milk which, if not drained, can create hard “swallows” where the milk condenses and therefore it is then difficult for the baby to dissolve them on his own with the feed.
To soften the breasts, you can make hot-moist compresses by wrapping a hot water bottle with a wet towel, take a hot shower or bath, or wet the sign at the sink. Once the breasts are warm, massages can be given to soften these lumps. The fingertips of 3-4 fingers are used, they can be moved by drawing circles or moving them towards the nipple, in both cases the movements must go from the periphery to the nipple. Immediately after the massage, the baby is attached to the breast so that when he is suckling he can empty the breast and also that lump. If the breast is very tense even after feeding, you can squeeze the breast with your hands to reduce the tension.
Cold compresses can be made between one feeding and another because when there is an engorgement, in addition to the stagnation of milk in the lactiferous lobules, there is stagnation of liquids in the tissues that protect the glands. This liquid can be drained with cold compresses and with massages that this time go from the breast to the shoulders to improve the flow of liquids in the tissues and along the lymphatic vessels.
Immediately before feeding warm wet compresses, away from feedings cold compresses. The poultices can also be made with ventilated green clay, hot or cold depending on the moment. In addition to this it may be useful to take soy lecithin which improves the quality of fats making the milk more fluid.
Mastitis
If the engorgement does not clear up, if there is a blocked duct for various reasons, if there is an infection there may be mastitis. Mastitis presents with redness of the breast in a particular area which may correspond to a lump or the whole breast, heat and often high fever.
You must continue to attach the baby to the breast and behave as for engorgement. If the fever remains above 38°C without going down for a whole day, it might be advisable to take antibiotics because often the cause of this type of mastitis is an infection. If the temperature fluctuates and resolves within a few days, it was most likely caused by an engorgement or blocked duct. Then attach the baby to the affected breast, hot, humid or cold compresses depending on the moment, compresses with ventilated green clay and soy lecithin… I forgot the most important thing: lots of rest!
He cries after a while being at the breast
It happens that there are children who refuse the breast crying after very few feedings, perhaps coughing or with milk coming out of the sides of the mouth. Maybe at night when they are breastfed in bed they have no problem and in any case they grow very well and wet the 6 diapers and 3-4 poops a day demonstrating that they are getting the milk they need… Yet they tear away from the breast crying.
This happens when there is a strong letdown reflex, ie the breast is so full of milk that the first milk that comes out has a lot of pressure and it is so much that the baby can feel drowned and not be able to swallow or breathe. In these cases it is possible to breastfeed while lying down, the position causes the force of gravity to make the milk stay firmer and that only the baby’s suction makes it come out; a position where the baby is upright so that swallowing the milk is easier; empty the breast a little to reduce the pressure and ensure that the baby does not get too much milk.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.