by Jennifer Wider, M.D.
Frequently Asked Questions
It's only been two days since I started breastfeeding and my breasts are killing me. Why?
Once your milk starts to come. in, and the milk volume quickly increases -- which usually occurs sometime during the first week after delivery -- your breasts have a tendency to become overfilled, or "engorged," and this can be quite painful. It may take a while for your body to learn how to regulate your milk production and for you to get the hang of breastfeeding. Until then, it is easy for your breasts to become engorged.
Many experts recommend breastfeeding frequently to avoid engorgement. As soon as yolr breasts start to feel firm, it's important to relieve the pressure. If the baby has been fully fed and is sound asleep, pumping, manually expressing, taking a warm shower, or even just gently massaging your breasts may do the trick.
What is colostrum?
Colostrum is the yellowish-colored liquid your breasts start to secrete right after delivery. It is filled with important nutrients and infection-fighting antibodies. Colostrum secretion continues for about five days, with a gradual transfer to mature milk during the next four weeks:
How do I know if I'm producing enough milk?
Many women, at one point or another, worry that their babies aren't getting enough milk. And who can blame them? It's not that easy figuring out how much the baby has gotten from your breasts, and if the breasts have emptied, or whether the baby is full. It's not like a bottle, where you can see how much the baby has consumed. Here are a few indicators of a well-fed baby:
• If the baby seems satisfied after each meal
• If the baby is steadily gaining weight (but don't freak out if the baby loses some weight in the first week or so. That's to be expected.)
• If you're changing about six to eight wet diapers a day
• If the baby is having more than two stools a day (though this can vary a lot, and the number will usually decrease as time goes on.)
If you don't feel that you are producing enough milk, don't hesitate to contact a nurse, lactation specialist, or your doctor. Until then, you can try to increase the number of feedings a day. Usually, the more often you feed, the more milk you'll produce. But everyone is different and a specialist may be able to offer better advice tailored specifically to you and your baby.
Is my baby affected by what I eat?
Definitely. When you're breastfeeding, it's important to eat a well-balanced meal, and also to notice if certain foods don't seem to agree with your baby. Some women swear that spicy or gassy foods affect their babies; other women don't notice a difference. If it seems to you that your baby is bothered by a certain food, you may want to avoid it. Just make sure to fill your diet with healthy foods.
Caffeine and alcohol can make their way into your breast milk, so it's important to limit these substances while breastfeeding. Certain drugs, including nicotine, can also affect your breast milk. Make sure to speak with your doctor or nurse about any medications you are taking, because they can best advise you about whether these will affect your baby.
Help! I'm a leaky faucet.
I can relate! A few years ago, about five weeks after I had my daughter, I was a bridesmaid at the wedding of one of my best friends. The tag inside my dress read: "Do not get wet!" As we walked down the aisle, I heard a baby cry and sure enough, I started leaking. And we're not talking about a slow leak; I was literally leaking like a faucet. I held my flowers tight to my chest, but when the ceremony was over, there were two large rings on the top of my lavender dress. Needless to say, I wore a T-shirt the rest of the night. And I left the dress in the closet of the hotel when I checked out!
Almost everyone I know has a story like this. Here are a few tips to avoid Niagara Falls at your best friend's wedding:
• Use disposable pads, make sure they are lined up properly, and change them frequently (especially if you're at an event where you can't breastfeed frequently)!
• Try to stop the "let-down" reflex by putting pressure on your chest. Crossing your arms sometimes works; other times, there's little you can do but grin and bear it!
• Try to breastfeed frequently, especially in the beginning as your body is trying to regulate. It's more common to leak during the first few weeks. So, if you find yourself at an event, unable to breastfeed, don't forget your pump!
Nipples
Your nipples are killing you. They're tender and sensitive and you cringe every time the baby latches on. Come to think of it, the mere thought of a baby nursing makes you want to run for the hills!
Why are your nipples so sore?
The most common reason for sore nipples is incorrect positioning of the baby during breastfeeding. You'll want to address this issue as soon as possible because it shouldn't hurt to breastfeed. Make sure the baby's mouth opens widely to fit in the entire nipple and areola area (darkened area around the nipple) when latching on.
Some babies have a harder time with this, so if the baby isn't latched-on properly, take the baby right off the breast and try again. The best way to release the suction is to put a finger in the corner of the baby's mouth between the gums.
You've tried all the positions, but your nipples still hurt. What else can you do?
There are some other things you can try. If one nipple is particularly sore, try nursing with the other one first. Remember, a hungry baby has a very strong suck reflex, especially at the start of the feed. Spare the sore nipple by introducing the other one; by the time the baby gets around to the sore nipple, the suck won't be as robust.
Some studies have shown that breast milk can actually help soothe and heal sore nipples. Try rubbing some on your nipples after you breastfeed and let them air dry. Don't rush to put your bra back on either; give those poor nipples some air.
One nipple is cracked and bleeding; is there anything I can do?
Many women mistakenly think that cracked and bleeding nipples are just part of breastfeeding. But there is a big difference between sore nipples, where the skin is not broken and cracked nipples, where the skin is broken. A cracked and/or bleeding nipple is not a normal part of the whole process and needs your prompt attention.
Many experts recommend using lanolin or a similar product on your breasts before and after breastfeeding to prevent problems. Once the skin on the nipple is broken, "moist wound healing" -- the use oflanolin or a hydrogel to maintain a moist environment -- can help mend the nipple and hasten healing. Ask your doctor, nurse, or lactation consultant for further advice.
Can you still breastfeed if there's blood in the milk?
It is safe to breastfeed your baby if your nipple is bleeding. The blood won't harm her. If you are very uncomfortable, some experts recommend breast shields, which can help ease your pain and let you continue breastfeeding while the breast heals. Continue using the lanolin or other wound-healing products until you feel better.
The above excerpt is a digitally scanned reproduction of text from print. Although this excerpt has been proofread, occasional errors may appear due to the scanning process. Please refer to the finished book for accuracy.
Copyright © 2008 Jennifer Wider, M.D.