Wow, My Nipples are S-O-R-E!
Solutions to common nursing challenges
The Challenge: Sore Nipples
Although the major cause of severe or chronic sore nipples is trauma from incorrect latch-on and sucking, other factors can exacerbate the problem. Inappropriate nipple care (such as overdrying or excessive moisture) can delay healing, and nipple cracks can become infected by bacteria or yeast in the baby's mouth. Siiiigh.
The Solution: Nurse 'Em!
Once you're certain that your baby is latched correctly, try applying medical-grade purified lanolin after feedings or wearing moisture-retaining hydrogel dressings (such as Ameda Comfortgel Hydrogel Pads, $25 a pair at amazon.com) between feedings. Your doctor can prescribe an antibiotic or antifungal medication if an infection is present. Begin breastfeeding on the least sore side to trigger your milk-ejection reflex. Once milk flow has begun, baby should suck less vigorously when brought to the second, more irritated breast. Frequent, short feedings are preferable, since delaying the interval between feedings results in greater breast engorgement and a ravenously hungry baby -- a combination that can cause further nipple trauma. If your nipple pain is so severe that you must interrupt breastfeeding, temporarily express your breast milk using a fully automatic, electric breast pump.
The Challenge: Blocked Milk Ducts
A plugged duct, also known as a blocked duct or a caked breast, results when one of the milk ducts draining the lobes of the breast becomes partially obstructed. It creates a firm, tender, engorged area of the breast, and often forms a lump near the armpits. If not quickly remedied, a blocked duct can progress to a breast infection. This usually occurs when you haven't breastfed your baby often or long enough. Women who produce abundant milk are particularly prone to it, and being separated from your infant or going for long periods without nursing is another common risk factor. Wearing constrictive clothing, such as a tight underwire bra or straps from a baby carrier that are pulled too tight, also can interfere with milk flow.
The Solution: Nursing as Much as Possible
Begin several consecutive feedings on the affected side, since babies nurse more vigorously and take more milk from the first breast. You can also place your baby so that her chin points toward the plugged duct, a position that will help promote drainage. Warm compresses or a warm shower can trigger your letdown reflex and improve milk flow, and gentle massage of the blocked area can also be effective. Be careful not to press too firmly, however, as causing trauma to your breast increases the risk of an infection called mastitis. Recurrent clogged ducts can be a sign of breast inflammation or low-grade infection; treatment with antibiotics sometimes curbs the problem. Occasionally, a breast lump is mistaken for a clogged duct. If a lump persists for more than several days, have it checked by a doctor.
The Challenge: A Not-So-Pretty Infection Known as Mastitis
This breast infection occurs in about 10 percent of breastfeeding women. Flulike symptoms are typical: fever, chills, headache, body aches and fatigue, along with an area of the breast that is tender, red and firm. Mastitis is often preceded by a clogged duct, an infected cracked nipple, irregular or ineffective milk removal or simple exhaustion.
The Solution: A Round of Antibiotics
This nursing challenge requires a trip to the doctor's office. If infection occurs while you are breastfeeding a healthy baby, continue nursing or your milk production may decrease. Nurse on the unaffected breast first and move her to the painful breast only once the letdown reflex has been triggered. Ibuprofen can help reduce inflammation and pain, and warm packs can provide comfort. If direct breastfeeding is too painful, pump. The best way to avoid another bout of mastitis: Nurse and/or pump as often as you can.
The Challenge: Another Not-So-Pretty Thing Called Thrush
This fungal infection sometimes occurs among moms who are diabetic or have recently completed a course of antibiotics. Signs include milky-white spots or a coating inside baby's mouth. The infection can also appear on your nipples as pink, shiny, oozy or flaky spots, and you may feel a burning sensation during or after nursing.
The Solution: Antifungal Medication
If you see spots on you or your baby, contact your respective doctors. It's important for you and baby to be treated simultaneously for about two weeks to keep the two of you from spreading it between each other. If you pumped and stored breast milk while you were infected, your doctor may advise you to toss it out. However, you may continue to nurse. To prevent thrush, keep your nipples clean and dry, and wash everything that goes into your baby's mouth with warm, soapy water.
