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The joyful intimacy and bonding with the baby during the process of breastfeeding makes it a special phase in the life of a mother. It also has tremendous health benefits for both the mother as well as the child.Thus it is crucial to tackle all the issues related to breastfeeding, allowing it to be a wonderful and amazing experience for both the mother and the baby. Here are some ways towards the prevention and treatment of the outcomes of the common problems caused to a mother while breastfeeding.
Breast Engorgement: The problem of breast engorgement is very common amongst new mothers. Breast engorgement can be defined as the painful swelling of the breasts due to congestion, milk accumulation. A way to prevent this is to start nursing as soon as possible. A mother should learn to use proper breastfeeding techniques and as far as possible, avoid the use of supplements. As a mum, you need to understand and be sensitive to your baby’s needs. Hence, breastfeed on demand and not to be done forcibly. Incase of the establishment of an areolar engorgement, express some milk manually prior to breastfeeding to soften the areola and enable a proper grasp. One can gently massage the breasts to liquefy the viscous milk and stimulate the let-down reflex. To reduce any inflammation or edema, use systemic analgesics or anti-inflammatory drugs.Use well-fitted, supportive bra with large flaps for relief from pain and proper anatomical placement of the ducts. One can also apply warm and cold compresses, for not more than 15-20 minutes, to facilitate milk ejection, reduce edema, vascularization and pain. The milk can be manually expressed using suction pumps incase the baby is not sucking. Breast emptying is crucial to provide maternal relief in order to reduce mechanical pressure on the alveoli and minimize the risk of insufficient milk production and mastitis.
Mastitis: Mastitis requires immediate medical attention. However, the ways to prevent it are the same as that for preventing breast engorgement, plugged ducts or cracked nipples. Proper emptying of breasts, with maintenance of breastfeeding and manual expression of milk post feedings is one way. Use antibiotic therapy in case severe symptoms persist. Antistaphylococcal drugs can be used in case of mastitis caused by S. aureus infections. Analgesics and non-steroidal anti-inflammatory drugs such as ibuprofen can be used to provide relief from pain. Along with these, an abundant intake of fluids and good rest are essential.
Breast Abscess: Efforts need to be taken to prevent breast abscesses as extensive abscesses may cause large resections resulting in breast deformities and malfunctions. Anything that prevents mastitis may consequently prevent breast abscesses too. Surgical drainage or aspirations can be used to empty the abscess. It causes less pain and involves less mutilation as compared to incision and drainage. It can be performed under local anesthesia too.
Sore Nipples/ Cracked Nipples: Sore nipples or nipple trauma are a curse to lactating mothers. So, one must make sure to use proper techniques, keep the nipples dry by exposing them to air or sunlight. Avoid using soaps, alcohol or drying agents that strip the nipples off their natural protection. Avoid the use of nipple shields. Also, make sure that your baby is not chewing on your nipple or tongue sucking. If so, break the suction, unlatch the baby from your breast and try latching again. See to it that your baby’s mouth is wide open for a good latch-on. Try different positions till a comfortable routine is established. Avoid the use of clothes made from synthetic fabrics that cause the collection of moisture and increased sweating. Use ointments containing olive oil and lanolin to help soothe dry or cracking nipples.7Oral systemic analgesics can be used too. The use of dry wound healing and moist wound healing techniques is recommended to hasten the healing of nipple trauma. Creams enhanced with vitamin A and D and corticosteroids like mometasone and halobetasol propionate can also be used.
Nipple Infections:For nipple infections caused by Staphylococcus aureus, the use of topical ointments like mupirocin (2%) and systemic antibiotic therapy is recommended. These have been found to be more effective as compared to any improvements in breastfeeding techniques.
Yeast thrives in a moist environment. Hence, candidiasis can be prevented by maintaining the nipples dry by exposing them to air and sunlight daily for a few minutes.Frequent replacement and boiling of all items that come in direct contact with the baby’s mouth such as pacifiers, bottle nipples, toys, etc. is another preventive measure. Use of disposable bras and frequent laundering of bra pads and bras with hot soapy water is recommended. For the treatment of candidiasis, one can use topical antifungal ointments. In case it proves to be ineffective, the use of systemic oral fluconazole is recommended for 14-18 days.1
Raynaud’s Phenomenonofnipples: The nipples may turn pale due to lack of blood irrigation. This is termed as Raynaud’s phenomenon and can be treated by using warm compresses to provide relief from pain. Also, medications such as nifedipine, vitamin B6, calcium and magnesium can be used.
Nipple preference: To prevent nipple preference, offer bottled milk as a supplement after breast feeding. Avoid bottle feeding till breast feeding is possible.
Plugged Ducts: Plugged ducts can be prevented by use of proper clothing, nursing techniques and frequent breastfeeding. Avoid the use of unnecessary creams on the nipples. Use varied positions for breastfeeding, get plenty of rest and adequate fluids. Avoid sleeping on the abdomen. In case the plug does not resolve in several days, contact a lactation specialist.
Lactation Failure: Reduced or poor milk production can be treated by an increase in the frequency of breastfeeding. Check for a proper and comfortable position and a good latch-on for your baby. Eat a balanced diet, drink plenty of fluids and take good rest. Medicines such as domperidone, metoclopramide and dopamine antagonists can be used to increase the prolactin levels.
The oversupply of milk and the strong let-down reflexes maybe controlled by the use of the side-lying position and football hold that enables a regulated milk flow.
This article is written by:
Dr. Mukesh Gupta
Consultant gynecologist with 16 years of experience. Past president of Association of fellow Gynecologist, Mumbai