“The breasts, especially after delivery, are liable to divers diseases; as inflammations, excoriations, indurations, tumefactions, nodes, absesses, schirrufes… ’
A supplement to Mr Chambers Cyclopedia 1753
For many women, breastfeeding is a completely pain-free experience. I have to admit though that, among my friends, they’re in the minority.
The good news is that none of the complaints that are listed in this chapter will affect your baby. Breastfeeding is vital to the survival of the species.
The bad news is that they hurt, with a particularly unrelenting kind of pain. If you sprain your ankle, then you can rest up for a while until it gets better. But if you crack your nipple, then that baby is still going to need feeding every couple of hours… Paracetamol is safe to take when breastfeeding, as long as your baby is healthy and full term. Ibruprofen should be your second choice for pain relief, and you can take it in combination with paracetamol. Don’t take aspirin while breastfeeding unless your doctor prescribes it.
But then the other good news is that most of the conditions listed here are temporary and curable. By a combination of bad luck and bad advice I had nearly all of these problems, and I still rate my breastfeeding experience as brilliant. In fact, I’m so enthusiastic about it that I had to write a book on the subject. So, unless I’m a masochistic weirdo, you can be sure that it’s worth persevering (through gritted teeth at times) when breastfeeding goes wrong, because breastfeeding can be so good when it goes right.
This often happens in the first week after the birth. Your breasts get over enthusiastic and produce more milk than your baby can drink. They become painful, round and hard, the skin is taut and shiny and they may feel hot. Your boyfriend thinks they look lovely. You have to resist the urge to slap him.
What to do:
• Ignore the boyfriend.
• Feed the baby as frequently as you can. If she is finding it difficult to latch on, then hand express just enough milk first to soften your nipple.
• Cooling gel packs or bags of frozen peas will help relieve the pain.
And now, it’s time for some cabbage leaves down the bra…
• Buy a green cabbage – Savoy is good.
• Rinse the leaves and put them in the fridge.
• When they’re cold, take them out, trim the big rib flat with a knife and bash them a bit with a rolling pin or similar.
• Cover your breasts with them, along to the armpits if they’re sore too. Hold in place with a supportive bra. Change them every half an hour. Cabbage leaves have been proven to provide effective relief for engorgement and inflammation of the breast. First the cool temperature helps relieve the swelling. Then as the leaves warm up they slowly release natural anti-inflammatory, antibiotic and anti-irritant chemicals.1 They are cheap and readily available. You can use them preventatively when your milk comes in for 20 minutes three times a day. The only down side is that they make you smell of cabbage.
There is some debate as to whether you should try and express off extra milk to relieve engorgement. It is only by being full that your breasts will get the message to reduce supply, so expressing milk makes the condition last longer. Don’t, initially. A warm shower may help the pain, and you can take ibruprofen up to the recommended dose. If engorgement persists for a week or more then discuss trying the block feeding strategy on page 77 with your midwife or lactation consultant.
The other time women commonly become engorged is when they wean their child. At this point it is worth remembering that alcohol reduces your milk production. Go on, you’ve given up breastfeeding, have a drink!
This is a rare cause of deep breast pain which can also happen in the first weeks when your milk supply is a bit enthusiastic. It feels like a painful ‘power shower’ tingling inside the breasts when you feed. There isn’t very much you can do about this except to wait for everything to calm down, although a couple of glasses of wine a week might help. Try deep breathing relaxation techniques. If you have an over-abundant milk supply, see page 77 of The Food of Love.
Prevention here is better than cure, so let’s have a look at the causes of sore nipples:
- Trying to toughen up your nipples during pregnancy will only cause, not prevent sore nipples. Nipples don’t crack because the skin isn’t tough enough, they crack because the baby isn’t latched on right.
- Blisters on the tip of the nipple. These are caused by the baby’s tongue rubbing on the tip of your nipple. Basically, he’s not on far enough. These are more common in the early days, especially if the baby has a tongue tie or a short tongue. They may also develop if an older baby gets distracted and tries to feed without latching on properly.
- Blisters on the tip of the nipple and cracks round the side of the nipple. These happen when a baby is very poorly attached, and the mother’s nipple moves in and out of his mouth as he suckles. OW! OW! OW!Crack at the side of the nipple. If you get the baby latched on well but then hold her wonky on the breast, then the skin at the junction with the areola can become stressed and crack. This can happen at any time if you feed your baby in a funny position. Say you’re feeding your baby lying on your side, then you start watching TV over your shoulder… you end up twisting your body slightly… the breast pulls sideways at your baby’s mouth… STOP. Wherever and in whatever position you end up feeding your baby, always make sure that her mouth is square onto your breast.
- Using a hand breast pump too enthusiastically can also crack your nipples. You can hire hospital grade electric pumps, which are gentler, to use until they heal.
What to do:
- Breathe out while you latch the baby on. Cracked nipples are sorest at the beginning of a feed, then the pain eases off as the oxytocin kicks in.
- If you are really dreading the next feed then take paracetamol and/or ibruprofen up to the dose recommended on the packet. Don’t take aspirin while you are breastfeeding.
- Don’t worry if your nipples are bleeding because it won’t affect or harm the baby.
- If you are suffering from blisters then improve your latch. Try pushing your nipple upwards with your thumb so baby gets a good mouthful of the underside of your breast. Visit a lactation consultant or a breastfeeding counsellor. Having an experienced woman evaluate what you are doing will increase your confidence. If you find it easier to latch your baby on well in one position (for example, the Rugby Ball hold) then just use that one for a few days and see if the soreness improves.
- If your nipple has cracked then change the baby’s position. Certain positions will be more painful, because the baby’s mouth will rub against the crack and reopen it. For example, if the crack occurred when you were lying down (watching telly) then when you feed using that position again it will traumatise the wound. So you will have to sit up and use the Rugby Ball or Cradle hold every single time until the wound has healed. (Damn. No sleep).
- If you are more comfortable expressing milk from a sore nipple you can choose to do that every three hours and feed off the other breast until it improves.
- When a scab forms on the thin skin of your nipples, it’s liable to crack off at the first opportunity and make the wound worse. A good solution is to use a technique called moist wound healing. Get hold of some pure lanolin-based nipple cream. There are several brands available: Lansinoh, Medela PureLan and Medilan. After a feed, wash your hands and smear a thin layer of ointment over the sore place. You don’t have to wash this off before you feed the baby, and it’s hypoallergenic. The lanolin will prevent a scab from forming and help the cut heal.
- If you can’t find any lanolin-based ointment, don’t use another sort of nipple cream as it won’t work the same way. Instead you can try squeezing some drops of breastmilk onto the crack to help it to heal. Breastmilk has healing and anti-infective properties, so you can use it on any kind of wound. Probably only on someone you know well though.
- You can try nipple shields as an absolute last resort if your nipples are so damaged that you just can’t feed any other way. Don’t use them for any longer than you have to, as they interfere with your feeding technique and milk supply.
- If the crack just won’t heal with moist wound healing or nipple shields and forms a kind of ‘crater’ then you might have thrush in the wound. • Air will help the soreness heal. Synthetic bras or soggy nipple pads won’t help. You can cut the handles off some plastic tea strainers and put them in your bra to let the air circulate.
A baby who isn’t latched on properly can squash your nipple and make it go white. This hurts. If this is the case your nipple will be flattened at the end of the feed, and it may have a white stripe across the tip.
- Try to improve the baby’s attachment.
- Sometimes babies clamp down on the breast to try and halt a really strong flow of milk. You can try the leaning backwards as described on page 77 if you are having a problem with this.
Some women experience nipple blanching after a feed, or between feeds, or during pregnancy. This is nothing to do with the way your baby feeds – it just happens. The nipples turn white as the blood vessels in the breast constrict, in severe cases they turn blue, then they go red with throbbing or burning pains or numbness. This is often triggered by cold, the same way that your fingers turn white on a cold day.
Vasospasm (to give it its medical name) is more common in women who have already suffered nipple trauma or thrush, who have had breast surgery, or have lupus, rheumatoid arthritis, fibromyalgia or endocrine disease. If you know you already suffer from Raynauds phenomenon, this is basically the same deal. It can also be caused by smoking, drinking caffeine or taking the Pill.
If this isn’t too painful then there’s nothing to worry about. If it is then the following suggestions may help:
- Wrap up warm. Cover your breasts quickly after a feed and stick a hot water bottle up your jumper.
- Take ibruprofen if you are really suffering.
- Vitamin B6 supplements and evening prim-rose or fish oil capsules work, but they can take about six weeks to take effect.
- Your doctor can prescribe a low dose of the hypertension drug nifedipine which is safe to use while breastfeeding. Take it for two weeks, then stop for two weeks. Repeat if the symptoms return.
Aaaagh! What did your excited friends and relatives buy you to celebrate the new arrival? Sparkling wine? A large box of chocolates? A lovely cake? Did they give any thought to the Candida Albicans fungus that might be lurking in your system, ready to feast on such delights?
We all carry the fungus that causes thrush. Usually it is kept in check by healthy bacteria in our gut. However antibiotic or steroid drugs, too much sugar, alcohol or the hormonal changes of pregnancy can all make the Candida fungus riot out of control.
Thrush can infect your nipples, your breasts and your baby’s mouth and bottom. It can come on at any time, although it is particularly common after antibiotic treatment, which is particularly common after caesarean birth. It can be quite tricky to diagnose correctly, so any time breastfeeding suddenly becomes painful, check for thrush.
Look in your baby’s mouth. Little white spots are a giveaway sign. They look like the little curds of milk that she’ll usually have in her spit, except that these can’t be brushed away with a cotton bud. A mild case of thrush may just show as a whitish bloom on her tongue. A severe case will hurt her and make her cry and pull away when she feeds.
Thrush will also pass into her poo and can cause a bright red, shiny nappy rash, sometimes with blisters or flat orange blotches.
Even if your baby shows no sign of thrush, you can still get thrush on your nipples. They might change colour slightly – if you have dark skin they may go pale pink, and if you have light skin they might go red. They may be shiny or flaky and painful or itchy. (These symptoms are similar to ezcema or dermatitis – it can sometimes be difficult to tell.) Or they may hurt, but look no different to normal.
If you have a cracked nipple that refuses to heal, then you could have developed thrush in the wound. I’m sending you some sympathy!
Even if your nipples show no signs of thrush, you can still get thrush in your breast. This feels quite distinctive – like someone has submerged some needles or broken glass deep within it. It can radiate out into your armpit or back. The pain starts in the breast that is being fed from, might get worse during the feed and can continue for some time afterwards. (Forceful let-down pain, which it can be confused with, is more likely to affect both breasts and stops at the end of a feed).
You can repeatedly pass thrush back and forth from you to the baby so both of you have to be treated, regardless of whether you both show symptoms. Thrush varies in severity from a mild condition that will clear up easily, to a horrible painful lingering thing that you need to blitz with nuclear strength chemicals and severe lifestyle changes, so the remedies here are arranged in order from simple things to try first, all the way up to serious measures for the desperate. If you have severe breast pain, skip to the end.
- Eat some natural, live yoghurt – the acid-ophilus good bacteria are active against thrush. You can put this on your nipples too, after a feed.
- Whenever you or your baby are prescribed antibiotics or steroids then it is a good idea to get an acidophilus supplement from a health food shop to restore gut flora to health.
- Don’t express breastmilk onto a sore nipple as you would if it was cracked – thrush loves breastmilk.
- Change soggy breast pads often as thrush loves moist warmth. Let your nipples air.
- Wash your hands well before you feed the baby, and again after you change his nappy.
- Leave his nappy off for a few hours if his bottom is sore. You can safely put yoghurt on his bottom too.
- Don’t use any soaps, baby lotions, baby bath, baby shampoo or baby wipes for a while. Wash him in plain water, or water with a splash of cider vinegar in.
- Nappy creams that contain tea tree or calendula are both active against thrush so you can use these on his bottom to protect him.
- Boil some water for 20 minutes, so it’s sterile, then add one teaspoon of bicarbonate of soda to one cup of water. Swab this around your baby’s mouth and over your nipples with a piece of clean cotton wool. Keep repeating this for a few days until you see an improvement.
- Grapefruit seed extract is a natural anti-fungal substance. Again boil some water for 20 minutes, then dilute the extract as directed on the packet for use as a mouthwash. Swab your baby’s mouth and your nipples repeatedly.
- Don’t drink any alcohol at all – thrush loves alcohol.
Any improvement? Yes? No? Right, more hard core solutions:
- The thrush fungus can survive outside your body on your clothes so you need to wash your bras, any washable breast pads, milky t-shirts and nappies on the hottest setting you can. Ironing also kills it. I’ll let you off washing and ironing the nappies if you’re using disposables.
- You can take paracetamol and ibruprofen, together if you need to, for the pain.
- Dummies harbour thrush so stop using them, or buy extra, change them frequently, and boil them for 20 minutes after use.
- If you have vaginal thrush then treat yourself and your partner, regardless of whether they show symptoms.
- See your doctor for a prescription for anti-fungal gel for your nipples and your baby’s mouth. This will work for sore nipples, but may or may not be effective for thrush that is actually inside your breast.
- The thrush in your system is affected by the food that you eat. It would make sense to lay off the yeast extract or nutritional yeast flakes.
- Gentian violet is a traditional remedy that is extremely effective against thrush. Use a 1% solution, or weaker, and paint it over your nipples and inside baby’s mouth with a clean paintbrush or cotton bud. It is messy and stains clothes and skin purple. Reapply a further time once the stain has faded, by which time there should be a marked improvement. It is difficult to buy gentian violet in this country because very large doses cause cancer in rats, however it has a proven track record as a safe remedy for thrush in babies. Best saved for occasional use.
Is this working yet? Brilliant! No? Oh, OK:
- Sorry, I hate to say this, but Candida Albicans feeds on sugar and bread (which contains yeast). Women with thrush commonly crave bread and sweet things, which is actually the evil yeast inside them demanding to be fed! If you suffer badly from recurrent thrush then it may be worth making some pretty radical changes to your diet. Start with cutting down on sugary foods, fruit juices and bread and see if it makes an improvement.
- Your doctor can prescribe a systemic anti-fungal treatment to be taken internally by you and your partner. This is usually only necessary if you have thrush inside your breasts, where anti-fungal gels and creams can’t reach. The most effective drug is fluconazole. Unfortunately fluconazole is not licensed for use by breastfeeding mothers because it passes into your breastmilk. Duh! That’s the whole point! It has to pass into your breastmilk – that’s why it’s so effective. The anti-fungal agent in your milk then goes on to treat the baby at the same time. The drug is licensed to be directly given to babies in doses ten times higher than the traces in your milk.4 The World Health Organisation recognises that it is safe for use when breastfeeding, but the UK drugs safety bodies don’t. This just makes me so cross. There is a serious condition here that is adversely affecting tho-usands of mothers and babies and two of the most effective treatments – gentian violet and fluconazole – are not readily available to the women who need them. Your doctor may still be up for prescribing fluconazole ‘off-label’ if you need it. Show her the references on page 200. Fluconazole works.
- Throw away any milk that you have expressed and frozen while you had thrush in case it reinfects you both.
Other causes of nipple pain:
Eczema or dermatitis may also cause itchy, flaky painful nipples. This is usually a reaction to something you have put on your nipples, so if you have recently started using a nipple cream or ointment, then stop. Change your washing powder. Don’t use soap or perfume on your breasts. Avoid plastic-backed breast pads.
Eczema can also be triggered by eating foods that you are allergic to.
Hydrocortisone cream is available on pres-cription as a last resort.
Other causes of breast pain:
If you don’t have any tender lumps in your breasts, and are experiencing pain at various times, consider these causes and solutions:
- Women with very large breasts may find that their breasts and back ache when breastfeeding. Wearing a well fitting and no doubt extremely expensive bra can help – some women find it helps to wear them at night too. Supporting your breasts from underneath with a fitted top or waistcoat around your abdomen could relieve the pressure on your upper back. Yoga classes can ease back pain. You can take paracetamol and ibruprofen if you need to.
- It is quite common to feel a deep ache in your breasts at night. This is a surge of prolactin hormone ramping up your milk supply and nothing to worry about.
- An old injury or surgery can cause lactating breasts to ache. Massage may help.
Food of Love, The: Your Formula for Successful Breastfeeding
A topical, refreshingly different approach to breastfeeding successfully. Features honest discussions about childcare and lots of fantastically funny illustrations.
Kate Evans’ brilliant cartoons offer hope and inspiration. And they’re funny, too. The IndependentMy Shopping Cart
A topical, refreshingly different approach to breastfeeding successfully. Features honest discussions about childcare and lots of fantastically funny illustrations.
- Paperback: 208 pages
- Publisher: MYRIAD EDITIONS; 2nd edition (6 Nov. 2008)
- Language: English
- ISBN-10: 0954930959
- ISBN-13: 978-0954930950
- Product Dimensions: 21 x 1.6 x 21 cm
Kate Evans’ brilliant cartoons offer hope and inspiration. And they’re funny, too. The Independent
‘I love your book! Very well-written and researched and great drawings too.’ — SUE GERHARDT, author of Why Love Matters: How Affection Shapes a Baby’s Brain
‘Vibrant, exciting, funny – there’s really nothing else like it. It’s so honest and based on up-to-date research.’ — SHEILA KITZINGER
This book is meant as a funny, handy guide to help new mothers enjoy their baby and is a valuable addition to the existing literature on the emotive subject of breastfeeding. The book is easy to read and… includes numerous pictures to look at if you are feeling too tired or brain-dead to read. It is a fun way to present the advantages of breastfeeding, yet Kate Evans has also included the latest facts and research surrounding breastfeeding… The Food of Love will meet the needs of many new mums and is likely to be of use to breastfeeding counsellors, antenatal teachers, midwives and health professionals. — New Digest NCT Newsletter
£16 with free postage within the UK – add £5 for postage to outside the UK.
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