Breast care

• Frequent feedings. Breastfeed baby every 1 – 2 hours, at least 10 times in 24 hours. Don’t skip feedings (even at night).
• Breast feed on demand. Watch for baby’s feeding cues.  If baby is sleepy, wake baby up for feedings.
• Avoid use of pacifiers or bottles of formula (unless recommended by your physician).
• Allow baby to finish the first breast before offering the other side. Engorgement tends to be less severe if baby stops nursing on his own rather than being taken off the breast after a set period of time.  Switch sides when baby pulls off or falls asleep.  Don’t limit time at the breast.
• Make sure baby’s latch is deep. Check your nipple after feeding.  Your nipple should be round (not flattened) and pulled out evenly on top and bottom.
• To make sure baby is effectively emptying your breasts; listen for swallows and check that your breasts are softer after a feeding.
• A supportive bra may be helpful; avoid tight-fitting and underwire styles. Do not bind the breasts, as this may lead to more pain and leakage.
• Some find applying a warm compress to the breast immediately before feeding t helps improve the flow of milk and the emptying of the breast. Apply warm moist compresses 3 – 5 minutes before latching baby. Prolonged use of heat is not recommended because it can increase the swelling.
• Before breastfeeding, use gentle massage to help stimulate the flow of milk and the emptying of the breast. Massage your breast from the chest wall toward the nipple area in a circular motion.
• If the areola is hard it may help to hand express a small amount of milk (or pump briefly to soften the areola) to help baby latch deeper.
• If baby does not feed long enough so that your breast is softer at the end of the feeding, you can hand – express or “pump to comfort” with a breast pump. Pump for as long as it takes to make your breasts more comfortable every 4 to 6 hours.
• Cold compresses can also reduce the swelling. After breastfeeding apply an ice bag with crushed ice or a bag of frozen vegetables that is wrapped in a cloth to protect your skin.  Apply for 10 – 15 minutes on, 10 – 15 minutes off, repeating as needed.
• There is some evidence that applying cool green cabbage leaf compresses to the breast can help reduce swelling. Rinse the refrigerated cabbage leaves in cold water.  Crunch the leaves slightly so that the veins are broken. After breastfeeding baby place the leaves around your breast.  Leave them on for 15 – 20 minutes or until they wilt.  Apply 2 -3 times a day until the swelling goes down.  Overuse can lead to a reduction in milk supply.
• If breasts remain very firm after a feeding it may be necessary to pump to fully drain the breast. Do this only once or twice to avoid over stimulating your breasts. Your areola may be more fragile when swollen, use breast pump at low settings. There is a protein in breast milk that is increased when the breast is very full.  This protein signals to your breast to cut down on milk production which can lead to decreased milk supply over time, so it is very important to empty your breast.
• Ibuprofen or acetaminophen may help reduce the pain. Ibuprofen may help reduce the swelling. You may continue to breastfeed while taking these medications.

• Sage tea may decrease and help dry up milk supply. Steep one teaspoon of rubbed sage in one cup of hot water for 15 minutes. Add milk or honey to taste as tea is bitter. Drinking one cup every 6 hours can help dry up milk quickly.
• Vitamin B6 200 mg daily for 5 days may help with milk suppression.

• Excess stimulation to the breasts (don’t let the shower spray hit your breast).
• Application of heat to the breasts between feedings can increase swelling and inflammation. Limit to a few minutes right before a feeding to help with milk flow.
• Restricting fluids. This does not reduce engorgement. Drink when thirsty.

After the initial fullness disappears, your breast will feel softer, even when your milk supply is plentiful. This is normal.

Correcting the latch, which is usually the source of the sore nipples, is the most important thing you can do to start the healing process. If you have sore nipples, or the nipple is cracked, follow these steps:

During the nursing session:

1. Nurse on the uninjured side first; baby will tend to nurse more gently on the second side.
2. Initial latch-on tends to be most painful for the first 15 seconds.
3. Use different breastfeeding positions to change the way the baby’s mouth compresses the nipple. Find the most comfortable position.
4. If breastfeeding becomes too painful, it’s important to express milk from the injured side to reduce risk of breast infection (mastitis), engorgement (hard, painful, swollen breasts) and to maintain milk supply. Use an electric breast pump set at low pressures or hand express.

After nursing:

• Rinse nipples with warm water or a salt water (normal saline) rinse. This should not be painful because it’s similar to your tears. Mix ½ teaspoon of salt in 8 oz. of water. Make a fresh rinse each day to avoid growth of bacteria.
• Apply expressed breast milk to the nipples.
• Promote moist wound healing by applying a pure lanolin cream to the nipples after breastfeeding. Ultra-purified lanolin helps to prevent thickening of the skin.
• In addition to over-the-counter ointments, there are prescription ointments that aid in healing.

Between nursing:

• Keep nipples exposed to air when possible. Always use fresh disposable pads; change when damp.
• Once daily, use a non-antibacterial, non-perfumed soap to gently clean the wounded area, then rinse well with running water. Only use soap if the skin is broken.
• If nursing is too painful, pump your breast at low suction to empty breast every 3 hours until able to re-latch baby to breast.
• Use cold compresses, such as ice packs, covered by a cloth for 20 minutes on, 20 minutes off. Repeat as necessary for comfort.
• Take over-the-counter medications, such as Tylenol or Ibuprofen, which are compatible with breastfeeding.

Breast pumping:

• Apply pure lanolin cream to the inside of the flange to lubricate and decrease the rubbing of your nipple against the plastic flange.
• Make sure you are using the correct size flange. Your nipple should not completely fill the tunnel of the flange.
• Pump on the lowest suction setting.

Usually, your temporary soreness will go away once the milk lets down and should disappear completely within the first week or two if your baby is positioned correctly on the breast. Prolonged or intense sore nipples need immediate attention.

Nipple shields are designed for temporary, short-term use with babies and mothers who are having difficult or ongoing latch-on problems during breastfeeding.

Studies show that premature or sleepy babies may latch better, suckle longer, and get more milk when suckling with a nipple shield.

The nipple shield:

• Helps baby learn how to use his or her tongue and mouth to draw the nipple into the mouth for effective breastfeeding.
• Stimulates the sucking reflex to keep a baby suckling longer and stronger to get more milk.
• Gives a baby a better grip on the breast so he or she won’t come off frequently.
• Glides easily into a baby’s mouth, making the latch easier for a baby who may be tongue sucking or thrusting.
• Helps shape a short, flat, or inverted nipple or a large and long nipple for a small mouth.
• Helps a baby manage milk flow that is too fast. May encourage a sleepy or premature baby to breastfeed more effectively.
• Encourages a nipple-confused baby to breastfeed again.

Tips for use:

• Apply lanolin cream, drops of water, or breast milk under the edges of the shield to create a seal and increase comfort.
• Turn the shield inside out and flip the edges out while placing it over your breast. This helps draw your nipple deeper into the shield. Your lactation consultant can show you how to use the nipple shield correctly.
• Wash the shield with soap and water and air dry after each use.
• Nipple shields come in three sizes. Choose the correct size. The nipple shield should fit the baby’s mouth. If it is too big, the baby will not be able to draw the nipple up or may gag on the shield. The shield should also fit mom’s nipple. If the shield is not a good fit for mom or baby, don’t use it. Check with your lactation consultant about which size is best for you.