Expert: Sally Wendkos Olds - 1/24/2008

Question
hello.my baby girl is one month old.initially when i started breast feeding ,my nipples got sore n they started bleeding badly.i went to the doc n she suggested me to decrease the frequency of breast feeding n instead give her formula bottle milk.bt now my problem is i feel my breast milk flow has decreased.even after feeding her for one n half hour she is still hungry n crying.wat do i do for this?
i even feel she got used to bottle feeding coz she cries horribly onces my milk flow decreases n refuses to tk my breast.wat do i do?how do i get her off the bottle feeding n increase my milk flow?n one more thing my nipples stil hurt while feeding,there is a pain when she latches on n lot of burning sensation after each feeding .when will my nipples get used to feeding?
i wil b v thanful if u answer my questions.i m really worried..sorry i asked a v long question...thanks for ur help...good day

Answer
Dear Ruvaida,

First, congratulations for giving your daughter the best start in life by breastfeeding her! And don't worry about asking a long question -- that's what I'm here for.

I'm sorry to hear about the problems you are having with  your nipples. Many cases of sore nipples are caused by improper positioning of the baby at the breast. I suggest that you contact a lactation consultant (maybe the one at the hospital where you gave birth) who can help you position your baby at the breast in a way that it won't hurt you. To find a lactation consultant near you, go to www.ilca.org. You can also get help from someone in your local La Leche League chapter. To find the closest LLL person, go to www.lalecheleague.org.

To boost your milk supply, try renting a hospital-grade pump, and pump your breasts several times a day. You can then give this milk to your baby. Keep trying to bring her to the breast, but maybe do it when she's not extremely hungry.

I'm attaching an excerpt from my book (see below) about treating sore nipples. I hope some of the suggestions help.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with Laura M. Marks, M.D.
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  SORE NIPPLES
Many women experience mild, temporary tenderness the first few days after giving birth, and sometimes through the first week or two. If you're not in real pain and if your discomfort is relieved when your milk comes in and lets down for your baby, you don't need to do anything special. This mild to moderate initial tenderness usually goes away in a few days, as your milk begins to let down. But if your nipples look red and chapped or cracked or if you feel severe pain during or after nursing, do something right away. Don't wait until the pain becomes unbearable, because that will make the problem much harder to clear up.
  Not all women experience nipple discomfort during early nursing. If you have positioned your baby properly from the start, and if he has latched on well, you can usually prevent sore nipples. Some infants, though, have more trouble than others learning how to latch on and to suckle; as a result, their mothers' nipples begin to hurt.
  Proper positioning techniques almost always alleviate or completely eliminate sore nipples. So check the way you're holding the baby. Is she in a position so she can get enough of your breast in her mouth without straining? If not, take another look at the pictures and text in Chapter 6 and try repositioning.
  Sometimes you may be doing everything right, but your baby may have a suckling problem. Some babies, for example, suck their tongues instead of the breast, or suck their lower lips along with the breast. Others thrust their tongues forward, or because of a tight frenulum (the membrane that attaches the tongue to the floor of the mouth) cannot grasp the nipple properly (see Box 15-6). If your nipple soreness persists beyond the first two or three days of nursing, ask someone knowledgeable in lactation to observe you and your baby while you're nursing. They may be able to pick up any problems in suckling and give you advice.
  Dermatologist Donald A. Sharp, M.D. likens cracked nipples to chapped lips. If your lips get dry, you put on a cream to restore their internal moisture and you avoid surface wetness by not licking your lips. The same principle applies to nipples.
  If your nipple cracks (develops a fissure), the current dermatological recommendation is "moist wound healing." This involves restoring internal moisture by increasing the moisture content of the skin. The best way to do this is to express a little bit of your breast milk and apply it to the affected areas. You will thus be taking advantage of the healing and antibacterial properties of human milk, as well as its moisturizing benefits. And of course, you don't need to wipe it off your nipple before your baby nurses.
  The second treatment of choice involves the application of pure medical grade, anhydrous lanolin, which is soothing and will also lubricate the skin and help it to retain its internal moisture. Pure lanolin (like Lansinoh for Breastfeeding Mothers®) does not need to be wiped off because it will not harm your baby.
  Even if some blood appears in cracks in your nipple, you can continue to nurse; your blood will not harm your baby. If you are bleeding, you will, of course, take immediate measures to heal your nipples.
  
  BOX 15-2 TREATING SORE NIPPLES
  * Be sure your baby is properly positioned for nursing, with her chest facing yours, her face and nose facing your breast, and her mouth covering all or part of your areola, as described in Chapter 6. Be sure that your nipple is well into your baby's mouth and that your baby's gums are compressing the milk ducts under the areola. If she is not properly positioned, take her off the breast carefully (breaking the suction with your finger) and bring her back to it. If you are in any doubt about your nursing technique, consult a lactation specialist.
  * Do not let your baby chew on your nipple. If you feel this happening, carefully take him off the breast as above, and bring him back. If he keeps doing it, end this feeding session.
  * Express a little milk manually before putting your baby to the breast; this will start your milk flowing, help your let-down reflex operate more quickly, and lubricate your nipple.
  * Practice a relaxation technique just before nursing. (See Box 10-3 in Chapter 10.)
  * Nurse your baby more frequently, but perhaps for shorter periods of time. Your breasts are less likely to overfill and your baby is more likely to suckle gently.
  * Offer the less sore breast first most of the time. This will give your milk a chance to let down from the sore breast, and your baby won't be suckling as hard by the time he gets around to his second course.
  * Change your position at each feeding. Lie down, sit up, hold your baby in different positions so that you can change the position of your baby's jaws on your breast. If you have a crack in your nipple, it's especially important to position your baby so his mouth clamps down elsewhere.
  * If a scab forms on your nipple during early nursing, leave it alone.
  * To ease pain, apply either ice, crushed and wrapped in a wet washcloth, or gauze squares that have been dampened and put in the freezer, briefly to your nipples, just before a feeding.
  * Avoid all irritating and drying substances. Do not use soap, alcohol, tincture of benzoin, or witch hazel on your nipples.
  * Do not wipe away milk left on your breast after a nursing. Let it dry there. In fact, you can express a few drops of your milk, rub that gently onto your nipples, and let them dry in the air. As we said earlier, mothers around the world treat their children's irritations and infections with human milk. Your milk's curative powers can help you, too.
  * Soothe the soreness with a cream prescribed by your doctor or with pure lanolin. Lansinoh for Breastfeeding Mothers® can be purchased from your local pharmacy or through Ameda/Egnell (see Resource Appendix). It is hypoallergenic and thus safe even for people who are allergic to wool, and it does not need to be wiped off before your baby nurses.
  * If only one breast has a sore nipple, breastfeed only on the other one and pump (with an electric pump) from the sore breast. If the nipples on both breasts are sore, consult with your lactation specialist on the best course of action. You may need to stop nursing completely for a couple of days, during which time you can pump or express your milk.
  * Keep your nipples free of surface wetness:
  -- If you wear breast pads to catch leaking milk, change them when they get wet. Do not use the kind with plastic liners.
  -- Wear an all-cotton bra, not one made of a synthetic fabric.
  -- If you wear breast shells (milk cups) to bring out inverted nipples, empty them often.
  -- Walk around the house with your nipples uncovered when you can. If the air in your home is very dry (as in an overheated apartment), humidify it by keeping a pan of water on the radiator.
  -- Let air circulate around your nipples while you're dressed, either by inserting in your bra small mesh tea strainers from the hardware store, from which you have removed the handles; or plastic breast shields (described in Chapter 4).
  * Expose your nipples to the light of a 60-watt bulb for 15 or 20 minutes three or four times a day, close enough to feel the soothing, gentle warmth but not so close that you burn yourself.
  * If your nipples are tender after showering, apply a coating of lanolin before you take your shower.
  * Occasionally take an ibuprofen or a glass of beer or wine to ease your discomfort.
  * Occasionally sore nipples are caused by thrush, a fungus infection, which may be affecting both you and your baby. See the next section for treatment suggestions.
  * Do not wear the rubber or soft plastic nipple shields that are sometimes advised to insulate your sore nipples from your baby's suckling. These shields consist of a cone attached to a rubber nipple. The cone fits closely over the breast and the baby sucks from the rubber nipple. They don't provide the stimulation your breasts need to keep making milk, they rarely relieve the soreness, and they cause some babies to develop nipple confusion, as explained in Chapter 5.
  * If you have been pumping your breasts with a hand pump, you may have been doing it too vigorously or improperly. Switch to an electric pump, which has a gentler motion.
  * If, as happens in rare cases, your soreness continues to worsen until your nipple cracks and bleeds and is absolutely too painful to nurse from, take your baby off the affected nipple for 24 to 48 hours. Nurse him often on the other breast. If necessary, give him expressed milk or formula in a bottle or cup. Express or pump your milk from the affected breast every three hours, or every time you would ordinarily be nursing.
  Gradually resume nursing on the breast with the sore nipple, starting twice a day. Continue to express milk from the sore breast at other feeding times until your nipple is healed enough to work up to the full nursing schedule. Apply pure lanolin and expose your nipples to the air to heal the nipple fissures.
  * If you have a persistent rash that does not clear up, see your doctor to rule out any underlying problem.
  END OF BOX