Expert: Sally Wendkos Olds - 6/10/2011

Question
My daughter is a week and five days old, she latches on the right nipple but not the left so i've been trying to just pump and give it to her in bottles, my left boob on the left side is all red and hurts when i touch it and hardly any milk will come out and its hard like its engorged, my first question is is it normal fro your boob to get red and hard even if your pumping? and my secind question is i have to go back to work soon anyway should i just switch to formula?

Answer
Dear Alissa,

First, congratulations for giving your daughter the best start in life by breastfeeding her!

No, it is not normal for your breast to get all red, hard and painful. I strongly suggest that you see either a lactation consultant or your obstetrician because you may have an infection. Even if you do stop nursing you should have this looked into and maybe treated.

I'm attaching an excerpt from my book (see below) about treating engorgement, and I hope that some of these suggestions will help while you're waiting to see the L.C. or the doctor.

If you can continue to nurse until you go back to work (or even after you return), I urge you to do it. The longer you can breastfeed your baby, the better it will be for her and for you. Meanwhile, you have already given her good antibodies and nutrients in the early milk, so you should be very proud of yourself!

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Olds & Marks, 4th edition, September 2010, published by Workman Publishing, and available in most public libraries, bookstores & La Leche League chapters.
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Engorgement (Hard, Swollen Breasts)
Your breasts will normally become larger, heavier, and somewhat tender about two to five days after childbirth. The combination of the swelling of the tissues, the increased circulation of blood in the breasts, and the pressure of the newly produced milk can sometimes make them feel hard, tight, and uncomfortable. The skin on your breasts may be shiny and your nipples flat and distended; these are signs of engorgement. Although this is common for the first few days, it is not inevitable and can usually be avoided.
  The best way to relieve, minimize, or even prevent engorgement is to nurse your baby as soon after birth as possible and very often from then on. Instead of waiting for your baby to cry, which is a late sign of hunger, feed him whenever he shows such early signs as sucking his fist, making sucking motions with his mouth, moving around, looking more alert, and so forth. Women whose babies nurse vigorously and frequently right from the start rarely suffer from engorgement. If you should become engorged, the procedures listed in the box on page tk should bring relief in a couple of days.
  When the engorgement goes away—and it will—be assured that you still have plenty of milk. Once your milk supply is well established, your breasts become softer and stay that way most of the time.

Sudden Weaning
If you have to wean your baby abruptly, you run a high risk of engorgement. In this situation, your approach will be different from the procedures given in the box on page tk, which you would follow if you were continuing to nurse. For suggestions on relieving the discomfort of abrupt weaning, see Chapter 17.

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Ways to Relieve Engorgement
The most important and effective way to relieve engorgement is to remove as much milk as possible from your breasts, as frequently as possible, either by nursing your baby often or by using a good breast pump. Some of the following remedies may help.
• Feed your baby frequently, eight to twelve times in a twenty-four-hour period in the first few days after birth, even if you have to wake her to nurse.
• Express or pump a little bit of milk just before feedings to soften your breasts and make the nipple easier for your baby to latch onto.
* The technique of reverse pressure softening (RPS) is sometimes helpful in the first two weeks postpartum using gentle pressure to relieve some of the congestion in the breasts. Ask your lactation specialist to teach you how to do this.
• If your breasts are severely engorged, massage them once or twice a day before feeding, starting gently at the outer edges with your fingertips and going toward the nipple area. A mild cream may make the process easier, but don’t get any on the areola, because that would make it harder for you to express milk. It may help to do the massage in the shower.
• Apply warm, moist compresses about ten or fifteen minutes before a feeding (and before a massage). Between feedings, apply cold compresses. The warm compresses aid the let-down reflex, and the cold packs relieve swelling and pain. Apply cold in an ice pack, a bag of frozen vegetables, or a blue freezer pack wrapped in a thin towel. Apply heat in a moist-heat pad, a small hot water bottle wrapped in a towel, a towel soaked in hot water, or in a hot shower. If you use a heating pad, be very careful not to burn your skin.
 • Wear a firm bra for support. Be sure it’s not too tight, since this can make you more uncomfortable and also cause other problems. If you use breast shields (see below), wear a bra that has enough room to insert the shields. Try taking off your bra while you’re nursing, to be sure it’s not constricting your milk ducts.
• Apply fresh cabbage leaves to your breasts. This simple home remedy seems to help some women. Pull two outer leaves from an ordinary head of cabbage, strip out the large vein in each leaf (or alternately, leave this in and crush the leaf as if you were crumpling paper into a ball). Then cut a hole for your nipple and wash the leaf to get rid of any chemical residue. Chill them for about ten minutes if you want to. Then wrap the leaves around the irritated areas of your breasts. They’re convenient, cheap, not injurious, and disposable, and some women report that they relieve pain. You might try it if you don’t mind staining your bra—and smelling like dinner.
• Wear a silicone breast shield (also known as a milk cup, breast shell, or Woolwich shield) inside your bra for 30 minutes before feedings to soften your areola and bring out your nipple.
• If you cannot breastfeed right after childbirth, express or pump your milk until you’ll be able to nurse your baby. An electric pump is easiest and most efficient (see Chapter 11).
• Take a pain reliever—either one of the over-the-counter agents listed in the box on page tk (Chap. 10), or something your doctor can prescribe that will not affect your baby or your milk.
• If only one breast is engorged because your baby is consistently not suckling from it, this may be a sign of a possibly serious medical problem. To rule this out, see your obstetrician.  
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