Challenges with breastfeeding

Effective emptying

You should attempt to empty your breast with each expression or feeding episode. Not achieving this can reduce the amount of milk you produce; it may also lead to infection of the breast tissue, known as mastitis.

Your breasts will start producing milk following the birth of your baby but they work on a demand and supply basis. The more you express or the more your baby feeds, the more breast milk will be made. If you miss out on some expressing, such as during the night, your milk supply will drop. Rest is very important, but it is equally important to maintain regular expressing. Once you have an established milk supply that meets your baby’s needs, then reducing how often you express might be something you would consider.

In addition to expressing frequently, it is important to always empty the breasts fully when expressing. This means continuing to express for a couple of minutes after milk flow stops. This will help you maintain a good supply but also help avoid blocked ducts and mastitis.

You may remember in thePhysiology of Lactation section, that ducts carry milk from the alveoli to the end of the nipple. Sometimes these ducts can block and milk builds up behind the blockage. Unless the blockage is cleared, the milk will move into the tissue and may form a lump. This lump is usually hard and sore, it may become red. To avoid a blockage occurring, ensure you breasts are emptyed with each feed or expression, and avoid wearing a tight bra. If you do feel a lump that is sore, gently but firmly massage the lump toward the nipple before, during and after expressing or feeding your baby. Your baby’s nurse may also show you different feeding positions which may help empty the breast.

Mastitis is usually the result of a blocked milk duct that hasn’t cleared. Signs and symptoms of mastitis include redness over part of the breast, the presence of swelling or a lump in the breast and pain or tenderness over the affected. Sometimes as mastitis progresses flu like symptoms may occur in the mother. If you have any of these symptoms it is essential to carry on expressing as this may relieve the blocked duct but it is also essential to seek medical advice as you may need antibiotics prescribed. Untreated mastitis can make a mother very unwell.

Thrush is another problem that can occur when breast feeding. Thrush is a fungal infection (candida albicans) that thrives in a warm, moist and sugary environment which is exactly what breast feeding provides. If a mother has been treated with antibiotics she is often more prone to developing thrush. Symptoms of thrush are painful nipples sometimes described as burning/ stabbing pains or itching. If you are experiencing either of these symptoms you will need to see your GP to discuss using a topical, anti fungal treatment.

Low milk supply

Some mothers who are expressing breast milk will experience a low milk supply. This can be extremely frustrating and very demoralising. There can be several reasons why a mother’s milk supply may be low and often understanding why it has happened and ways of improving the supply can help a mother cope. Many of the causes are unavoidable so therefore a mother should be kind to herself and not feel guilty that she is doing something wrong. Listed below are some of the reasons for low milk supply

Maternal reasons:

• Pain – Pain is known to inhibit milk production. This pain can be caused by trauma from the breast pump, infection such as mastitis or thrush and poor attachment of the baby at the breast. Other pain from either caesarian section wound or perineal damage can also affect milk supply.
• Breast surgery – Previous breast surgery can affect milk supply especially if the milk ducts have been damaged. Breast implants or biopsies tend to cause fewer problems than a breast reduction.
• Health conditions – Health conditions such as obesity, high blood pressure, polycystic ovaries, insulin dependant diabetes, thyroid disease and pituitary issues can all affect the body’s ability to produce breast milk.
• Medications – Some medications can affect milk supply such as labetalol and the decongestant pseudoephedrine

Baby reasons

• A baby who has an immature sucking pattern and strength e.g. a premature baby
• A baby who is sleepy e.g. a premature baby, a baby with jaundice, a baby who has maternal drugs in his system e.g. opiates
• A baby who has difficulty with latching on effectively e.g. a baby with cleft lip and or palate, a baby with Down’s syndrome, a baby with tongue tie
• A baby who has had severe hypoxia (lack of oxygen) e.g. a baby with hypoxic ischaemic encephalopathy

Reasons associated with a difficult birth

• Premature birth – If a baby is born extrememly prematurely the development of the mother’s breast tissue is incomplete
• Large maternal blood loss – This will result in the mother becoming anaemic and this in turn can affect the production of breast milk
• A long and/or traumatic labour and delivery – This can raise the body’s cortisol level as in the “fight or flight mechanism” and this raised cortisol level may affect milk supply
• Retained placenta – A retained placenta can be very distressing as it often means returning to theatre to have it removed. It also affects the body’s hormone levels which are responsible for breast tissue development and the production of breast milk.

Postnatal reasons

• Separation of mother and baby
• Delayed or little milk expression
• Anxiety/stress.

Can your baby being in NICU affect your milk supply?

Mothers of preterm and sick babies in the neonatal unit experience many difficulties which mothers of healthy newborns do not. For example – 

• Infant/maternal separation
• Medicalised environment
• Anxiety about the wellbeing of your baby
• Difficult /stressful labour
• Caring for other children whilst being in the NNU
• ‘Stress’ whether it is physical or psychological may hinder lactation in a number of ways.

Understand that it is OK to be feeling worried, stressed and fatigued. It’s ‘normal’ but these feelings can negatively effect your milk supply.

The following suggestions will help you in establishing a milk supply for your baby. In the early days post delivery, establish a regular expressing routine. This is the time when the hormones responsible for lactogenesis directly affect milk production. Don’t worry if you feel progress is slow, this is normal, especially for mothers of preterm babies. A few drops of colostrum to start is brilliant!

To help you with expressing you can:

• Express next to your baby.
• Remember massage, stroke and shake!

Remember kangaroo care