Breastfeeding is the most natural thing for every mother. It is a unique experience to be cherished. Sometimes certain simple problems faced by mothers result in stoppage of breastfeeding or giving of supplements of animal milk/commercial infant formula to the baby. Problems may be like flat nipples, inverted nipples, breast engorgement, swelling, sore nipples or not enough milk etc. These problems are preventable if due care is taken from the pregnancy period to prepare for breastfeeding.

Some of these problems relate to shape and size of the nipple and other's relate to breast tissue as a whole.

Flat nipple

The length of the resting nipple is not important for breastfeeding. However, the areola embedded in the breast tissue beneath should be able to be pulled out to form the teat. The nipple is just a guide to show where the baby has to take the breast. Having flat nipples should not worry you.

See if your breast nipples are working for breastfeeding

Touch your nipples and try to gently pull it. If your nipples stand errect , they are working for breastfeeding. This is called the "Nipple Protractility"

Inverted nipple

Nipple that does not come out errect and on trying to pull out rather it goes deeper into the breast is an inverted nipple. Fortunately, true inverted nipples are very rare and usually during pregnancy the nipple becomes normal and protractile. If they remain inverted, these can be treated in consultation with your doctor.

Long nipple

A long nipple may be a common problem as the baby may suck on the nipple only and may not take enough of breast tissue into his mouth. To help, the baby should be brought closer to the breast to enable him to take more breast tissue into his mouth.

Sore nipples and cracked nipples

The most common cause of sore nipples in the first few days of feeding is the incorrect position/attachment of the baby at the breast meaning that your baby sucks only at the "nipple". If feeding continues in the poor position, it may lead to cracked nipple and later to mastitis and breast abscess.

Treatment

If it pains during breastfeeding, you should wait until your baby releases the breast, or put your finger gently into the baby's mouth to break the suction first, so as to avoid injury at the nipple. Then, again start to breastfeed in a CORRECT POSITION and if your child is attached properly it will not cause pain to you.

Breastfeeding should be continued on the affected breast as sore nipples usually heal after correcting the suckling position.

For cracked nipples, treatment consists of feeding in correct position, washing the nipple once daily only with water and exposure of nipple to air and sun as much as possible, and application of a drop of your hind milk on the nipple after each feed and continued breastfeeding will help.

Medicated creams are best avoided as they may worsen the soreness and draw away the attention from the crucial issue.

Fullness and engorgement of the breast

Fullness of the breast is a frequent problem. Milk production is continuous and, if enough milk is not removed, engorgement of breasts may result. The engorged breast is tight, shiny and very painful.

The common causes of engorged breasts are :

If breast is engorged the baby is not able to take feed properly due to poor attachment , inadequate emptying which further leads to decreased production . Engorgement of the breast can be prevented by avoiding other feeds being given before breastfeeding, keeping the baby always with the mother, unrestricted and exclusive breastfeeding on demand, and feeding in the correct position.

When engorgement occurs expression of breastmilk should be done to relieve breast engorgement, reduce pain and make the mother comfortable.

Blocked duct

If the baby does not suckle well on a particular segment of the breast, the thick milk blocks the milk duct leading to a painful hard swelling.

Treatment

Swelling of the breast

If the blockage of the duct or engorgement continues, infection may supervene. The breast becomes red, hot, tender and swollen (It is called mastitis). An abscess may form or swelling may occur, associated with fever.

Treatment

Leakage of milk from the breast

Milk leaking is usually the result of an active ejection reflex during first few weeks of lactation. It commonly occurs when it is time for a feed or when intervals between feeds are increased and when you have loving thoughts about your baby.

You remain reassured that this is due to normal oxytocin reflex.

Blood in the milk

Some mothers notice a little blood in the milk, even in the absence of a nipple fissure. It is usually a harmless and self-limiting condition. You should continue breastfeeding.

It is possible to continue breastfeeding the baby after returning to work. Working outside the home is often cited as a reason for the decline in breastfeeding rates around the world because breastfeeding and working outside are seen as mutually exclusive activities. But it has been observed that many working mothers have breastfed their babies successfully.

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