Taking care of the breast

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BREASTFEEDING is a perfectly natural thing for mothers to do, yet much education is needed to help them, especially when it comes to breast care.

While you may have taken your breasts for granted all along, this is the time when your breasts need special care.

Breast and endocrine specialist consultant surgeon Dr Harjit Kaur Perdamen says there is no way to tell if a woman will run into problems like mastitis, engorgement and abscesses.

“Some women have it and some women don’t. The most important thing is to take care of your breasts even before your delivery, which means keeping your nipples and areola well lubricated with body oil. But of course once you start breastfeeding you don’t put anymore oils on it,” she advises.

Engorgement

Engorgement occurs when the milk is not expressed causing the breasts to swell up and become hard and painful.

Dr Harjit says some women produce milk so quickly that their breasts get overwhelmed. The problem starts when they don’t empty the breasts in time or regularly.

“You need to use a pump because if the baby is not ready to feed, that doesn’t mean you keep your breasts engorged and wait till the baby decides they want to feed. That’s when you run into trouble.

“In between feeds, if you feel your breasts are already starting to fill up, you should empty them out. Keep your breasts soft all the time. Don’t allow engorgement to take place. When the baby feeds, automatically milk will start being produced. So, it’s not to say if you pump out now, then when baby wants to feed you won’t have enough milk. It doesn’t work that way. The stimulus of the baby’s mouth will stimulate milk to be produced.

“I think that’s a mistake that some women make. They keep the milk in their breasts until their baby wants to feed, and then it becomes engorged and they run into trouble,” says Dr Harjit.

She explains that it’s not necessarily long periods of time. For some women, the milk production is quite fast and they will need to express the milk more frequently.

While there are several home remedies, including using cabbage leaves to cool down the breasts, Dr Harjit recommends using warm or cold towels to provide comfort. Follow that up by gently massaging the breasts and pumping out the milk.

For those who don’t want to express their milk because it will mean feeding their baby by bottle and possibly causing nipple confusion, Dr Harjit says they can always use a spoon to feed the baby the breast milk or even use a bottle that comes with a spoon attached.

Cracked nipples

Nipples sometimes become sore and cracked; a lot of times this is due to poor attachment.

Dr Harjit says that if the nipple is sore and / or cracked, it’s time to use the breast pump and take the baby off the breast.

“When the baby suckles it will be very painful and will bleed. So, use a pump to empty out the milk on that particular breast and take care of the nipple until it heals. Once you see it’s healing nicely then you can put the baby back on the breast.

“If it’s just starting to crack and you take care of it, usually it settles within two or three days,” she adds.

Dr Harjit explains that mothers can suffer with cracked nipples and risking bigger complications like abscesses requiring surgical drainage, or they can give the child breast milk through a bottle for a couple of days and take a chance that the child will go back on the breast after that.

She admits that many young mothers with abscesses come to see her. They are in so much of pain but want to continue breastfeeding because everyone tells them that they must keep it up.

“That is not bonding. You’re starting to get angry and irritated with your baby because every time the baby puts the mouth there it’s excruciatingly painful. What thrill is it to bond with your child when you’re in so much of pain?” she asks.

According to Dr Harjit, it is important not to let the baby suckle on the breast too long. This is when they are not just drinking milk but suckling for comfort.

She says the constant moisture of baby’s mouth on the nipple causes it to crack.

Mastitis and blood

If you have mastitis, or a severe infection with pus, you are advised not to feed that milk to your baby. Dr Harjit says the baby will have diarrhoea and other issues.

She says mums can continue breastfeeding with the other breast.

“The problem usually arises when there is a delay in emptying the breast. If you don’t sort it out, then you end up with a bigger problem like mastitis and abscesses. Very often people don’t realise that in a lot of this breast abscess and mastitis cases, the root of the problem is an infection from the baby’s mouth. It’s not always purely because of engorgement. Engorgement aggravates it because you have stagnating milk inside. But it’s actually from the baby’s mouth and having cracked nipples and still breastfeeding is how bacteria gets in.

Dr Harjit: 'You don't want to be giving your baby 'strawberry' milk.'
Dr Harjit: ‘You don’t want to be giving your baby ‘strawberry’ milk.’

“If there’s no pus but there’s a little bit of blood it’s not a problem. But if it’s a lot, it’s quite scary. You don’t want to be giving your baby ‘strawberry’ milk. If you’re bleeding that much, the baby should not be on your breast. You should be resting that nipple to let it heal,” says Dr Harjit.

Plugged milk ducts

You get plugged milk ducts when the milk ducts are obstructed. It can get painful. Dr Harjit says it could be due to defects in your breast, although this is rare.

“You have things called milk granulomas where the milk hardens and blocks the duct. At the nipple, you can see this white seed-like thing. Never, never try to dislodge it. It is worse if you try to take a pin and dislodge it because you might traumatise that duct and cause bleeding. When it heals, it heals with scarring. So, it actually makes matters worse. You’re actually damaging the duct than doing any good.

“The best thing to do is to just take a warm towel and keep it there and sometimes nature will take its course – it’ll just open up and it will dislodge itself,” she advises.

To soap or not to soap

Some people seem to think that when you’re breastfeeding you shouldn’t use soap over your breasts when bathing.

According to Dr Harjit, when you’re bathing you can use your soap but you need to make sure that your nipple area is really washed well.

“If you have any soap residue on your breast, the minute the baby puts their mouth there, they may get put off. That itself will put the child off because there’s a sudden funny bitter taste in their mouth.

“That’s why hygiene is very important. Before breastfeeding use a warm towel to wipe the breast down and clean the nipple nicely before you put the baby to the breast. After that, again do the same thing – use a warm towel to clean the breast and nipple and then squeeze out a bit of milk to moisturise the nipple and let it dry,” says Dr Harjit.

Breast pad

Breast pads should be changed every three hours. You shouldn’t use the same breast pad the whole day because bacteria starts colonising in the breast pad. That’s another reason why you might end up with mastitis, if the bacteria gets into your cracked nipples.

Underwire bras

Chances are you will be using nursing bras, but if your breasts are not too swollen and you want to wear your regular bra, Dr Harjit says it’s okay to use underwire bras as long as the wire is sitting under the breast and not on it. Otherwise you risk damaging the breast tissue.

When to see the doctor

Dr Harjit advises mothers to come in to see the doctor as soon as they start having problems.

Usually by the time women come in to see Dr Harjit, they are in pain and have severe mastitis, abscesses or engorged breasts. They might even have a fever because of the infection.

“Usually, I try to manage without conducting surgery and I have to say I hardly do surgery for breast abscesses. I don’t like to do surgery because it’s very messy to give a big cut to a woman while she’s breastfeeding and then doing daily dressing which can be excruciating. That’s why I say as far as possible come early. Don’t wait until it’s very late and there’s nothing much we can do but surgical drainage.

“I manage all my patients by ultrasound-guided aspirations. So, I scan them, if I see a collection of pus, I put a needle in and suck it out. Then I put them on antibiotics and maybe do repeated aspirations as required. So, they come back to me every two or three days and we aspirate again. You will find that that way most of them settle down without surgery. This is better because they can continue to breastfeed. Everything continues like normal and at the same time we manage their problem. Surgery is the last option, when all else fails,” says Dr Harjit.

She believes that if mothers are given advice on breast care early, complications can be avoided and they need not come in to see her.

Best practices

Dr Harjit says the best way to take care of the breast is to:

  • Clean the nipple with a warm towel before breastfeeding.
  • After breastfeeding, clean the area again with a warm towel.
  • Squeeze out a little bit of milk from the nipple.
  • Use that milk to lubricate the whole nipple.
  • Let the milk dry on the nipple.

The milk layer will protect the nipple from cracking. It’s one of the most effective ways to look after your nipple.

“Creams are very drying agents actually, so they sometimes make things worse, causing your nipples to crack. That can be very painful when baby feeds and then the bleeding will start. Your discomfort is one thing, but that’s also when bacteria from the baby’s mouth gets in. That’s how people end up with infections and abscesses,” says Dr Harjit.

Conclusion

Breastfeeding can be a wonderful and joyful experience for mothers.

It should not be about pain, blood and pus.

Dr Harjit says, “To enjoy breastfeeding, it’s important to get things right from the start, to make sure you’re doing the right thing and if you’re not sure, ask. Learn before you leave the hospital. If anything happens and you’re unsure, see a doctor immediately. Don’t sit around and wait until things get bad because then it becomes miserable and your whole experience of childbirth and having a baby is a mess because all you’ll remember is having terrible mastitis and breast abscess and pain.”