Dec 4, 2017
AP: Welcome to Growing Healthy, today we are speaking
with Di, a lactation consultant about what are the common issues
that come up in the beginning of the breastfeeding journey, and how
can you manage them. We will get to them right after this
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Di, welcome! Tell us a little bit about yourself….
AP: So lets talk about engoregment…what is it? and why does it
Di: Engorgement sure can be a surprise, the breasts can become
quite a bit larger, firmer and feel uncomfortably swollen. The body
is preparing for feeding the newborn throughout pregnancy and
breast changes are usually noted as birth nears. Colostrum (the
early milk) is present at time of baby's birth, but full milk
production is waiting for the signal that babe is born. This is a
hormonal signal to the brain. The placenta releases progesterone,
which tells the brain that the baby is still in utero - "not born
yet, don't start the full milk production yet".
So the body is all set, but waiting for the delivery of the
baby and the placenta and the drop in progesterone.The best analogy
that I've heard from a recent course, is thinking of the placenta
like the e-brake on a car...the car can be revving up, but it's not
until the e-brake is released that the car can then drive
So, baby is born, the placenta is delivered and it's a GO -
the body now starts the full-on milk production. Over the next few
days the volume starts to increase, the milk ducts fill and the
breasts become full. This is also combined with extra fluid and
therefore some swelling can happen. Thus, engorgement!
Moms can help this process and try to reduce the extent of
breast engorgement by feeding their babies "early and often". If we
can keep up with the production of milk and the emptying of the
breasts with shorter intervals in the early days, then the milk
ducts hopefully won't become painfully full.
AP: Are there any tips and tricks you can offer to women and
their partners to help manage engoregement?
If engorgement occurs, continuing to feed baby every 2 hours,
cold cloths following feeds to reduce swelling and expressing the
milk can be helpful. We need to be cautious with pumping or manual
expression, however, that it is just to move the milk for mom's
comfort and not to signal to the body to make even MORE milk.
Interestingly, cabbage leaves can help alleviate engorgement.
So, you peel off the leaves of a green cabbage, crush it a bit with
a rolling pin and place in your bra a couple of times a day. As the
cabbage wilts the components help to reduce engorgement. Use with a
bit of caution, however, as it can also reduce milk supply if used
more than twice a day.
As with any challenges with breastfeeding, please seek help
early if you're having trouble latching your baby. Sometimes, when
the breasts are very full and firm, the baby may have difficulty
staying latched or may slide down on the the nipple and cause
AP: Yes! So important to get help when you need it! and
you are right about the nipple pain. Lets chat a bit more
For sure there is some adjustment to having a babe (or two or
three) at your breast feeding frequently! Likely the number one
reason that we see moms for BF help is nipple pain, and thankfully
is usually is the BF challenge that we can most quickly resolve
with a latch assessment. I once overheard a conversation between
two women that it was advised to 'toughen up' the nipples by
scrubbing them with a toothbrush ahead of time! Please do not think
that there is any need to toughen up your nipples. Yes, to a
certain extent it takes some 'getting use to', having your baby
nurse for many hours in the day, but your nipples should not be
bearing the brunt of this. Remember: babies Breastfeed, not
"Nipplefeed" as they might with a bottle. Maybe we can talk more
about achieving a deep latch in a moment.
If you have pain with latching your baby, please seek a latch
assessment by a skilled breastfeeding support person- whether
that's your Doctor, Public Health Nurse or Lactation Consultant. We
are all more than happy to help alleviate that pain on latching.
You do not need to 'just push through and get used to it',
generally if there's pain there's an issue we can help
AP: Now it’s not just a latch issue that can cause nipple
pain…what are some of the other reasons that this can happen?
There also might be other causes for nipple pain: if it's not
just a latch correction, it might be something else going on with
the nipple. For instance, there might be an overgrowth in yeast. We
all have yeast, or candida, on our bodies and given the right
environment it can have rapid overgrowth and cause discomfort.
Symptoms of yeast overgrowth, or thrush, can include a burning
discomfort on the nipples and areola, shiny, red skin on the areola
and even some shooting pain following feeds. Anyone who has baked
bread would know that yeast loves warmth, moisture, sugar and
darkness-- all of these are present with soaked nipple pads, so
change them out frequently and seek treatment options from your
medical care provider. Thrush is generally easy to treat in the
I have often heard that yeast pain described as like someone
is stabbing you with a knife through your nipple into your
back….not a pleasant experience! Definitely ask for help
Sometimes, vasospasm may occur with the nipple either by the
nipple being compressed during a feed and coming out looking
blanched or occurring immediately after the feed. When vasospasm
occurs after the feed it is generally a result of a latching
challenge or a damaged nipple.
Sometimes there are other conditions present like Reynaud's
phenomenon. A woman may be aware that they have Reynaud's that
shows up as vasoconstriction on fingers and toes and then it is
exacerbated by breastfeeding. Keeping the nipples warm
following a feed is key, either by immediate covering with a warm
cloth or with your baby held to the breast. If this is not enough,
speak to your doctor for other treatment options.
AP: Raynaud’s of the nipple is often worse in the colder
months, and you are right ….warmth is very helpful. sometimes
I even suggested hand warmers behind the nipple pads to provide
some extra warmth!
AP: Can we talk a little more about latch? Especially in those
first few days it is soooooooo important to really focus on getting
the best latch you can with your baby…..
Absolutely, I agree that often we meet moms who have been so
excited that their baby has latched on that they will endure any
pain they might feel just to keep their precious babe
As we've talked about, latch is key to successful
breastfeeding. Over the last couple of decades we have realized
that culturally we have been trying to breastfeed babies in a
bottle-feeding position (as in, cradled in our arms on their back)
and often we imagine that a mom's nipple should look like a bottle
nipple. But, in fact, nipples can look very different and babies
are born seeking to feed in a way that doesn't look like the
classic 'bundled in your arms bottling position'. Babies are
instinctively driven to seek out the breast by way of using all of
their senses and all of their body.
It's pretty cool to watch the videos on babes crawling up to
latch onto the breast themselves, and although we might not have
this exact experience, it is also very cool to watch your own baby
seek out the breast by bobbing their heads around at the breast and
batting their little hands around to initiate the letdown
AP: It is great watching these videos! Lets post some in
our show notes!
What we know is that babies are 'ventral feeders' meaning that
they are sort of 'hard-wired' to have their chests touching mom,
ideally skin to skin. They tend to feel calmer, more regulated and
focused on feeding when they are 'belly to belly, skin to skin'
especially with the early feeds. We also know that the depth of the
latch is important for both the comfort of mom's nipples and for
the best transfer of milk. So, using gravity to babe's advantage,
lying back and allowing baby to fall onto the breast during a feed
is more productive than sitting straight up and having babe fall
AWAY from the breast and onto the nipple during a feed.
This is a little hard to describe without visuals, but we
encourage moms to go with their intuitive, right-brain thinking
when feeding their babies. One of the most impressionable talks
I've attended over the last few years was from Nancy Mohrbacher
(who has written several great breastfeeding books). She says
something along the lines of, "just get comfortable and feed your
baby, like in a TV watching position" to her breastfeeding
patients. It is both mom and baby who need to 'learn' to acheive
the best latch. Mom's can go with the comfort piece: if it hurts,
is pinching or they're uncomfortable, then take babe off and try
again. Babies learn by the best transfer of milk: the deeper on the
breast they are, the more of a reward of milk they will
Sometimes there can be difficulties with the latch due to
baby's tongue shape, mom's breast shape (particularly with
engorgement) or other barriers to achieving a deep and comfortable
latch- again, please seek help, ideally in person.
AP: Great! Some great tips…now we talked earlier about feeding
often, especially in those first few days….Part of the reason
babies need to do that is to help mom’s milk come in and to signal
to mom how much milk they need!
One of the most common concerns that moms have is that
they won't know exactly how much milk their baby is getting when
breastfeeding. They may feel anxious about not feeding their baby
enough, particularly when babies want to feed VERY often in the
early weeks. It is completely normal for newborns to feed every
2hours, and sometimes clusterfeed in a way that feels like
'non-stop' for a few hours in a row. This does not mean that you
don't have enough milk, it's just how newborns behave. We can
determine if babies are getting enough milk at the breast by both
their diaper output and weight gain. So, you will be given
guidelines on what to watch for with both of these. For instance,
we want to see that babies are peeing frequently (6-8 times/day by
the time they are a week old) and that they are gaining
appropriately. Your care provider will go over what healthy weight
gain should look like for your baby. If your baby is sleepy,
because of jaundice, for instance, you may need to wake your baby
Human milk is designed for frequent feeds, and human babies
are born needing to feed on cue. Another point that Nancy
Mohrbacher makes is, remember that we are CARRY Mammals. Like
chimpanzees and gorillas we are meant to carry our newborns and
feed them often. We are not Follow Mammals like horses where the
newborn needs to walk straight away and catch-up to their mom for a
feed a few times a day, or Den Mammals that leave their newborns
and return a few times to offer feeds in the den. We sometimes,
collectively, like to think of ourselves as den mammals with
creating lovely nurseries and cribs thinking that our newborns will
politely sleep there and feed by the clock every 4 hours, (LOL) but
our milk and our babies are not designed this way...so, know that
it is completely normal when your newborn wakes up after an hour
and a half to feed again.
AP: Really glad you mentioned this….I think we all want to
have a predictable schedule, including feeding times, and sometimes
it gets there…but certainly not at the beginning….I asked a group
of women once what they wish they knew in the first few days after
giving birth…and one said…that if your baby seems hungry…feed it!
don’t try to stick to a 3 hour schedule! So for those parents
who are struggling..what can we do to support them?
Di: So glad you mention the importance of support! In regard
to breastfeeding, specifically, moms can check-in with their care
providers for BF assessment, book an appointment with a community
professional for a BF consult (with public health or a lactation
consultant). You can also connect with your local La Leche League
group. Having adequate support in the early weeks is so important
in general for new parents. It means, perhaps, the difference of a
mom being able to spend quiet skin-skin time with their newborn,
instead of needing to shop or cook. Or, being able to catch up on a
bit of sleep to allow them recovery time from birth. Or, even just
to be able to talk about how you are feeling and feel heard and not
alone in your new parent struggles can make moms feel validated and
supported. We encourage you to reach out to who you would
identify as a support person. There are many community baby groups
that you can attend to meet other moms, whether through Public
Health, the rec centres, libraries or the monthly groups here at
Grow Health. Connecting with your doctor or nurse about how you are
coping is often the best way to start identifying your best
supports. We are not meant to do this alone!
AP: Great advice Di! It is hard to ask for help
sometimes….but trust me you will not regret that you did! A
little help early on in the journey can make a huge difference in
your infant feeding experience, and our hope is that it makes it
more enjoyable for both you and your wee one….We will put some
links to resources in and around Victoria BC, so check them
out….and in the meantime…..Keep on growing healthy!