By Mary Kay Vogel, IBCLC
 Lactation Consultant
Iowa State University Extension
A GOOD START
Breastfeeding is so good for you and your baby. Get off to a good start and avoid most problems by holding and latching your baby on correctly and breastfeeding 8 to 12 times in 24 hours.
Holding Your Baby
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- Use a pillow to support you and your baby.
- Turn baby's whole body toward you.
- Hold your baby level with your nipple.
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Helping Your Baby Latch On
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- Support your breast with your thumb above, fingers below.
- Tickle your baby's bottom lip with your nipple.
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When your baby opens wide, like a yawn, quickly center your nipple in baby's mouth and bring baby very close.
- Baby's nose and chin should touch your breast.
- Baby's lips should be rolled out, not tucked in.
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SORE NIPPLES
In the early days, some nipple tenderness is common, especially as yourbaby latches on. After breastfeeding a few minutes, the milk will begin to flow and breastfeeding should be comfortable.
To Prevent Soreness
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- Hold and latch your baby on correctly
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Breastfeed in different positions: sitting, using the side hold, and lying down.
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If you need to stop breastfeeding, put your finger in the corner of your baby's mouth to break the suction.
- Let your nipples air dry after feedings.
- Avoid breast pads with plastic linings.
- Use only water to wash your breasts.
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If You Are Very Sore
Take time to relax before the feeding. Breathe deeply. Massage your breasts and express some milk. Before the feeding, ease the soreness by putting ice on your nipples for a few seconds. Start the feeding on the least sore breast. After the feeding, put some breast milk on your nipples and let them air dry. If the soreness continues more than 24 hours, seek help.
Flat or Inverted Nipples
Your nipples may be sore because they are difficult for your baby to latch on to. They may be flat or inverted. Wear breast shells under your bra 1/2 hour before feedings. They make your nipples easier for your baby to latch on to.
Thrush
If sore nipples occur after the first several weeks, you or your baby may have thrush, a common yeast infection. Contact your health care provider for medication for your nipples and your baby's mouth. Breastfeeding can continue.
UNCOMFORTABLY FULL BREASTS
Fullness is normal in the first weeks. However if milk is allowed to build up in your breasts, they may feel uncomfortably full, hard, or warm to the touch. This is called engorgement.
To Prevent Engorgement
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- Hold and latch your baby on correctly.
- Breastfeed every 1 1/2 to 2 hours during the day and every 3 hours at night.
- Avoid pacifiers and bottles that delay or omit feedings
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If You Are Engorged
Follow the above steps. Also, before feedings, put a warm, wet cloth on your breasts, or take a warm shower to help your milk flow. Massage your breasts gently. Express some milk to soften your nipples. After the
feeding, put an ice pack on your breasts for comfort. If your breasts become red and tender and you have a fever, call your health care provider.
LEAKING MILK
In the early weeks, your breasts may leak while adjusting to making milk. They will leak less over time. Until then, do the following:
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- Catch the leaking with a clean cloth during feedings.
- Apply gentle pressure to your nipples if you need to stop the leaking.
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Between feedings wear washable or disposable breast pads or use clean
cotton handkerchiefs. Avoid pads with plastic. They keep your nipples wet
and may cause soreness.
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LOW MILK SUPPLY
The amount of milk you make depends on how well and how often your baby breastfeeds. In the early weeks, six wet and three dirty diapers a day tell you that baby is getting enough milk.
Check with your health care provider before taking any medications because they could decrease your milk supply. Avoid feeding on a schedule or offering formula, water, or other foods to your baby. These cause your body to make less milk.
To make more milk:
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- hold and latch your baby on correctly;
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breastfeed more often, every 1 1/2 to 2 hours during the day and every 3
hours at night;
- breastfeed at least 20 to 30 minutes each time; and
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switch breasts when your baby's swallowing slows down, using both breasts
at least twice.
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Take care of yourself. Drink whenever you are thirsty. Eat a healthy diet with a variety of foods. Rest with your baby. After a day or two, you will have more milk.
BREAST SORENESS OR INFECTION
If you notice a red or tender spot on your breast, you may have a "plugged duct." The breast milk is not moving through the milk duct. This can happen when your breasts become too full of milk, your baby is not latching on well, or there is constant pressure on your breast. If you also have a fever or feel like you have the flu, you may have a breast infection.
To Prevent A Plugged Duct Or Infection
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- Breastfeed 8 to 12 times each 24 hours.
- Hold and latch your baby on correctly.
- Breastfeed in different positions: sit, use the side hold, or lie down.
- Avoid anything that is tight or puts constant pressure on your breast,
such as a tight bra.
- Take care of yourself. Rest and eat well.
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If You Have A Plugged Duct Or Infection
Take the above steps. Also, before feeding, put a warm, wet cloth on your breast. Gently massage the area. Breastfeed from the sore breast first. Breastfeed every 1 1/2 to 2 hours. Rest in bed with your baby. Call your health care provider if the pain and fever continue more than 24 hours - you may need medication. You can continue breastfeeding.
ASK FOR HELP
Sometimes breastfeeding problems develop. Be patient with yourself and your baby. Find out why you are having a problem and what you can do. Call a lactation consultant, health care provider, hospital nursery, WIC breastfeeding specialist, or La Leche League (1-800-525-3243).
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