We interviewed breastfeeding expert Clare Byam-Cook on problems commonly associated with breastfeeding. Clare trained as a nurse and a midwife, working for several years at Queen Charlotte’s Maternity Hospital in London before joining Christine Hill’s antenatal practice in Chiswick, where she taught breast-feeding classes. Clare now carries out home or hospital visits to any mother experiencing feeding problems.
How do I cope with breast engorgement?
Many mothers experience engorged breasts when their milk first comes in on about day three or four. So long as the engorgement is not too severe the best thing is to leave them to sort themselves out, which normally takes a few days. But if your breasts become so hard and engorged that it is really painful, you need to do something otherwise you are at risk of triggering off a bout of mastitis. Through trial and error, I have discovered the best method is to use a breast pump to express all the milk off both breasts so that they become soft and comfortable. The feedback I get from my clients is that this normally solves the problem completely – their breasts do fill up again ready for the next feed but they do not become engorged again. If the engorgement does return, you can use the pump one more time to empty your breasts, but if it doesn’t resolve the issue you need to stop expressing otherwise you will over-stimulate your breasts and make things worse.
Are there any tips to prevent mastitis?
Mastitis is a common problem which can affect many mothers. Some mothers get mastitis for no obvious reason but it is often associated with engorged breasts, sore nipples (because infection can travel up through cracked & bleeding nipples) and bad latching, which may prevent the breast being emptied properly. If you can avoid any of these problems you are less likely to get mastitis.
Bad latching can not only create sore nipples, but can also prevent the baby from emptying the breasts evenly and effectively which can result in blocked milk ducts. If you develop lumpy areas that are not cleared when your baby feeds, use a breast pump after the feed and try and massage the lumpy area out – if you don’t do this you might develop mastitis.
Sore nipples are usually caused by bad latching, thrush or a tongue-tie, which might prevent the baby sucking correctly. Ask an experienced health professional to make a diagnosis – once the cause has been identified and corrected, feeding should be come pain-free. But if no-one can show you how to latch your baby on easily and pain-free, I suggest that you consider using my method of latching, which my clients find a revelation! I do not believe in the ’nose-to-nipple’ theory. Instead I recommend lining your baby up ‘mouth-to-nipple’ and then shaping your breast to make it smaller, rather than expecting your baby to open his mouth wider. This technique is described in great detail in my book (What to Expect when you’re Breastfeeding …. and what if you Can’t?) and on my DVD (Breastfeeding without Tears).
Blocked milk ducts
Bad latching can not only create sore nipples, but can also prevent the baby from emptying the breasts evenly and effectively which can result in blocked milk ducts. If you develop lumpy areas that are not cleared when your baby feeds, use a breast pump after the feed and try and massage the lumpy area out – if you don’t do this you might develop mastitis. You should also check that your baby is latching correctly – see my advice above re sore nipples.
Top tip: Don’t press your breast away from your baby’s nose as he feeds. Not only do you not need to do this (he can breathe perfectly well) but pressing on your breast throughout a feed may prevent that part of the breast from emptying correctly.
Why are shields not approved as a permanent way of feeding?
The main reason mothers are told not to use shields is because there is a belief that this will prevent the baby from emptying the breasts efficiently and getting enough milk, which in turn can reduce milk supply. Mothers are also told that shields will create nipple/teat confusion which will prevent the baby from being able to suck correctly on the breasts without them. I have not found this to be the case! Of course you must use common sense; if your baby clearly is not able to empty the breasts effectively through the shields you must stop using them. But if your baby is feeding well and gaining weight you can continue using shields so long as this is the case.
Shields can be a lifesaver and it’s always worth giving them a go to see whether they help with your particular problem.
Mothers suffering from very engorged breasts may find the baby just cannot latch on. It’s like trying to suck on a football, the breasts are just too big and too hard! These mothers can try using a shield until her breasts soften up and her baby can latch on without.
You can also use a nipple shield if you have very painful nipples. Sore nipples are nearly always caused by bad latching, but nipple shields may help until you are able to sort out what you are doing wrong.
Here is an example of the closed mind of some health professionals when it comes to using nipple shields:
I had advised one of my clients to use nipple shields as her milk flow was so fast that her baby panicked and choked whenever she tried to feed him without one. When her baby was four months old, her health visitor was congratulating her on the fact that she was still breastfeeding and the fact that her baby’s weight gain was so good. But when my client mentioned that she was using nipple shields, she got a lecture from the health visitor who said, “You can’t use nipple shields! Your milk supply will decrease and your baby won’t get enough milk!” This, despite her earlier congratulations on the baby’s perfect weight gain.
Worse still, the Health Visitor didn’t even bother to ask the mother why she was using the shields. Had she done so, she might have learnt some useful information to pass on to other mothers attending her clinic.
What ratio do you advise – how long should a baby feed from one breast – do you switch during a feed, or one breast per feed?
Some babies can get a full feed from only one breast, but most babies need to use both. How long the baby feeds from each breast depends entirely on how much milk the mother has, how quickly it flows and how efficiently the baby sucks – and this varies hugely from mother to mother. Some babies can get a full feed in 20 minutes while others need to spend at least an hour on the breast.
My main advice is to keep your baby sucking on the first breast for as long as he is sucking efficiently. As soon as he starts falling asleep and doing shallow sucks it’s time to offer him the second breast. Although you should try to empty each breast completely, you should not worry about getting every last drop of milk out in order to ensure that he gets the hindmilk. This is because, contrary to what many mothers are told, the hindmilk starts coming through within minutes of the baby sucking on the breast. You can check this for yourself by using a breast pump; what you will see is that the first bit of milk that comes out tends to be very watery but within a very short space of time you will notice that the milk becomes much richer.
How to handle guilt if you’re failing and have to give formula
The first thing to recognise is that a new mother is not an expert on breastfeeding. So if it goes wrong the last person who should feel guilty is the mother. It may be that the ‘experts’ have not given you the correct advice, or it may be that you were genuinely unable to meet the government target of exclusive breastfeeding for six months. I always point out that just because breastfeeding is natural doesn’t mean it is easy and that everyone can do it. In the animal world not all dairy cows are good milk producers and not all lambs are capable of breastfeeding – and women and babies are the same.
Although breast milk is the ideal food for your baby, formula milk is a perfectly good option if you can’t manage exclusive breastfeeding. There is a big difference between giving formula milk in Britain to giving bottles in developing countries where they don’t always have access to clean water and sterilising equipment.
It is also important for mothers to be aware that exclusive breastfeeding does not guarantee perfect health for their baby. Nor is it true that giving even one bottle of formula will ruin breastfeeding forever and put your baby at high risk of diabetes, asthma, eczema etc.
This little story illustrates this perfectly:
Several years ago a mother persuaded her husband to drive her all the way down from North Yorkshire to see me when she was pregnant with her third baby because she had failed to breastfeed her first two children. She rang me when her baby was six months old to tell me that breastfeeding had gone brilliantly, right from the word go and she’d never needed to give formula. She then finished off the conversation by saying ‘… and I’m so glad I’m breastfeeding because this baby has terrible eczema, and if I was bottle feeding I’d feel so guilty’. When I asked whether her first two babies had eczema her response was “ No! They were fine! This does rather highlight that life isn’t fair ….. and breastfeeding is not a guarantee of perfect health!
Does breast size affect milk supply?
Not at all, breast size does not affect milk flow or supply. It differs from mother to mother.
What’s the one piece of advice you’d give to new breastfeeding mothers?
Be aware that breastfeeding is not always as easy as everyone makes out. Prepare well in advance of the birth by deciding how you want to feed your baby and choosing books/DVDs that will suit your method of feeding and parenting. For example, don’t buy a Gina Ford book if you hate routine! Research all the aids such as breast pumps and nipple shields that are available to you if breastfeeding does go wrong. Find a breastfeeding counsellor in your area who is good, – not just someone who’s advertising, but someone who has been recommended to you. And finally ….. view all the health professionals/breastfeeding counsellors as you would a plumber. If they don’t fix the problem, it doesn’t matter how nice or supportive they are, it’s time to call in someone else!
Did you know? Breast milk helps heal baby’s conjunctivitis
If your baby has sticky eyes you could try squirting a bit of breast milk into them as antibodies in breast milk may help clear up the infection. If it doesn’t clear up in a couple of days, you should consult your GP.
Clare Byam-Cook SRN. SCM
Author of ‘What to Expect when You’re Breast-feeding….and what if you Can’t?‘
Top Tips for Breast-feeding
Top Tips for Bottle-feeding
Presenter of her DVD ‘Breastfeeding without Tears’.