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Overcoming Breastfeeding Problems and Difficulties 87
enters the breast tissue, causing oedema. Infrequent Mastitis
feeding or abrupt weaning may cause it. One or
both breasts may be affected. It may be the areola or Mastitis can be prevented by early diagnosis of and
the body of the breast or both that are infected. successful treatment of blocked ducts. However, if
Indications are: it does occur the mother should continue to
breastfeed, but it is essential that her positioning
●● the breast is warm, painful, throbbing – this and attachment be improved. If it fails to respond
may extend up into the mother’s armpit or gets worse, the mother may need to take
antibiotics in addition to correct management.
●● skin may appear red, shiny, taut and oedematous Unless positioning and attachment are improved,
mastitis may re-occur. Unresolved mastitis may
●● low-grade pyrexia may be present. lead to a breast abscess.
Possible actions to deal with engorgement include: Breast abscess
●● massaging before feeds; kneading with A breast abscess may require a surgical aspiration
fingertips using a circular motion, beginning at or operation and drainage. However, breastfeeding
the chest wall and travelling around the breast should continue. If the abscess is close to the nipple,
in a spiral towards the nipple the mother may wish to express on the affected
side, until it is a little more comfortable.
●● applying warm water before a feed (shower/bowl
of water/warm compress) Inadequate milk supply
●● combination of massage and heat (e.g. shower Inadequate milk supply is a common reason that
and massage together) mothers cite when they perceive that their milk is
not satisfying their infant. This perception may be
●● expressing gently, aiming to soften the areola due to persistent crying or fussing by infants.
and enabling the baby to attach and feed However, infants do not only cry because they are
hungry. They often cry because they are
●● breastfeeding more often, finishing the first uncomfortable, cold, lonely or bored. A crying
breast before moving on to the second infant may just need comforting and someone to
talk and interact with them. Some infants
●● changing breastfeeding position experience more discomfort than others (e.g. those
who have colic). Comforting an infant who has
●● applying cold compresses after feeds to help colic or some other cause for discomfort other than
reduce swelling and relieve pain hunger can be very time consuming.
●● using cabbage leaves – anecdotal evidence says Any of the following measures may help to
women find these soothing when worn inside increase milk supply:
the bra next to the skin with a hole cut out for
the nipple. ●● Different positioning (e.g. underarm or lying
down) may help the infant to feed more efficiently.
Analgesics such as paracetamol can be used to
reduce symptoms. Aspirin should NOT be taken by ●● The infant needs to feed on both breasts at each
breastfeeding mothers. feed and for as long as he or she wishes on each
breast to ensure adequate intake of the
Blocked ducts high-calorie hindmilk.
Blocked ducts may be caused by engorgement or ●● More frequent feeding may help some infants
poor positioning and attachment. The mother but it is important they are allowed to feed as
should be shown how to massage the affected area long as they wish on both breasts.
and express her breast. Hot flannels and a bath or
shower may help. Cold, washed cabbage leaves
around the breast are a traditional method still
used but without evidence to support it.
