Breast Care & Nutrition

New moms are understandably preoccupied with the health and well-being of their baby, but don’t forget to take care of yourself! Eating right and maintaining good breast health is important for successful breastfeeding.

Engorgement

(Usually happens the second to fifth day after delivery)

 

The medical dictionary defines engorgement as congestion, swelling with fluid. Engorgement is characterized by painful swelling of the breasts due to the sudden increase of milk volume.

When milk production increases rapidly, the volume of milk in the breast can exceed the capacity to store it. Some degree of engorgement is normal. Minimal or no engorgement in the first week postpartum can signal insufficient milk production.

The following factors may place a mother at a higher risk of engorgement:

  • Failure to empty breast milk properly resulting from infrequent or inadequate drainage of the breasts. The higher the cumulative number of minutes of sucking during the early days after birth, the less pain from engorgement mothers describe.
  • Small breast size. While small breast size does not limit milk production, it can influence storage capacity and feeding patterns. Mothers with small breasts may need to experience a greater number of breastfeedings over 24 hours than women with a larger milk storage capacity. Women who became engorged are more likely to wear significantly smaller bra cup size (34 percent) than women who do not become engorged (12.5 percent).
  • Previous breastfeeding experience influences engorgement. Second-time breastfeeding mothers experience greater levels of engorgement sooner with faster resolution than first-time breastfeeding mothers.
  • Mothers with high rates of milk production (hyperlactation) or large amounts of milk such as mothers of multiples may see milk stasis magnified if infants consume less milk, if less milk is pumped, or whenever milk volume significantly exceeds milk removal.
  • Limited mother/infant contact in the early days. Research suggests significantly less engorgement on day three in mothers who participate in skin-to-skin contact of their full-term babies rather than standard nursery care.

Mothers experience less severe forms of engorgement with early frequent feedings, self-demand feedings, unlimited sucking times, and with babies who demonstrate correct suckling techniques.

More Information:

Thrush

Thrush is a common yeast infection that can live on your nipples and in your baby’s mouth because they both offer warm, moist environments. Symptoms for babies are usually white patches or unusual redness inside their mouths and can also be accompanied by a diaper rash or a change in their normal moods. For you mothers the symptoms range from cracked, itchy, or burning nipples that might appear more red than normal, to breast pain both during and after breastfeeding. If pain occurs, first try to reposition your baby and have him or her latch back on. If the pain continues or your baby also shows thrush symptoms, see your doctor and your baby’s pediatrician for treatment.

Symptoms of Thrush can include:

  • Itchy or burning nipples that appear pink or red, shiny, flaky, and/ or have a rash with tiny blisters.
  • Cracked nipples.
  • Shooting pains in the breast during or after feedings.
  • Intense nipple or breast pain that is not improved with better latch-on and positioning.
  • Deep breast pain.

Your treatment can be either a topical ointment or an oral medication (medicine taken by mouth) depending on the severity. Your baby’s treatment will probably be an oral ointment. Treatment for your baby is separate from yours because not a high enough dose of the medication is passed through your breast milk. It is important that you follow your doctor’s instructions on how to treat both of your thrush cases so that they don’t return.

More Information

Sore Nipples

Nipple tenderness at the beginning of a feeding may be normal in the first two to four days of breastfeeding. Soreness that is more intense or continues for a longer time indicates that some adjustment needs to be made. Let your nipples air dry after feeding. This can help prevent soreness.

Facts:

  • Spending time preparing your nipples for breast feeding doesn’t prevent nipple soreness. Don’t waste your time. Rolling and tugging on your nipples causes uterine contractions. Doing this for several minutes at a time can over stimulate your uterus. (This definitely isn’t a good idea if you have a complicated pregnancy.) Stimulation of your nipples during lovemaking is not usually a problem since the stimulation tends to be intermittent, not prolonged.
  • Limiting the amount of nursing time on each breast doesn’t prevent nipple soreness; it only delays it. You reduce the amount of stimulation you need to produce more milk. By nursing for only a few minutes the baby only gets the “foremilk.” The real calories and hunger satisfaction come from the “hindmilk.” Let your baby nurse at their own frequency and for their own duration. Unlimited sucking also prevents engorgement.
  • The goal in breastfeeding is to avoid sore nipples. The best way to accomplish that is to learn to put your baby to the breast in the proper position to minimize trauma to your nipple.

More information

Mastitis/ Breast Infection

Mastitis occurs infrequently, but can be quite painful. When it does occur, it is important to seek prompt medical attention.

Signs:

Women with a breast infection (mastitis) often describe flu-like symptoms, including weakness, headache, nausea, soreness, chills, and fever (greater than 101 degree F or 38.4 degrees C). The breast can be red, hot and painful.

Causes:

When breastfeedings are infrequent, delayed, or missed, or when babies are positioned incorrectly on the breast, milk collects in the breast and puts pressure on surrounding tissue causing engorgement. Engorgement damages the tissue and increases the risk of infection. When bacteria enter the breast through an opening in the nipple or break in the skin, the damaged tissue becomes infected.

Recommended treatment:

  • Call your doctor. An antibiotic may be necessary. Take the antibiotic until it is gone even if your symptoms improve.
  • Put warm water on the infected area before each breastfeeding to aid let-down and relieve pain. Warm washcloths, a warm shower or bath or soaking the breasts in a pan of warm water works well.
  • Continue to breastfeed frequently on both breasts. Breastfeed every 1 – 3 hours during the day and every 2 – 3 hours at night.
  • Start each feeding on the uninfected breast until the let-down reflex occurs, then switch to the infected breast. Breastfeed only until the breast is soft. If necessary, hand express or pump to soften the breast.
  • Apply cold packs after each breastfeeding to relieve pain and reduce swelling. Bags of frozen peas wrapped in a cold washcloth work well.
  • Drink enough fluid to satisfy your thirst. Water and unsweetened fruit juices are best.
  • Take acetaminophen or ibuprofen for pain.
  • Get plenty of rest.

Prevention:

  • Position the baby correctly on the breast and use 2 – 3 different breastfeeding positions each day.
  • Do not delay or miss feedings, but if you do, or if the baby breastfeeds poorly, hand express or pump to soften the breast and relieve fullness
  • Avoid under wire bras or bras that are too tight or bind.
  • Wean gradually. Pump or hand express to soften the breast and relieve fullness.

More Information

  • La Leche League International
  • The Bump
    The Bump gives first-time parents the lowdown on fertility, pregnancy, birth, and babies with stage-by-stage advice, stylish ideas, local resources, and interactive tools.

Caloric Intake

It is recommended that breastfeeding women consume 500 more calories per day than they did before they were pregnant. These extra calories are needed for the additional energy requirements of a breastfeeding mother.

Fluid Intake

Average breast milk output is 25 ounces a day. To make up for this water loss, make sure to drink enough water or non-caffeinated beverages so that your urine is a pale color (dark urine is a sign of dehydration).

Vegan/ Vegetarian Diets

While vegetarian diets usually contain the proper amount of needed vitamins for breastfeeding, vegans are advised to supplement their Vitamin B12 intake. This can easily be done by taking a multivitamin. Vitamin B12 is also found in animal products (meat, dairy and eggs).

Calcium and Vitamin D

It is very important that women, whether breastfeeding or not, receive the proper daily amount of calcium and Vitamin D. Vitamin D aids in calcium absorption, and calcium is needed for healthy bones. A woman should consume at least 1,000 mg. of calcium (approximately 3 to 4 servings of dairy) and 200 IU of Vitamin D per day. Both can be obtained through Vitamin D fortified milk or a supplement if needed. Finally, although breastfeeding does temporarily decrease bone mass, this loss will correct itself once your child has stopped breastfeeding.

Fish (Mercury Guidelines)

Due to the effects of mercury on an infant’s nervous system, pregnant and nursing mothers should limit the amount of fish they eat to one or two 6-ounce servings a week depending on the type of fish. All shark, swordfish, king mackerel, and tilefish should be avoided. Shrimp, canned light tuna, salmon, pollock, and catfish are safe to have twice a week, while canned albacore or white tuna is only safe to have once a week. You can find information on mercury levels in fish such as warnings about mercury or pollution levels in the body of water where it was caught. Local fish should only be consumed once a week.

Alcohol

Alcohol consumed by a breastfeeding mother clears out of her breast milk at the same rate it is cleared out of her body, approximately two hours for every one drink. Therefore, breastfeeding mothers do not have to avoid all alcohol but should wait the appropriate time after drinking before breastfeeding their infant (one drink = two hours, two drinks = four hours, etc.).

Caffeine

It is usually alright for mothers to consume caffeinated drinks in moderation while breastfeeding. The general guideline is no more than two or three caffeinated drinks per day–caffeinated drinks include some sodas, coffee and tea. Mothers should watch their infants for signs that the caffeine is affecting them, such as irritability and trouble sleeping. If the caffeine does affect your infant, modify your caffeine intake as needed.

Tobacco

Even if a mother smokes she is encouraged to breastfeed. However, it is important to know that there are known medical risks for babies exposed to secondhand smoke including respiratory conditions, ear infections, and an increased risk for sudden infant death syndrome (SIDS). Babies and children should always be kept away from secondhand smoke. It’s important to make sue that people do not smoke while holding the baby.

People who have been smoking (including yourself) should wash their hands and change their clothes before they hold the baby or before you start to breastfeed.

For more information see Oh Baby – We want to keep you safe from secondhand smoke.

For more information, check out the frequently asked questions about breastfeeding page of this website.