Breast pain and breastfeeding

There are a number of reasons why you may experience breast pain while you are breastfeeding.

"Usually the reason can be resolved fairly quickly if you get the right help," says Bridget Halnan, infant feeding lead in Cambridgeshire and Fellow of the Institute of Health Visiting. "Never put off asking for help early. Persevering on your own, hoping it will get better, may make matters worse."

Here's how to deal with some of the most common reasons for breast pain while breastfeeding.

Breast engorgement

Too much breast milk

Blocked breast milk ducts

Mastitis

Breast abscess

Thrush

Breast engorgement

Breast engorgement is when, for whatever reason, your breasts become overly full. They may feel hard, tight and painful. It was once considered a normal part of beginning to breastfeed, but this is no longer thought to be the case.

"In the early days, engorgement can be due to your milk coming in and your newborn not feeding as much as perhaps they need to," says Bridget Halnan.

Newborns need feeding little and often. It can take a few days for your milk supply to match your baby's needs.

If your baby isn't well attached to the breast it may be hard for them to take your milk when your breast is engorged. The nipple can become a little over-stretched and flattened, and possibly painful.

Ask your midwife, health visitor or a breastfeeding specialist for help immediately to help your baby drain your breasts more effectively.

See more about positioning and attachment.

Engorgement can still happen once you have learnt the skill of positioning and attachment, usually when your baby hasn't fed for a while.

Your baby usually knows when they need a feed, for how long and from which breast. Early signs (cues) that your baby is ready to feed can include:

• moving their eyes rapidly
• putting their fingers into their mouth
• rooting (turning to one side with their mouth open as if seeking the breast)
• becoming restless

Crying is the very last sign that your baby needs feeding. Feeding them before they cry often leads to a much calmer feed. Keeping your baby close so you can watch and learn their early feeding cues will help.

How to ease breast engorgement

To ease the discomfort of engorgement, apart from your baby feeding, you could try expressing a little breast milk by hand.

"You don’t need to strip the breast of as much milk as you can. This will only lead you to produce more," says Bridget Halnan. "But taking a little off can relieve the pressure."

Ask your midwife, health visitor or breastfeeding specialist to show you how.

See more about expressing breast milk.

You may also find it helps to:

• Wear a well-fitting breastfeeding bra that doesn't restrict your breasts.
• If your breasts are leaking, apply warm flannels just before hand expressing.
• Apply chilled cabbage leaves to your breasts after feeding or expressing to reduce the pain and swelling.
• Take some paracetamol or ibuprofen at the recommended dose to ease the pain. These are safe to take while you are breastfeeding.

Too much breast milk

Occasionally women make too much breast milk and their babies struggle to cope. It's best to get your midwife, health visitor or breastfeeding specialist to watch a feed to see if they can spot why this is happening. They can also suggest ways to decrease your supply.

"They may be able to help you pick up your baby's cues about how long they want to stay at one breast," says Bridget Halnan. "Remember, it is your baby at the breast that makes the milk. Switching them too early can cause an oversupply."

Blocked breast milk ducts

The milk-making glands in your breasts are divided up into segments, rather like an orange. Narrow tubes called ducts carry the milk from each segment to your nipple.

If one of the segments isn't drained properly during a feed (perhaps because your baby isn't attached properly), this can lead to a blocked duct. You may feel a small, tender lump in your breast.

"This needs relieving as soon as possible, and your baby may be able to help," says Halnan. "If possible, place them with their chin pointing towards the lump so they can feed from that part of the breast."

Avoid wearing tight clothes or bras so your milk can flow freely from every part of your breast.

Other things that may help include:

• frequent feeding from the affected breast
• warm flannels or a warm shower to encourage the flow
• gently massaging the lump towards your nipple while your baby feeds

It's important to deal with a blocked duct quickly as, if left, it could lead to mastitis.

Mastitis

Mastitis (inflammation in the breast) happens when a blocked duct is not relieved. It makes the breast feel painful and inflamed, and can make you feel very unwell with flu-like symptoms.

Mastitis starts off as "non infective", in other words with no infection. But if left it can then become "infective", and you'll need to take antibiotics.

If you have mastitis you will probably have at least two of these symptoms:

• a breast that feels hot and tender
• a red patch of skin that's painful to touch
• a general feeling of illness, as if you have flu
• feeling achy, tired and tearful
• a high temperature (fever)

"This can happen suddenly, and can get worse quickly," says Bridget Halnan. "It's important to carry on breastfeeding as this will help to speed your recovery."

If you think you are developing a blocked duct or mastitis, try the following:

• Check your baby's positioning and attachment – ask your midwife, health visitor or a breastfeeding specialist to watch a feed.
• Carry on breastfeeding.
• Let your baby feed on the tender breast first.
• If the affected breast still feels full after a feed, or your baby can't feed for some reason, express your milk by hand.
• Warmth can help the milk flow, so a warm flannel, or a warm bath or shower, can help.
• Get as much rest as you can – go to bed if you can.
• Take paracetamol or ibuprofen to relieve the pain.

If you are no better within 12-24 hours, or if you feel worse, contact your GP or out-of-hours service. You may need antibiotics, which will be fine to take while breastfeeding.

Stopping breastfeeding will make your symptoms worse, and may lead to a breast abscess.

Breast abscess

If infective mastitis is not treated it can lead to a breast abscess, which may need an operation to drain it. This can also develop if the mastitis doesn't respond to frequent feeding plus a course of antibiotics.

You can carry on breastfeeding after an abscess has been drained.

See more about breast abscesses.

Thrush

If you experience pain in both breasts, often after a period of pain-free breastfeeding, and if the pain lasts for up to an hour after a feed, you may have developed thrush.

See more about thrush and breastfeeding.

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