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Breastfeeding Problems - Possible Reasons Behind It!

Dr. Rahul Manchanda 88% (75 ratings)
MBBS, MD
Gynaecologist, New Delhi  •  24 years experience
Breastfeeding Problems - Possible Reasons Behind It!

Breastfeeding is universally recognized as the best way to feed an infant because it protects mother and infant from a variety of health problems. Even so, many women who start out breastfeeding stop before the recommended minimum of exclusive breastfeeding for six months. Often women stop because common problems interfere with their ability to breastfeed. Luckily, with sound guidance and appropriate medical treatment, most women can overcome these obstacles and continue breastfeeding for longer periods.

The most common reason women stop breastfeeding is that they think their infant is not getting enough milk, but in many cases the mother has an adequate supply. A true inadequate supply can happen if the infant is unable to extract milk well or if the mother doesn't make enough milk. Unfortunately, figuring out if a mother has enough milk and if not, why not, can be challenging.

Inadequate milk production — There are a number of reasons why a mother might not make enough milk, including that:

  1. Her breasts did not develop sufficiently during pregnancy – This can happen if she doesn't have enough milk-producing tissue (called glandular tissue)
  2. She previously had breast surgery or radiation treatment.
  3. She has a hormonal imbalance.
  4. She takes certain medications that interfere with milk production.

Women who have had breast surgery, such a breast augmentation or breast reduction surgery, often have trouble making enough milk. For some, breastfeeding is impossible. If you had breast surgery, ask a healthcare provider if the type of surgery you had would totally interfere with breastfeeding. If not, or if you are unable to get complete information on your surgery, do go ahead and try, but make sure your healthcare provider closely monitors your baby's progress.

Poor milk extraction — The most common reasons infants have trouble getting enough milk are:

  1. They do not get fed frequently enough (which can cause milk production to slow or stop).
  2. They cannot latch on properly They are separated from their mother too much.
  3. They are fed formula.

Babies are sleepy and it is difficult to keep them awake during the first several days after birth. This can prevent the baby from getting enough to eat. Other babies can have trouble controlling the muscles involved in suckling, which makes it hard for them to extract milk. Feeding difficulty is especially common among premature and late preterm babies. Many mothers judge adequacy of feeding by lack of crying. This can be misleading if the baby is not getting enough milk and is overly sleepy.

Diagnosis of inadequate intake — Healthcare providers determine whether a baby is getting enough milk based on the following:

Number of feeding sessions the mother reports having – During the first week of life, mothers with term infants (meaning they are not premature) generally nurse 8 to 12 times in 24 hours. By four weeks after delivery, nursing usually decreases to seven to nine times per day.

Amount of urine and stool the baby makes – By the fifth day of life, infants who are getting enough milk urinate six to eight times a day and have three or more stools a day. (Once a mother's milk comes in, her infant's stool should be pale yellow and seedy.)

Weight of the baby – Term infants lose an average of 7 percent of their birth weight in the first three to five days of life. They typically get back to their birth weight within one to two weeks. Once a mother's breasts fill with milk – by day three to five – her infant should not keep losing weight. If an infant has lost 10 percent of its weight or fails to return to its birth weight when expected, healthcare providers start to explore potential problems. Household scales are not accurate enough to detect these small weight differences. If you are using a medical scale for infants, remember to weigh the infant with the same clothes and diaper before and after the feeding.

Management of inadequate intake — If your healthcare provider suspects your baby is not getting enough milk, he or she will want to figure out why. To do that, the healthcare provider will ask you about your experiences breastfeeding and about your and your baby's medical history. A healthcare provider should also watch as you try to breastfeed to see if there could be something wrong with the way your baby latches on or with the baby's mouth. If so, it will be important for you to learn how to position your baby so that the baby can latch on properly .If you are having trouble with this, the healthcare provider will direct you to community resources − often a lactation consultant − for assistance.

If your baby has a good latch, but you still have problems with inadequate milk intake, your healthcare provider might suggest that you try to feed more often or try to stimulate more milk production by using a breast pump or expressing by hand.

There are medications called galactagogues (or lactagogues) that supposedly increase milk production, but it's unclear whether these medications actually work and whether they are safe for a nursing baby, so we do not recommend their use.

Nipple & Breast Pain

The second most common reason mothers stop breastfeeding early is nipple or breast pain.

The causes of nipple and breast pain include:

  1. Nipple injury (caused by the baby or a breast pump)
  2. Engorgement, which means the breasts get overly full
  3. Plugged milk ducts
  4. Nipple and breast infections
  5. Excessive milk supply
  6. Skin disorders (such as dermatitis or psoriasis) affecting the nipple
  7. Nipple vasoconstriction, which means the blood vessels in the nipple tighten and do not let enough blood through

Possible causes of breast or nipple pain related to the baby could include:

Ankyloglossia (also called tongue-tie), which is when the baby's tongue cannot move as freely as it should, making it hard for the baby to suckle effectively

To determine the cause of your pain, your healthcare provider will examine you and your baby, and watch you breastfeed. He or she will also ask about your pain (when it started, what makes it better or worse), and about aspects of your health that could hold clues about the cause of your pain.

The most important part of the exam takes place when the healthcare provider watches you breastfeed. That's because most cases of breast pain in the nursing mother are due to incorrect breastfeeding technique. One common problem is that the baby is not latching on properly, and so injures the nipple, but also cannot empty the breast. This, in turn, can lead to engorgement, plugged ducts, and breast infections.

Nipple pain — Sore nipples are one of the most common complaints by new mothers. Pain due to nipple injury needs to be distinguished from nipple sensitivity, which normally increases during pregnancy and peaks about four days after giving birth.

You can usually tell the difference between normal nipple sensitivity and pain caused by nipple injury based on when it happens and how it changes over time. Normal sensitivity typically subsides 30 seconds after suckling begins. It also diminishes on the fourth day after giving birth and completely resolves when the baby is about a week old. Nipple pain caused by trauma, on the other hand, persists or gets worse after suckling begins. Severe pain or pain that continues after the first week after birth is more likely to be due to nipple injury.

Nipple injury — Nipple injury usually is due to incorrect breastfeeding technique, particularly poor position or latch-on. Other factors that can make pain caused by injury worse include harsh breast cleansing, use of potentially irritating products, and biting by an older infant.

If your baby is biting you, position the baby so that his or her mouth is wide open during feedings. That will make it harder to bite. Also, stick your finger between your nipple and the baby's mouth any time he or she bites you and firmly say "no." Then put the baby down in a safe place. The baby will learn not to bite you.

Engorgement — Engorgement is the medical term for when the breasts get too full of milk. It can make your breast feel full and firm and can cause pain and tenderness. Engorgement can sometimes impair the baby's ability to latch, which makes engorgement worse, because the baby cannot then empty the breast.

If the engorgement makes it hard for your baby to latch on, manually express a small amount of milk before each feeding to soften your areola and make it easier for the baby to latch on .To do this, place your thumb and forefingers well behind your areola (close to your chest) and then compress them together and toward your nipple in a rhythmic fashion. You can also use your hand to present your nipple in a way that is easier to latch and to help get milk out for the baby while the baby is suckling.

You can use a breast pump to help soften your breast before a feeding, but be careful not to do it too much. Using a pump too much will stimulate your breast to make even more milk, which will make engorgement worse.

Breast Infections

Lactational mastitis — Mastitis is an inflammation of the breast that is often associated with fever (which might be masked by pain medications), muscle and breast pain, and redness. It is not always caused by an infection, but most people associate it with infection. Mastitis can happen at any time during lactation, but it is most common during the first six weeks after delivery.

Mastitis tends to occur if the nipples are damaged or the breasts stay engorged for too long or do not drain properly. To prevent and treat mastitis, it's important to get these problems under control.

MILK OVERSUPPLY

Some mothers make too much milk, which paradoxically can make breastfeeding difficult. Generally the production of milk is determined by the infant's demand, but in this case the supply exceeds demand. The problem begins early in lactation and is most common among women having their first child.

In women with an oversupply of milk, the rush of the milk can be so strong that it causes the infant to choke and cough and have trouble feeding, or even to bite down to clamp the nipple. Infants whose mothers make too much milk can either gain weight quickly or gain too little weight because they cannot handle the flow of milk, or because they do not get the last of the milk in the breast, which has the most calories.

If you have a problem with overproduction, don't worry. The problem usually goes away on its own. But tell your healthcare provider about it, so he or she can check whether you have any hormonal imbalances or take any medications that could make the problems worse.

WHEN TO SEEK HELP

If you are unable to breastfeed due to engorgement, pain, or difficulty latching your infant, help is available. Talk to your obstetrical or pediatric healthcare provider, nurse, lactation consultant, or a breastfeeding counselor.

Contraceptive methods of birth control are usually quite successful. By  these methods, you can enjoy your sex without the worry of pregnancy. Modern technology has led to the formulation of avid techniques of contraception; some are temporary and the others permanent. However, no matter how well these methods work, almost all of them have got a variety of side effects on your body and health.
Here is a list of different modes of contraception and the side effects they may cause:

Hormonal implants
This long term method of birth control is an effective one. The side effects are:

  1. A surgery is required where rods are inserted under your skin. This might be risky surgery.
  2. If you want to remove it, again another surgery has to be carried out.
  3. An Infection may develop in the area where the thin rods are inserted.

Intra Uterine Device
A device is fitted into the uterus, which does not cause pregnancy. An effective method with the following side effects:

  1. There is a risk of the device falling off.
  2. This causes puncture in the uterus.
  3. The device made of copper may lead to menstrual cramps and spotting.

Depo Provera Hormonal Injection
This mode of contraception involves taking an injection, which restricts pregnancy for a period of three months. The side effects are:

  1. Gaining of extra weight, fatigue.
  2. Decrease of bone density.
  3. Menstrual bleeding along with spotting takes place.

Birth Control Pills
Birth control pills are one of the most common and most effective ways of birth control or contraception. However, several side effects may be observed.

  1. Causes nausea, headaches and also blood clots in rare cases.
  2. In case you use other prescribed medicines along with birth control pills, severe damage may be inflicted.

Vaginal Ring
This mode of contraception is very effective. It also helps in making menstrual periods of women much lighter and in continuity. The side effects are:

  1. May cause nausea and headache.
  2. There is a vast increase in appetite
  3. There is a risk of blood clot formation.

Diaphragm
A very successful mode of contraception where a diaphragm is inserted and fitted into the vagina. The negatives of this mode are:

  1. It may get out of place during sex and is likely to cause damage
  2. The process can be a mess
  3. Causes urinary infections

All modes of contraception irrespective of their effectiveness have got some side effects on your health. Hence, you must choose them wisely.

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