Taking care of your breasts in the postnatal period is so important to prevent pain and infection. Whether you plan to breastfeed or not your boobs will behave as if you are going to, and lots of changes happen from the first trimester of pregnancy.
How are my breasts doing this?
There are two hormones in your body that control breastfeeding. Prolactin makes you produce milk, oxytocin makes you release it. Prolactin is already working away in pregnancy, which is why your breasts get bigger in preparation for breastfeeding.
Once you give birth you have a huge hormonal shift, which allows oxytocin to release the milk. When your baby latches on or you are anticipating a feed this causes a surge of oxytocin, often referred to as “the let down”. Oxytocin then stimulates tiny muscle cells in your breasts to contract and start the flow towards the nipple, giving you a tingly feeling. Your baby then uses suction to draw it out. How insanely clever is that?!
Something’s not right, help!
Sometimes this process doesn’t go to plan. Here’s a little troubleshooting guide for common issues such as breast pain, breast lumps or swelling…
Painful nipples – Unless you’re used to having someone sucking on your nipples for several hours a day, some discomfort in the beginning is to be expected. However, if it continues, or if you find your nipples getting very sore, the likely culprit is a poor latch. It’s important to address this because a poor latch is not only uncomfortable for you, but frustrating for your baby, who might not be getting enough milk as a result. Even if baby is a healthy weight, your comfort matters too. A good latch means your nipple should be at the back of their mouth and so their tongue should not be causing friction.
How to remedy painful nipples: Ask to be referred to a lactation consultant for specialist help to solve the underlying issue. Short term, Lansinoh nipple cream was my go-to, as you don’t have to remove it before a feed. Slap it on it’s so soothing!
Engorgement – this is a swelling of the breast from increased milk flow, but it can get confused with mastitis. It can be really uncomfortable, you will not want any pressure on your boob, the skin will be tight, areola very hard and the nipple might even be pulled flat. However, unlike mastitis you will not have any flu like symptoms or fever because there is no infection.
How to ease engorgement: You can relieve engorgement by hand expressing until the breast is soft enough for your baby to latch on and drink all that milk (or for you to use a pump). Alternatively, if expressing is too painful, run a warm bath or use hot flannels to encourage the milk to dispense without pressure. If you’re not continuing with breastfeeding, only express enough to relieve the pain, otherwise you will encourage the milk supply to continue.
Blocked milk ducts – you will feel a hard lump within the breast which will be sore particularly when you start a feed. There won’t be any warmth or redness, and you should feel well in yourself.
How to shift blocked milk ducts: Try feeding from the affected side first and expressing on the other side to protect milk supply and not get blocked in the other boob. You can also try putting a hot water bottle and gentle massage towards the nipple as your baby is feeding. Blocked milk ducts may right themselves naturally as your baby feeds. Talk to your GP if you notice the lump is not going away, begins to feel hot, or looks red and swollen.
Mastitis – the key difference is that bacteria is part of the problem, which causes inflammation and infection. Often bacteria have found a way into the breast tissue through cracked nipples and so a poor latch puts you at a higher risk. It can be difficult to tell whether a blocked milk duct has transitioned to an infection. The key symptoms you are looking for is severe pain and redness over a lump, feeling unwell potentially with a fever. It often comes on more suddenly as well.
How to cure mastitis: It is important you seek help from your GP as you may need antibiotics to clear the infection. If you have reoccurring episodes of mastitis then it is important to check for low iron levels as this can be a factor.
How can I prevent these issues?
The key thing is to make sure your breasts can fill and empty milk well. Here are my top tips…
- Feed on demand and alternate between breasts to keep your milk supply as even as possible.
- Eating well and managing stress will optimise your immune systems response if bacteria does get in.
- We also need to perfect that latch and position. Breastfeeding is a skill that has to be learnt between you and your baby. Trust your instinct about what feels right, but also ask your midwife and health visitor to check your latch in those early weeks.
- Don’t restrict your breasts with tight bras or compression from baby slings. Give the boobs some space!
Which bra is best?
The simple answer is one that fits, so do get properly measured and fitted once baby has arrived. Marks & Spencers have a free bra fitting service. Bear in mind that just before feeding your breasts will be at their biggest as they contain more milk. Once you’ve fed your baby your breasts will be smaller. We want to wear a bra size that comfortably fits when your boobs are at their biggest, even if that means the bra is looser after a feed.
How do I safely reduce or stop breastfeeding?
Once we are in the breastfeeding hormonal state our body will keep doing it as long as there is a demand for the milk. Think back to the olden days of wet nurses – they would breastfeed for a living. Ideally, once we have decided to stop breastfeeding, we would do it gradually to allow our breasts to adapt over a period of time. What we are trying to do is stop producing prolactin. As you reduce the number of feeds, the prolactin levels will also drop so you produce less milk. If you drop a feed at a time then the supply chain gradually dwindles down. If you need to stop breastfeeding more quickly then hand express a small amount at regular intervals so your boobs don’t overfill, as this can cause issues.
I hope this helps you feel more confident in looking after your breasts. They are such an important part of your pregnancy and postnatal journey.