Am I making enough milk?
If you're making enough milk, your baby will show signs that he is getting enough to eat, including:
- feeding 8 to 12 times in 24 hours (about 10 to 20 minutes or longer per feeding). Four weeks after delivery, feeding usually decreases to 7 to 9 times per day
- making 6 to 8 wet diapers every 24 hours
- making stools at least once per day for the first month and every 2 to 7 days after that
- gaining weight normally (usually 4 to 7 ounces, or 0.1 to 0.2 kilograms, per week)
- making swallowing sounds while feeding
- appearing healthy, alert, and active
If you're concerned about your milk supply, contact your doctor or lactation consultant.
Am I making too much milk? What can I do about it?
You may be making too much milk if your breasts feel very full and uncomfortable, your baby is fussy or gassy between feedings, your baby feeds only for a short time (5-10 minutes), or milk sprays from your breast when the baby comes off.
Often, your milk supply will adjust itself after the first few months. To help slow down milk production, use the same breast for all feedings within a 2-hour window, then switch to the other breast for the next 2-hour window. If necessary, you can also try to slowly increase the length of time you feed your baby from one breast. You can pump the breast that's not being used for a maximum of 20-30 seconds, just to relieve pressure. Any more will trigger the breast to make more milk. If this doesn't work, contact a lactation consultant.
How do I get my baby to latch on well to my breast?
Tickle your baby's bottom lip with your nipple and wait for her to open her mouth wide. When she does, bring her towards you, chin first, as you aim your nipple towards the roof of her mouth.
You can tell if your baby is latched on well if her nose is almost touching your breast and her lips are rolled out. At least half an inch (about 1 cm) of your breast (near the nipple base) should be in your baby's mouth. The latch should not be uncomfortable for you. If it is, adjust your baby's position by pushing the baby's bottom towards your body with your forearm. You may also try to gently pull down on the baby's chin so she has more of the breast in her mouth. If this does not work, detach your baby by putting your finger gently between her gums and try again. However, unlatching and re-latching the baby is not recommended, as it can end up causing you more pain and frustrate the baby.
What is a lactation consultant, and when should I call one?
A lactation consultant is a health care professional specially trained to help parents manage breast-feeding issues.
You may wish to contact a lactation consultant if:
- you need breast-feeding advice or support
- you're having problems with your milk supply
- you're not sure if your baby is feeding well
- your baby doesn't seem to be gaining weight
- you have breast or nipple pain
- you have a complicated situation, such as twins, a baby who is ill, or a baby with a cleft palate
Your doctor or health clinic can help you find a lactation consultant, or you can check the listings in your phone book.
Breast-feeding shouldn't hurt. But some women suffer from breast problems and pain when they breast-feed. Here's what you can do to manage some common causes of breast pain and discomfort:
A blocked milk duct (a channel that milk flows through in the breast) is not a type of breast infection. What usually happens is that the mother has a painful, swollen, firm mass in the breast. The skin over the affected area may be slightly red and tender. Fever is rarely seen. A milk duct can become blocked due to a poor latch, which leads to poor emptying of the breast.
A blocked milk duct will usually resolve itself within 1-2 days. During that time your baby may be fussy because the milk may come out slower. You can help clear the duct quicker by doing such things as massaging the sore area, using a warm compress on the area, feeding from that breast often (ensure you have a good latch), and getting some rest. If the pain persists or if you develop a fever, speak to your doctor or lactation consultant.
Mastitis is a breast infection that can happen if a milk duct becomes blocked and infected. Mastitis can cause breast pain, fever, and fatigue. To deal with mastitis, breast-feed frequently to help relieve the blockage in the milk duct, get some rest, apply a heating pad to the affected area, soak the breast in warm water for 10 minutes three times a day, and gently massage the breast. Don't worry about your baby catching the infection if you breast-feed - your milk has antibacterial substances that protect him. If things don't get better within a day, contact your doctor, as antibiotics may be needed to help heal the infection.
Breast engorgement occurs when your breasts become uncomfortably full of milk. The first instance of breast engorgement usually happens 2 to 5 days after birth, when your milk "comes in." This is sometime also referred to as postpartum breast engorgement. In this case, it usually goes away within 12 to 48 hours. Other reasons for engorgement can also include:
- you are producing too much milk
- you experience a delay in nursing or pumping milk from the breast
- your frequency of feeding diminishes because your baby is beginning to stop breast-feeding
To deal with engorgement:
- Start breast-feeding as soon as possible after birth.
- Breast-feed often - at least every 2 to 3 hours during the day and at least every 4 hours at night.
- Before switching sides, wait until your baby falls asleep or comes off the breast.
- Before feedings, briefly apply a warm compress, then express some milk. Use cold compresses between feedings.
- Gently massage your breasts. Move downward from the top to the nipple, using a circular motion.
- Don't miss feedings. Use a breast pump if you are unable to breast-feed.
If these tips don't help, talk to your doctor or lactation consultant.
Sore or cracked nipples
The best way to manage this problem depends on the cause. There are many possible causes for sore or cracked nipples, including:
- improper positioning of the baby
- improper use of a breast pump
- a short tongue, a high palate, or other conditions affecting your baby's mouth
- nipple infections
- breast engorgement
- nipple confusion (a pacifier or bottle uses a different sucking technique than breast-feeding; if the baby uses this technique while breast-feeding, it may cause nipple pain)
- allergic reactions to personal care products
Your doctor, nurse, or lactation consultant can help you sort out the cause of the problem. Your doctor can also help you manage nipple infections and irritations (which may require medications) and identify any health conditions in your baby that may be causing the nipple soreness.
You can also try rubbing some breast milk on the sore areas. Breast milk can help soothe the area and also has some antibacterial properties. Don't apply wet tea bags, honey, or cooking oil to your breast - this won't help and could make things worse.