Breast-feeding problems

Definition

The term "breast-feeding problems" is used to describe a variety of physical, behavioral, and emotional difficulties with nursing an infant.

Description

Breast-feeding, or nursing, is the practice of nourishing an infant with the milk in the human breast. Full-term babies have a natural suckling instinct, and breast-feeding comes naturally to most as soon as they leave the womb. After delivery, levels of prolactin, the hormone that triggers milk product, begin to rise in the body. At first, babies feed on a nutrient-rich substance known as colostrum , which is produced by the breast before milk production begins. New mothers will experience engorgement in the days following the birth of their babies, where breast milk "comes in" and engorges the breasts. After this time, regular feedings and proper breast-feeding techniques usually ensure a healthy milk supply for most babies until it is time to wean. However, breast-feeding can be a complex process and in many cases, there is a problem with the infant's suckling technique, the mother's milk supply, or other factors, and breast-feeding problems result.

Causes & symptoms

Inadequate weight gain and a failure to thrive in nursing infants is the most obvious sign that there is a breast-feeding problem.

A number of factors may interfere with successful breast-feeding. These include:

• Milk supply problems. A variety of factors can cause an inadequate supply in new mothers. Milk production is largely a supply and demand process. If the baby does not feed frequently enough, milk production will adjust itself, going down accordingly. A study published in 2002 showed that women who gave birth to a second child within two years of the birth of their first child produced about 30 percent more breast milk in the first week after birth with their second baby.
• Latching problems. Some babies, particularly preterm infants, have difficulty suckling. This can be due to an abnormality of the mouth, or simply to a lack of coordination of the jaw muscles. In addition, the mother may not be placing her breast into the infant's mouth properly.
• Scheduling problems. Breastfed infants should be nursed at least once every three hours during the day, and should go no more than five hours at night between feedings. Scheduling also becomes a problem for women who work outside the home, as they often find that their milk flow diminishes after they return to work.
• Nipple and breast problems. Infants may have difficulty latching on to inverted or flat nipples. Other structural problems such as insufficient mammary glandular tissue, may result in reduced milk production. In addition, cracked and sore nipples and breast infections (mastitis) can make nursing painful.
• Retained placenta. If a woman's milk has not "come in" and she continues to experience abnormal bleeding after delivery, she may still be retaining pieces of the placenta within her uterus.
• Stomach sleeping. A nursing mother who sleeps on her stomach may experience decreased milk production due to the extended pressure on her breasts.
• Stress and fatigue . New mothers need proper rest in order to produce an adequate milk supply. The ability to relax is also fundamental to proper breast-feeding. Women who are stressed can have difficulty achieving milk "let-down," the sensation of the mammary glands releasing milk.
• Psychological issues. Some women are unable to breastfeed because of preconceived notions about the practice, or ideas instilled by their parents and peers, that have put up a psychological barrier for them. A 2002 study showed that most women are uncomfortable breast feeding in public and may even abandon the practice because they don't want to be shut off from others or feel squeamish about feeding their babies even in front of friends and family members.

Diagnosis

Breast-feeding problems are first determined by an infant's inability to gain weight. Most babies lose some weight in the first week of life. However, they should regain the weight quickly and be back at their birthweight at two weeks of age. An average weight gain of 6–8 oz per week should be maintained through the second or third month. After that, growth charts can demonstrate whether the child is gaining adequate weight.

Once a problem has been established, a healthcare practitioner will ask questions about the baby's feeding schedule and may observe the mother's breast-feeding technique so he or she can determine if an improper latching technique or inadequate suckling is causing the difficulty. Lactation counselors can be helpful in diagnosing these problems. Further physical examination and tests may be necessary to determine if structural breast problems or placental fragments are causing the difficulties.

Treatment

Proper treatment for breast-feeding difficulties depends on the cause of the problem.

Inadequate milk production

Milk production can be boosted in several ways. The easiest way is for the mother to encourage more frequent feedings at the breast. If this is impractical or the baby does not cooperate, milk production can often be increased through intermittent use of a breast pump, a device that expresses milk from the breast. Breast pumps are available in manual and electric models, and can be purchased or rented. Pumped breast milk can be bottled or frozen, and fed by bottle to the baby at a later time, although if milk production is a problem the mother will probably want to put the baby to the breast at every opportunity.

Milk thistle ,(Silybum marianum ) is sometimes prescribed to promote increased breast milk secretion. Although the herb is considered safe for nursing mothers, it should be acquired from a reputable source and prescribed by an herbalist, naturopathic physician, or other healthcare professional familiar with its use.

Each breast contains both foremilk and the richer, fat laden hindmilk. Infants need the nutrients and fat of the hind milk, but must get through the foremilk to reach it. This is why it is important that the mother completely empty one breast before starting the baby on the other one. This can be accomplished by nursing at least 10 minutes per breast. If the baby does not completely empty a breast, the job can be finished with the aid of a breast pump. The next time the mother nurses, she should start the child on the opposite breast.

Latching problems

To ensure proper breast-feeding, the mother should encourage the baby to latch on to the entire nipple, with his or her lips past the outside perimeter of the areola, before starting to suck. The mother will likely have to guide the breast into the baby's mouth, and repositioning may be required.

Practice makes perfect, and sometimes all an infant needs to improve his latching and suckling technique is time. If the baby has a structural problem in his mouth, such as a cleft palate, a breast pump may be required to keep milk production going. In some cases where suckling does not improve, feeding with a supplementary nutrition system may be required. The system consists of a feeding bottle containing the mother's own breast-pumped milk, and two tubes that run down from the bottle and attach to the nipples. Milk flows easily from the tubes with a weak sucking action from the baby. Both baby and mother can still maintain closeness while providing the baby with adequate milk flow.

Scheduling problems

Nursing infants who are sleeping through the night without a feeding are probably not getting enough milk. They should go no longer than five hours at night without feeding, and may require waking to ensure they get enough to eat.

Women who have returned to work can use a portable breast pump at least once during the work day to encourage sustained milk flow and to store milk for their babies to eat during their time away from home.

Nipple and breast problems

Liquid vitamin E applied regularly to sore or cracked nipples can soothe the pain and help the healing process. Women who think they have a breast infection should see their healthcare provider immediately, as they will probably require a course of antibiotics.

Retained placenta

Minor surgery known as a dilatation and curettage (D and C) is usually required to remove pieces of placenta that were retained by the uterus. Once the placenta has been removed, prolactin levels should rise, stimulating milk production.

Stress and fatigue

Relaxation exercises, yoga, meditation , massage, and aromatherapy can all be useful tools for relieving stress. Women should establish a quiet, restful environment for nursing. Warm compresses to the breast may also assist in milk let down. If it is feasible, taking naps when the baby is sleeping can help to ease the fatigue caused by nighttime feedings.

Psychological issues

Support from family and friends is necessary for any new mother, especially one that chooses to nurse her child. If no familiar support network exists, women may seek help from groups for nursing mothers such as the LaLeche league.

Many hospitals offer mothers and their spouses classes on breast-feeding techniques and nursing issues. Women who have negative feelings about breast-feeding may find classes helpful in overcoming these issues.

Expected results

In most cases, treatment for breast-feeding problems is successful and mother and baby do well. Other women may be able to breastfeed in limited amounts, but require supplementing their child's diet with formula to ensure proper weight gain and adequate nutrition. For a small percentage of women, physical problems or psychological issues may prevent successful nursing altogether.

Prevention

The best way for a new mother to prevent nursing problems is to take care of herself by eating right, drinking plenty of fluids, and staying rested and relaxed. It's important, because breast feeding incidence and duration are both associated with reduced breast cancer risk in women, according to a large international study released in 2002.

Resources

BOOKS

Eisenberg, Arlene et al. What to Expect the First Year. 2nd edition. New York: Workman Publishing, 1996.

Eiger, Marvin S., and Sally Olds. The Complete Book of Breast-feeding. New York: Bantam Books, 1999.

PERIODICALS

"Milk Production and Number of Births (Breastfeeding)." Special Delivery (Fall 2002):18.

PERIODICALS

"Mothers Uncomfortable Breastfeeding in Public." Australian Nursing Journal (July 2002):31.

PERIODICALS

Worcester, Sharon. "Breast-feeding Linked to Reduced Breast Ca Risk (Duration and Incidence)." OB GYN News (September 1, 2002):18–21.

ORGANIZATIONS

The LaLeche League. 1400 N. Meacham Rd., Schaumburg, IL 60173-4048. (847) 519-7730. http://www.lalecheleague.org.

Paula Ford-Martin

Teresa G. Odle