Expert advice on overcoming common breastfeeding problems during the first month of breastfeeding.
Breastfeeding is a learned skill, just like driving, and over the first month some mums and babies may experience a few bumps in the road! It takes time and practice for it to feel instinctive for both of you. Tackling breastfeeding challenges now means you’ve a better chance of establishing a good milk supply and continuing breastfeeding for longer. Here are my tips on how to overcome the most common breastfeeding difficulties mums experience from the end of the first week to the end of the first month.
Problem 1: There’s a painful lump in my breast
There are various reasons for lumps and bumps in a lactating breast. One of the most common is a blocked duct, clogged by milk, causing a hard lump that may be sore and tender.
- Massage the affected area, especially when feeding or expressing, to help release the blockage.
- Gently press a warm flannel on your breast, or try a warm bath or shower before a feed to help ease the discomfort.
- Continue to breastfeed normally to avoid the risk of milk build-up, which can lead to mastitis.
- Try pumping from the affected breast after feeds to ensure good milk drainage and to help remove the blockage, allowing the duct to work again. You can explore Medela’s full pump portfolio and choose one that meet your needs.
- Ask about therapeutic ultrasound treatment. If you suffer with recurrent blocked ducts your lactation consultant or breastfeeding specialist may recommend this procedure, which can help get milk flowing again. It is performed by a physiotherapist.
- See your healthcare professional if you notice signs of infection (a red, painful breast, or flu-like symptoms such as a high temperature, aches and pains, or headache), or you think the lump isn’t related to breastfeeding.
Problem 2: My breasts are red and painful
If one or both of your breasts are red and painful, and it isn’t a blocked duct, it’s likely you have mastitis. This is a condition where the breast tissue becomes inflamed. Signs include a red and hot area, tenderness, flu-like symptoms – being hot and cold with aching joints, and a temperature of more than 38.5 °C (101.3 °F). If you’re experiencing these symptoms, seek medical advice straight away. Mastitis needs to be treated quickly, as it can worsen in just a few hours.3
The causes of mastitis can be:
- an untreated blocked duct
- bacteria that have entered you breast via cracked or damaged nipples
- poor attachment to the breast
- leaving long periods of time between feeds
- having breasts that are too full
- wearing a bra or clothing that is too tight and ‘cuts in’ to your skin
- weaning your baby from breastfeeding quickly
- an oversupply of milk
In addition to seeking medical advice, you can also try the following self-care tips:
- Take paracetamol or ibuprofen (not aspirin) to relieve the pain, as instructed on the packet or by a pharmacist.
- Keep breastfeeding or pumping frequently. Your milk is still safe for your baby to drink. Flowing milk will help clear any blockage and prevent further painful build-up. Stopping suddenly could exacerbate symptoms. You may need to express any leftover milk after feeds.
- Offer your baby the affected breast first. This may help your baby to drain it adequately. If this is too painful, start on the non-affected side to get the milk flowing, then switch.
- Rest, drink and eat well. Make sure you’re having plenty of fluids and eating nutritious foods.
- Massage the area in a warm bath or shower, or compress with a warm flannel or heat pack to help release the blockage and ease symptoms before feeding or expressing.
- Use a cool pack after feeds to reduce inflammation.
Problem 3: I’m feeling exhausted
Breastfeeding can feel tiring and relentless at times during the first weeks. Your baby will likely be feeding every few hours, day and night, while you’re still recovering from the birth.
- Look after yourself. It may be easier said than done when you have a newborn, but get as much rest as possible, try to eat healthily and regularly, and drink plenty of water. Get help from your partner, family and friends – even paid help if you can afford it.
- Feed lying down. This may feel more relaxing and place less pressure on any sore spots, stitches or caesarean scars.
- Don’t skip feeds. A well-meaning loved one may offer to give your baby a bottle while you rest. Although this can be tempting, it’s recommended that you establish milk supply over the first four weeks by breastfeeding. Once breastfeeding is established, you can try giving your baby an expressed milk feed, but until then, ask family and friends to do other jobs so you can concentrate on breastfeeding.
Problem 4: How can I produce more breast milk?
It’s easy to lose confidence in your breast milk supply, especially when your baby has developmental spurts, common at three to four weeks. You may worry she’s increased her feeds because you’re not producing enough breast milk, but if your baby continues to have her regular number of wet and dirty nappies – see breastfeeding: what to expect in the first month – she’s most likely breastfeeding more frequently for comfort. It’s easy for her to become overwhelmed by all the new sights and sounds around her, and breastfeeding makes her feel safe.4
- Avoid top-ups feeds of formula, unless healthcare professionals are concerned about your baby’s weight gain or levels of hydration. Keep offering your baby the breast to increase your supply naturally – it’ll soon catch up.
- Don’t use a feeding schedule. Breastfeed your baby on demand to ensure your supply matches her needs.
- Use a breast pump to increase breast milk production, in addition to continuing breast feeds.
Problem 5: I’ve got too much milk
Hyperlactation, or an oversupply of milk, can cause breastfeeding difficulties for you and your baby. While you suffer from swollen breasts that are leaky and uncomfortable, she may struggle to latch on, start choking on your fast flow of milk, and may not be able to finish a feed properly.6
- Remove a little breast milk at the beginning of a feed to reduce the force of your let down. Don’t express too much as this could make your oversupply difficulties worse – just enough to relieve any discomfort. Try hand expressing, or use a breast pump (check out our range of breast pumps to find one that meets your needs).
- Use a towel or muslin to soak up any excess milk, or pop a milk collection shell on your other breast while you feed to catch leakage.
- Ensure your baby feels supported. Hold her firmly (it makes her feel secure) and in a comfortable position where she’s able to move her head. Talk her through the initial fast flow, so she’s less likely to be surprised and pull away from your breast.
- Consult a lactation consultant or breastfeeding specialist, who will take a look at you both and may suggest one-sided feeding or block feeding as ways to regulate your supply.
- Be patient. Problems with milk production usually improve after a few weeks.
Problem 6: My breasts are lop-sided!
You may find your baby prefers to latch on one side, or that one breast produces more milk than the other, which could make them different in size or shape. This is very common and shouldn’t cause any problems when breastfeeding. If it’s not bothering you or your baby, there’s no need to do anything about it, but there are things you can try if you feel self-conscious.
- Offer the least-used breast first at every feed, as your baby will usually suck more vigorously at the start.
- Use a breast pump to help increase lactation in the less-efficient breast.
- Don’t neglect the fuller breast. You’ll need to keep feeding from the larger one, too, to avoid blocked breast ducts and mastitis.
- Seek medical advice. Sometimes an ear infection may cause your baby to only feed on one side. This is because certain positions can cause discomfort – a more upright hold can help with this. In addition, if you have a breast infection this may change the taste of your milk and put her off.
Problem 7: There’s a blister on my nipple
The demands of frequent breastfeeding can sometimes cause a painful friction or blood blister on the breast, nipple or areola.7
- Ask a lactation consultant or breastfeeding specialist to check your baby’s latch. A shallow latch can cause nipple or areola blisters.
- Take paracetamol or ibuprofen (not aspirin) up to an hour before you feed your baby to ease pain during breastfeeding.
- Try different feeding positions to avoid pressing on the painful area.
- Use ultra-pure lanolin cream to soothe the soreness.
- Wear breast shells to stop clothing irritating the blister and aid healing via air circulation, or try cooling hydrogel pads to ease pain and encourage healing.
- Try pumping. Using a breast pump may be an alternative way of getting milk without aggravating the blister. Make sure you use a correctly sized breast shield so your nipple can move freely and doesn’t rub against the breast shield tunnel.
- Don’t pop the blister, as this could lead to an infection.
- Seek medical advice if the problem persists and is painful.
Problem 8: I have a painful white dot on my nipple
When the opening of a milk duct becomes blocked with thickened milk, or a thin layer of skin grows over it, this can create a tiny white or yellow spot on the nipple tip. These plugged milk ducts – sometimes known as milk blisters or blebs – can cause localised pain for some mums, especially during feeding or expressing. Others don’t experience any discomfort. White blebs can persist for days or weeks, lasting until the skin eventually breaks and the hardened milk can escape.8
- Follow the advice above for dealing with friction blisters.
- Loosen the blockage if you see the milk plug protruding – try to pull it out gently with very clean fingernails.
- Keep breastfeeding or expressing to try to get the duct working normally again. It won’t harm your baby if the duct unblocks while she’s feeding.
- Apply a hot, wet flannel to the bleb immediately before feeding or pumping to encourage the blocked duct to open. Also try rubbing it briskly with a clean, moist flannel.
- Hand express before feeding to try to push out hardened ‘strings’ of milk. If this doesn’t work, feed or pump as normal. Repeat several times a day.
- Soak a cotton wool ball in olive oil and leave it in your bra next to the nipple with the bleb. It may help to soften the skin.
- Seek medical advice if it persists. A healthcare professional, lactation consultant or breastfeeding specialist can remove the plug with a sterile needle. This should be done after feeding so the bleb is at its most prominent.
Problem 9: My nipples hurt when I breastfeed
It’s normal for your nipples to feel tender, or even sore, in the early stages of breastfeeding, but this usually subsides after a few days. If you’ve had your baby’s latch checked by an expert and the soreness persists, or you experience nipple pain every time you breastfeed, you might need medical help to resolve the problem.2,7
If you have any of these symptoms and signs in one or both breasts, during feeding or afterwards, you could have either a bacterial infection or thrush:
- nipples that burn, itch or sting, either mildly or severely
- nipple pain made worse by wearing clothes that touch your breast
- nipple pain that continues despite making adjustments to how your baby attaches
- nipples that are tender to touch
- stabbing, shooting, burning or deep aching pain
- breast pain that lasts throughout the feed, as well as up to an hour afterwards
- nipples that look bright pink
- a change in the areola’s colour or texture – to bright pink, darkened, dry or flaky
- a white rash on the areola or breast
Also look out for these symptoms and signs in your baby:
- thick, white patches or coating on her tongue
- white spots on her cheeks that you cannot rub off
- a bright red rash with spots on her bottom that does not clear with nappy rash creams
- Seek medical advice. Your healthcare professional will probably want to take swabs of your nipples to find out if there is an infection and, if so, what sort. Bacterial infections are treated differently to thrush (yeast) infections, so getting the right treatment as soon as possible is best. There are other issues that could cause similar nipple pain, including eczema, psoriasis or vasospasm (narrowing of blood vessels) in mums, or a poor latch or tongue-tie in babies, so it’s important to get an accurate diagnosis.
- Practise good hygiene. Wash your hands before and after breastfeeding, applying any treatments, and nappy changes too. Change breast pads frequently, wash your bras, tops and towels at a high temperature, and thoroughly clean breast shields and any items that make contact with your baby’s mouth, such as teats.
- Allow your nipples to dry after feeding, as infections thrive in warm, moist environments.
- Go back to your healthcare professional if there’s no improvement after several days. Don’t leave the problem to get worse.
- Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol# 20: Engorgement. Breastfeed Med. 2009;4(2):111-113.
- Jacobs A et al. S3-guidelines for the treatment of inflammatory breast disease during the lactation period. Geburtshilfe und Frauenheilkunde. 2013;73(12):1202-1208.
- Amir LH. Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol# 4: Mastitis, revised March 2014. Breastfeed Med. 2014;9(5):239-243.
- Kent JC et al. Principles for maintaining or increasing breast milk production. J Obstet, Gynecol, & Neonatal Nurs. 2012;41(1):114-121.
- Amir L. Breastfeeding managing ‘supply’ difficulties. Aust fam physician. 2006;35(9):686.
- Trimeloni L, Spencer J. Diagnosis and management of breast milk oversupply. Journal Am Board Fam Med. 2016;29(1):139-142.
- Berens P et al. Academy of Breastfeeding Medicine. ABM Clinical Protocol# 26: Persistent pain with breastfeeding. Breastfeed Med. 2016;11(2):46-53.
- Australian Breastfeeding Association [Internet] White spot nipple; March 2015 [Accessed 08.02.2018].