Mother’s milk production normally will increase rapidly 3-5 days after delivery for about 3-5 weeks, or until milk supply is established.  It is common to have engorgement in the first couple weeks because once your first milk colostrum changes to mature milk, your body has to adjust with baby’s needs. The principle is: the more you feed your baby the more milk you will produce.

With engorgement, mother’s breasts usually become hard and swelling along with discomfort and pains. Some mothers may have light fever. However, as long as you breastfeed baby frequently, it will eventually go away after few days.  Try to express some milk before the next nursing session because it can help to soften the areola; otherwise, baby may have difficult time to latch on a firm breast.

Here are some tips on relieve engorgement pain:

• Hand express breast milk between feedings: push the breast area behind the nipple slowly and gently;
• Use breast pump: Medela offers many types of quality breast pumps. When use breast pump to relieve pain, never pump for more than three minutes each breast; as it will stimulate your milk production that may worsen your engorgement;
• Use ice pack or frozen cabbage leaves can relieve discomfort of engorgement;
• Once express some breast milk before feeding, massage breasts gently for about 30-60 seconds, it helps to soften the breast.

In addition, with engorgement, your milk flow maybe too fast for a newborn to swallow which can cause her to gag or sometimes push your breast away. In order to cope flow rate of your breast milk with baby, make sure allowing baby to take many breaks as she wants to during one nursing session.  Hand-express or pump out some breast milk prior to nursing. This will not only soften your areola but also slow down the initial breast milk flow.

When you feel you may not be able to breastfeed your baby due to engorgement, make sure talk to your doctor or lactation consultant for help.

Nevertheless, breastfeeding should not be painful or discomfort. It is actually a very enjoyable bonding process between you and your baby.

Sore/Painful/Bleeding/Cracked Nipples

Normally, nipples started to be sensitive during the last trimester of your pregnancy. The sensitivity will gradually become stronger and stronger, but it will disappear normally after the first week of delivery.  In the first few days of breastfeeding, it is very common to feel sore once baby latches on your nipple. However, it will only last for about one minute maximum and you will slowly feel less and less sore, and then eventually disappears after a few minutes.

On the other hand, if baby latches on in a wrong way, such as she only takes a small portion of the area behind your nipple into her mouth; you probably will feel painful throughout a nursing session and it may cause you nipple crack, blister or bruise. More severely, you may develop a breast infection to some degree.

There are many ways of preventing and treating sore nipples including:

• Use lukewarm water clean your nipple before and after each nursing session, then express some breast milk and place it on the nipples. Let them air dry before put on your nursing bra;
• Apply some nipple cream after each nursing session, Lansinoh and Purelan 100 are the best creams in healing injured nipples;
• Use nipple shields (everyone is different, some people may not like the feeling of wearing a pair of shields)
• Assess whether your baby’s latching-on position is correct.

Mastitis

Mastitis is generally caused by infection. Breastfeeding mothers who have mastitis typically have a hard, red and swollen area of one breast and likely get a fever (38-39.5 ºC).

Consult your doctor immediately if you notice you may have mastitis. Your doctor may prescribe you some antibiotics for about one to two weeks. Your infections unlikely will pass to your baby; however, she may have severe diarrhea. In this case, change your baby’s diaper frequently in order to prevent diaper rash. Meanwhile, mothers can also take some probiotic supplement because it may help curing baby’s diarrhea.

Here is a good article on “Breastfeeding and Sore Nipples” by Dr. Verity Livingstone.

Majority of new mothers may experience hard time getting started with breastfeeding; as a result, they give up breastfeeding after trying for the first few days or weeks. Dad’s encouragement reassures the new mother feels much more confident in her decision of nursing her baby.

Here are some tips for dad to help mommy to succeed in breastfeeding:

• The first important step dad needs to do—attend parental class and breastfeeding clinic with mother before baby’s birth.  (Once daddy is knowledge of the benefit of breastfeeding for mother and child, the potential pains mother may experience such as sore nipple and engorgement, mood swing and postpartum depression;  he soon may realize that breastfeeding is not just for mother, it has become a family matter and requires a team work);
• Set up a comfortable nursing area for mother with some soft supporting pillows and a foot stool;
• Make sure there is always a cup of water, juice or milk beside mommy’s nursing chair as she may feel thirsty while nursing;
• Try prepare nutritious meal for mother as it is very important for mother’s milk production and the quality of the breast milk;
• Help newborn to latch on mother’s nipple in the first few days. (Both mother and baby are learning the breastfeeding process during the early days and weeks, if baby does not latch right, it may cause mother’s nipple sore, bleeding or very painful while breastfeeding);
• Mother needs to get up every 1-3 hours at night to breastfeed newborn during the first few weeks. Daddy may help to wake up baby and change her diaper first and then bring her to the mother, so mother may have time to prepare for breastfeeding.
• Baby tends to be colicky in the first few weeks, she many cry for hours. This is perfect time for daddy bonding with his baby. Cuddle the baby and have mommy taking a hot shower to relieve engorgement or sleeps in another room for couple hours before she nurses again. Good rest is very important for breastfeeding mother;
• Encourage mother when she faces discomfort or difficulties while breastfeeding. Praise her by saying “honey, you are doing a great job”, “you are the best mom ever”, “I love you honey and I am so proud of you”.

In sum, dad’s support in breastfeeding is very critical because he is the person knows the mother and the baby the best and be with them the most.

• What is my lifestyle? For example, do you always drink alcohol with each meal? Do you go to sleep late and get up late as well? Do you smoking? Do you love to eat spicy or Szechuan cuisine? Breastfeeding is a big commitment. You have to be available to your baby 24/7. Especially for the first three months, when baby sleeps, it is your time to sleep as well. You cannot drink alcohol or eat too much spicy food if you decide to breastfeed your baby exclusively.
• Do I want to spend four to eight hours each day to feed my baby?
• Is my partner supportive? For example, does he want to help me changing baby’s diaper at night? Can he cook and do groceries for the family? If I have mood swings or depression during postpartum, will he understand me? Will he help me to recover?
• Do I want to breastfeed; or breastfeed and occasionally bottle feed with pumped breast milk or formula; or just bottle feed with formula?
• How long do you want to breastfeed your baby? Three months, six months, a year or maybe even two years?

Breastfeeding is really a personal choice. If you are comfortable with breastfeeding, go ahead. If not, do not force yourself to do it because everyone tells you breastfeeding is good for your baby. It is YOUR decision.