Engorged breasts

When breast milk first comes in, the breasts may feel hot, swollen, lumpy, heavy and hard.

• If this happens you should feed your baby often. Engorgement is less likely to happen if you feed your baby frequently when your baby wants to, day and night, from birth.
• If feeding does not make your breasts feel any better, your midwife can show you how to express some milk from your breasts.
• After a few days, your breasts will feel less full even though you are still making plenty of milk.
• Apply a warm washer to the breast, or have a warm shower before a feed, for comfort and to help the milk flow.
• Use cold packs or washed cabbage leaves after a feed to reduce inflammation.
• Remove your bra before breastfeeding (and leave it off).
• Gently massage the breast in a downward motion from the chest wall toward the nipple while your baby is feeding.

Sore nipples

Sore nipples are a problem for some new mothers. This usually happens because the baby is not attached to the breast properly. Breastfeeding should not be painful.

• Sometimes the nipple may be sore (or tingling) at the beginning of a feed for a few sucks, but if the soreness lasts longer than this, it means the baby is not on the breast properly.
• If you find your nipples are starting to get sore, ask your midwife to watch you feed and to help you get the baby on properly each time you feed.
• If your baby continues to feed in a poor position, you may end up with cracked nipples, which can be very painful.

If you have sore nipples, wash them with water after every feed and allow them to dry. You can use a sterile nipple shield to protect them.

You can take painkillers, but talk to your doctor or pharmacist first. Many household remedies are ineffective or harmful.

If your nipples are too sore, you may take your baby off the breast for 24 to 48 hours to rest the nipple, then gradually reintroduce feeds. Ask a midwife to help you.

Watch this video for advice on good attachment.

Breastfeeding a premature or sick baby

Breast milk is easier than formula for babies to digest — especially premature babies. It helps the baby's immune system, and has special qualities that benefit premature babies. Even the smallest amount will help the baby.

In neonatal intensive care units and special care nurseries, staff are aware of the importance of skin-to-skin contact and breast milk, and encourage mothers to provide breast milk for their babies.

If you have a premature or sick baby, you will need to start expressing milk as soon as possible after the birth, and to do it as often as your baby will feed (6 to 8 times a day at least).

In the first day or 2, you will only be able to express a small amount of milk (colostrum); then your milk will ‘come in’, and the amount you can express will increase.

When your baby is strong enough to start sucking, the nursery staff will show you how to help and encourage your baby to feed from the breast.

Expressing milk and then trying to feed premature babies is hard work and often mothers are not able to fully feed their baby.

Smoking

Cigarette smoking can decrease milk supply and the chemicals in smoke can cause health problems for babies. For example, nicotine is absorbed into a mother's bloodstream and passes into breast milk.

• If you cannot give up smoking, try to cut down the amount you smoke.
• Do not smoke during a feed — apart from the harm of the smoke, there is a danger of hot ash burning the baby.
• Do not let anyone smoke near a baby because the baby will breathe in the smoke. This is called 'passive smoking'.

If you quit smoking:

• no tobacco poisons are passed to the baby through breast milk
• you will produce more breast milk
• your baby will feed better

If you do continue to smoke while breastfeeding, then it is better to smoke after you have fed rather than before or during a feed.

For more information on how to quit smoking, visit the Quitnow website, or contact Quitline on 13 7848.

Drinking alcohol

If you drink alcohol when you are breastfeeding, some of the alcohol will get into your milk. The amount of alcohol in your breast milk will be almost the same as in your blood.

Therefore, it is best not to drink any alcohol while you are breastfeeding. But if you do want to have an alcoholic drink, make sure you do so after you breastfeed your baby.

You need to plan ahead. As a general rule, it takes 2 hours for an average woman to get rid of the alcohol from one standard alcoholic drink. The time is taken from the start of drinking. You can use the to work out when it is safe to feed your baby after drinking alcohol.

The occasional drink is not harmful. Drinking a lot or very often can be dangerous for the baby.

Breastfeeding help and support

Breastfeeding support and advice can be sought from other mothers and from a range of health professionals including midwives, baby health nurses, Australian Breastfeeding Association counsellors, lactation consultants and doctors.

Australian Breastfeeding Association (ABA)

The Australian Breastfeeding Association offers mother-to-mother support and encouragement to breastfeed. It also provides counselling from trained ABA counsellors, a newsletter, a library and other activities. ABA support is available in all states and territories of Australia.

The website Breastfeeding Australia Association is an excellent source of useful hints and information. One feature is information for fathers. It provides an email counselling service and links to other breastfeeding sites.

You can get more information from:

• Pregnancy, Birth and Baby on 1800 882 436.
• The Australian Breastfeeding Association's National Breastfeeding Helpline on 1800 686 268.
• Child and family health services provided by your state or territory government.
• Parent helplines in your state or territory.
• Chat to a Tresilian nurse online.