as possible and having a good seal, not a ‘gappy’ one, and keeping the nose clear from obstruction.
When they have finished, squeeze out some hind milk and gently rub it into the nipple to help soothe and protect it. Using breastfeeding gels before and after feeding may also help make you more comfortable. Also, don’t over-wash the breasts as this may actually be a cause of soreness.
Trust Yourself
Aching Back? Maybe You Need a Bigger Bra
The size of your breasts increases as the milk comes in, and many women go up several cup sizes. Having an ill-fitting bra can cause backache. A loose-fitting bra to begin with for your hospital bag and wearing around the house is fine until you feel like a trip out to get properly fitted.
Cracked nipples
If your nipples are very sore and using expressed breast milk or gel is not sufficient, then you may need to get a prescription for cream to heal the nipples. Any cream you use will need to be washed off before feeding the baby so they are fiddly and more time-consuming than using gel or hind milk. But sometimes if you use a cream for just 24 hours and let plenty of air get to the breasts, the nipple will heal a lot faster.
If you are suffering, using a cream to heal faster is well worth the bother, and much better in the long run than feeding on a very sore breast. Apply the cream in a thick layer, then wipe off with damp cotton wool before you feed your baby. I know this can be a real pain during night feeds, but do make sure it’s all gone, as the baby should not ingest any of the cream.
While the nipple is healing you may want to breastfeed on only one side and express milk from the sore breast, just until it is comfortable to feed again.
If you are diagnosed with thrush, then not only will you need to finish any course of treatment to clear the infection but the baby will need to take oral medication as well (see also the A–Z section for more about thrush).
Blocked ducts
You may notice a small tender lump in your breast that could indicate a blocked duct. Try massaging the breast or using the warmth from a covered hot water bottle or warmed pad to help to disperse it. You may find this works best if you gently massage the breast to unblock the duct while you are in the bath or shower. This is best done after a feed; a good feed will help to empty the affected breast and clear the blockage. If a blocked duct does not clear it may lead to mastitis, so ask your health visitor or doctor for further advice at the earliest opportunity.
Mastitis
Mastitis can be a mild or severe inflammation of the breast and sometimes can cause fever and vomiting. If the breasts are painful and swollen and/or hot and red, you may have mastitis. Seek medical advice as soon as you notice the symptoms, especially if you have flu-like symptoms and are feeling hot and cold with achy joints and feeling generally unwell. Your doctor may prescribe some antibiotics if the mastitis has become infected. Only take medication as instructed by your health practitioner.
Drink lots of fluids and try using warm packs, or sometimes an ice pack can help, or even a small quantity of frozen peas in a plastic bag wrapped in a clean towel (remember not to eat the peas later on, though you could label them and refreeze for medicinal use again).
Do keep feeding the baby if you can, and check the position for breastfeeding and how the baby latches on to ensure you’re going to be as comfortable as possible. (Revisit the Latching Techniques and positioning advice earlier in this chapter to double-check.)
Expressing breast milk (EBM)
You can express breast milk either by hand or by using a hand or electric pump so that your baby can get their milk from a sterilised bottle, cup or spoon rather than at the breast for a feed.
It is usually preferable to feed your baby at the breast and not to express milk in the early days but it may be something you want to do for a short time if you are experiencing sore nipples or you are separated from your baby. You may not be able to meet all your baby’s milk needs through EBM alone but it can be a useful supplement alongside breastfeeding or for babies who are in a special care baby unit.
Breastfeeding Shopping List
Breast pads
Nipple gel or cream
Freezer bags
Steriliser
Breast pump
Bottles
Bottle brush
Nipple shields
Breastfeeding tops, dresses, cardigans
A shawl
Feeding pillow
Muslin
Breastfed babies need to get milk from both breasts as often as possible to establish and increase the supply of breast milk with frequent sucking. It is very unlikely that a mother can express the same amount of milk for her baby that feeding at the breast delivers, so unless there are special circumstances, like the baby being in a special care unit, I would advise that you feed from the breasts for the first two weeks or so to get the milk supply established.
If a baby is premature or poorly and is in a special care unit, a mum has no other choice than to use EBM if they are not allowed to put the baby to the breast. Whatever your circumstances are, expressing breast milk is hard work. It often gives you flexibility, but some women find it draining, and you will need even more sustenance to both express and also breastfeed.
EBM can be really handy to have in the fridge when your baby is demanding huge amounts of milk in the night; giving your breasts a rest, and if your partner takes over it’ll give you a rest, too. Expressing milk does mean extra washing and sterilising of bottles and equipment (this is often a good job for your partner to take on; have a look at Chapter 2 to find out how to sterilise bottles and equipment). Many mums find that expressing after a feed works best. This milk can either be chilled in the fridge for up to 48 hours or frozen for up to three months for later use.
Pumps can be bought at the pharmacy, and some breastfeeding organisations lend out pumps, usually for a small charge, as electric pumps are expensive.
There are many pumps on the market but the important thing to remember is that they must be sterilised before each use and you will need to follow the instructions for correct assembly and usage. This is a job your partner could take responsibility for, as the pump needs to be ‘built’ before each use, and it is much better to be handed the pump sterilised, assembled and ready to go. Even if you prefer to express whilst your partner is at work, they could always get it ready for you before they go in the morning.
Leaking milk
Leaking varies enormously for many women: some mums find a crying baby (not always their own) causes leaking and can’t leave the house without breast pads; other women have only a little leak now and then. Most women do need to use breast pads inserted in their bra to cope with leaking between feeds in the first months of breastfeeding, as this is when milk production is highest.
When there have been some hours between feeds, leaking is often copious and the first feed of the morning may soak your clothes whilst you are feeding from the first side, so it can be helpful to insert a muslin (soft cotton) cloth into your nightdress or top
