As you begin to build your breast milk volume, you will feel changes in your breasts. Between Day 2 and Day 3, you will notice that your breasts feel warmer to the touch and the breast tissue feels denser when squeezed (compressed). Between Day 3 and 5, your breasts will feel fuller as your breast milk volume builds. As your baby requires more milk and demands more nursings, your breasts will produce more milk. Breastfeeding works on the principle of demand and supply. The more milk your baby demands, the more breast milk your breasts will supply for feedings.
During the first week of breastfeeding, some women notice engorgement or edema. Engorgement/edema is swelling of the breast tissue along with the mik volume building. This breast tissue swelling can cause the breast to be hard and firm. At times, this hard firm swelling can result in difficulty with latching the baby due to the swelling and fimrness of the areola and the resulting flattening of the nipple. In the past, warm compresses prior to latching were recommended, but some women found that the warmth actually increased the tissue's swelling. The current recommendation is the use of ice. The engorgement/edema will usually reabsorb within about 48 hours if you follow the suggestions below:
If your nipple is not available for your baby to grasp, gently pump your breast just long enough to form a nipple and soften the areola, then swiftly latch the baby to your breast. During the feeding, gently massage the entire surface of your breast with long soft feather-like strokes towards baby's mouth or use gentle breast compressions during baby's active suckling to help your milk flow throught the swollen breast tissues. Discontinue breast massage or compressions if uncomfortable. After nursing, you may still feel firm breast tissue due to the unabsorbed tissue swelling. Ice bags or cool cabbage leaf compresses will help relieve this swelling.
Place 4 to 6 large bags of frozen peas or ice bags over and around both breasts including your armpits. Place the ice over a layer of clothing not directly on your skin (avoid freezer burn). Leave ice bags in place for 10 minutes, remove for 10 minutes, reapply for 10 minutes, remove for 10 minutes -- repeat on and off the breasts until the next breastfeeding. If the tissue swelling is still present -- repeat use of ice bags on and off your breasts until the next breastfeeding. Continue applying the ice bags and evaluating your breasts response until the breast tissue is comfortable after nursing. Then discontinue the use of ice.
Cool green cabbage leaf compresses are also used to relieve engorgement/edema. Use enough fresh cool leaves to cover the skin of both breasts and armpits. Hold the leaves in place with your bra and wear the leaves continuously until the next breastfeeding. Remove leaves and discard before breastfeeding. Reapply the leaves after each nursing and evaluate how your breasts feel after breastfeeding. As soon as your breasts feel relieved/comfortable after breastfeeding, discontinue the use of cool green cabbage leaf compresses to avoid decreasing your milk supply. Use the cool green cabbage leaves only to relieve engorgement/edema not to decrease milk volume.
Fullness is due to the breasts filling with milk between breastfeedings. As the lobules in the breast fill with milk, the breasts feel full and lumpy. Some mothers notice certain areas of their breasts not draining well afte nursing, especially the top and outer portions of their breasts. Massaging with soft gentle feather-like strokes from your neck towards the baby's face and from your armpit towards the baby's face while baby is suckling may help to drain these ovefull areas. Gentle breast compressions (squeezing while baby actively suckles) during the nursings may also be helpful As your baby drinks your milk and your breasts empty, the production of more breast milk is stimulated. If you baby does not drink enought to make your breasts comfortable, please take care of your uncomfortable breasts. Avoid a breast infection by use of ice bags/cool green cabbage leaf compresses (see engorgement/edema) or pump your breasts just until comfortable and store pumped breast milk for later use.
Mastitis is a bacterial infection in your breast tissue, not in your breast milk. By continuing to breast feed, you will pass on antibodies to you baby in your breast milk. Symptoms are a very sore angry breast plus either a fever of 100 degrees or higher and/or flu-like symptoms. Call your physician and a lactation consultant immediately for advice. Remind your physician that you are a breastfeeding mother and prefer treatment that is safe while breastfeeding.
Antibiotics are usually prescribed to treat this infection. Follow the directions carefully and take all the medication prescribed, even if you feel better fast. The usual course of treatment is 10-14 days. If you are not beginning to feel much better after taking the medication for 2 days, recall your physician and discuss the possibility of needing a different and more effective antibiotic. If you have any concerns about taking a medication while breastfeeding, call your baby's physician, you own physician, and/or lactation consultant for updated information on the medication. Ibuprofen or acetominophen may help relieve discomfort -- follow directions on label for dosage.
Rest is essential during mastitis, especially for the first 2 days. Ask family and friends to help with toddlers, older children, errands, and preparing meals. Ignore everyday chores, if possible. Rest in bed with your baby in the cradle within easy reach. Keep very well hydrated. Allow your body time to heal.
Some mothers find that soaking the affected breast in a extra large bowl of very wam water for 5 mnutes prior to breastfeeding, is very soothing. Some mothers find that the warm soaks actually increases the breast discomfort. Experiment. If soothing, then soak; if not soothing, do not soak. Gentle breast compressions (squeezing while baby actively suckles -- TMJ movement, slight pause noted between wide jaw opening and closing) may help the milk flow throught the ducts surrounded by the infected breast tissue.
After nursing, place ice bags/bags of frozen peas, over a layer of clothing covering the affected area of your breast for 10 minutes, then remove for 10 minutes. If the cool is soothing, repeat on and off in 10 minute periods until the next breastfeeding. If possible, continue between breastfeedings until the infected breast tissue is no longer "angry". When your breast is comfortable, discontinue the use of warm soaks and/or ice bags/peas.
Breast milk during a breast infection may have a salty taste and have the odor and taste of the antibiotic. Some babies need to become accustomed to the change in flavor and smell of their breast milk. Keeping yourself well hydrated will dilute this new flavor and make baby's acceptance of the change easier.
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