As a registered nurse, internationally board-certified lactation consultant (IBCLC), and mother of 4, I understand the joys and challenges that come with breastfeeding and pumping. It’s a beautiful and natural way to nourish your baby, but it can also be accompanied by various complications that can leave parents feeling overwhelmed and defeated. In this comprehensive guide, we will explore common breastfeeding complications including milk blisters, ductal narrowing, engorgement, mastitis, thrush, and Raynaud’s phenomenon. Whether you are exclusively breastfeeding, pumping, or practicing combo feeding, this information is tailored to help you on your breastfeeding/pumping journey.
Milk blisters, also known as blebs, present as a white/yellow colored spot on the nipple and almost resembles a pimple. This happens when ductal inflammatory cells move to the outside of the nipple and essentially clog the nipple pore, blocking milk flow. Trying to open or pop a bleb is discouraged as this could cause trauma and make the passageway inside the duct even smaller. Some ways to manage this include applying cool compresses on the nipple, nursing from the unaffected breast first, nurse or pump according to baby’s demand (no extra pumping) and managing oversupply. Other pharmacological interventions, with a healthcare provider’s approval and/or prescription, can include taking oral lecithin capsules or applying a topical steroid cream to reduce inflammation. Using a topical steroid cream is safe for breastfeeding and can be wiped off with a tissue or wash cloth prior to breastfeeding. As always, please consult with your healthcare provider or lactation consultant prior to starting any medications/supplements.
Engorgement is a common issue that many breastfeeding parents encounter. Early postpartum engorgement is a process of your milk increasing or “coming in” along with increased blood flow and swelling between the cells in the breasts. This typically occurs between days 3-5 postpartum but can also occur as late as 9-10 days postpartum depending on your background and history. Factors that can affect how soon or how late you experience your milk increasing include (not all inclusive) how many babies you have birthed, if you breastfed before, or if you experienced any labor & delivery complications. Engorgement can also occur when there are prolonged periods between feeds. Symptoms of engorgement include breast pain, fullness, swelling, areolas that feel firm and/or appear swollen, a puffy areola (rather than firm), is thought to be due to tissue swelling possibly contributed by IV fluids given during labor and delivery.
Some ways to manage engorgement include nursing baby on demand (do not nurse or pump more than what baby needs). If needed, hand express or pump small volumes: prior to nursing to help baby latch, and/or after nursing to soften the breast to comfort. Applying cool compresses after nursing will help to alleviate pain and inflammation. Breast massage, lymphatic drainage, and reverse pressure softening are techniques to decrease swelling and excess fluids surrounding the breasts and areolas. Over the counter pain relievers and anti-inflammatories can also help manage the discomforts of engorgement.
Clogged/plugged ducts are now termed ductal narrowing. Current research has shown that a “clogged duct” is not a collection of a “milk plug,” but rather an inflammation and narrowing of the milk ducts related to the expansion of milk sacs or an imbalance in the bacteria in the breasts. Ductal narrowing can present as a hard lump in the breast which is often painful and tender. It may feel hot and look mildly red or swollen. Management strategies include applying cool compresses before and after feeds, medications to reduce inflammation, rest, nursing on demand (again, do not pump or nurse in excess), starting with nursing on the unaffected breast first, then switching to the affected breast and gentle breast massage only, if at all. Avoid aggressive breast massage as this can increase inflammation and tissue damage. The goal to relieve ductal narrowing is to reduce inflammation/swelling and temporarily decrease milk production just slightly, on the affected side. This is because more milk production can equal more inflammation and congestion in an already inflamed breast.
When symptoms of ductal narrowing worsen with increased pain and redness, low grade fever, flu-like body aches and/or general fatigue, and persists for greater than 24 hours, it may progress to mastitis. Mastitis is a painful inflammation of the breast tissue often requiring a visit with your healthcare provider and initiation of antibiotics. Potential causes of mastitis are oversupply, milk stasis, infection (from cracked or bleeding nipples), stress, fatigue, weakened immune system, altered maternal gut microbiome, or previous history of mastitis. Management strategies include continuing to nurse on demand (milk may taste salty so some babies may resist or refuse to nurse temporarily). If baby refuses to nurse, pumping should be initiated, but only as often as baby demands (no extra pumping) and this pumped milk should be paced bottle fed to baby. By doing this we ensure that the baby is fed, maternal milk supply is protected and the risk for further breast complications is reduced. Other treatments are the same as for ductal narrowing such as cool compresses, gentle massage, pain relievers/anti-inflammatories.
Thrush, a fungal infection caused by Candida Albicans yeast, can significantly affect breastfeeding mothers and their infants. When a mother and baby contract thrush, it can lead to discomfort and complications during nursing. Symptoms of thrush in mothers often include nipple pain or burning sensation, itching, and sometimes sharp shooting pain deep within the breast. Babies may exhibit signs such as fussiness during feeding, refusing the breast, white patches in their mouth that do not easily wipe away, or a diaper rash with a red scalded bottom. Managing thrush typically involves antifungal medications for both mother and baby, ensuring proper hygiene, and frequently washing and sterilizing any items that come into contact with mother’s breasts and the baby’s mouth, such as breast pump parts, breast pads, bras, pacifiers, and bottles. Probiotics may be taken to help support maternal gut microbiome. It’s essential for both mother and baby to be treated simultaneously, even if only one displays symptoms, to prevent reinfection.
RAYNAUD’S PHENOMENON AND VASOSPASM
Raynaud’s syndrome is a condition where blood vessels in the nipples constrict or narrow excessively in response to cold or stress, leading to decreased blood flow, which is called a vasospasm. This can cause significant discomfort and pain during breastfeeding or pumping. Symptoms typically include sharp, burning, or throbbing pain in the nipples, which can occur before, during, or after nursing sessions. Nipple color changes, such as turning white, blue, or purple, are also common. To manage Raynaud’s syndrome while breastfeeding, mothers are advised to keep their nipples warm, use warm compresses before and after feeding, and wear well-insulated clothing. Stress reduction techniques can also be beneficial. In severe cases, healthcare professionals may recommend medications or dietary supplements to improve blood circulation.
Ultimately, breastfeeding and pumping is a unique and extremely rewarding experience, but it’s essential to be informed and prepared for the potential challenges along the way. As a parent, I know life can throw some curve balls just when everything is getting back to “normal,” or your “new normal.” By understanding and addressing common complications like milk blisters, ductal narrowing, engorgement, mastitis, thrush and vasospasms, you can navigate your breastfeeding/pumping journey with confidence. Parents remember this; you have access to valuable resources and support to help you succeed in providing the best nutrition for your baby while ensuring your well-being. As you continue your infant feeding and parenting journey, always consult with healthcare professionals, including lactation consultants, to address specific concerns and tailor solutions to your unique needs. I know it’s very cliché, but I genuinely believe knowledge is power! You got this!
https://www.bfmed.org/protocols, Mastitis Spectrum #36, 2022