What to Expect the First Year (23 page)

• Drain, baby, drain. Make sure the affected breast is thoroughly drained at each feed. Offer it first (assuming baby feeds from both breasts at each meal), and encourage baby to take as much milk as possible. If there still seems to be a significant amount of milk left after nursing (if you can express a stream, rather than just a few drops), express the remaining milk by hand or with a breast pump.

• Keep the pressure off. Be sure your bra isn't too tight and your clothes aren't too constricting on the clogged duct. Rotate your nursing positions to put pressure on different ducts at each nursing.

• Enlist baby for a massage. Positioning your baby's chin so that it massages the clogged duct during suckling will help clear it. Or give yourself a massage while baby's busy nursing.

• Dangle feed. Try breastfeeding while leaning over baby (put baby on the bed and lean over your little one). It might not be the most comfortable position, but the gravity could help in dislodging the plug.

• Sometimes milk that's left on the nipple after a nursing session can dry and crust, causing the outlet of the duct to become clogged. If milk can't flow out the duct because it's plugged up with dried milk, the duct itself can become clogged, causing a red lump. Washing the nipple with warm water can often help clear the crust and the outlet clog.

• Don't stop nursing. Since it's all about draining the clogged duct, now is definitely not the time to wean your baby or to cut back on nursing—which will only make the problem worse.

Occasionally, in spite of best efforts, an infection can develop. If the tender area becomes increasingly painful, hard, and red, and/or if you develop a fever, call your doctor (see next question). If you want more reassurance that the lump isn't something more than a clogged duct, have it checked out by your gynecologist.

“My little guy is a bit of a chomper, but even with my nipples being so cracked and sore, breastfeeding was going pretty well. Until now—one of my breasts is all of a sudden so tender and so sore, worse than when my milk first came in. And I have chills.”

Sounds like mama has mastitis, a breast infection that can happen anytime during lactation but is most common between the second and sixth postpartum weeks. And though he definitely didn't mean any harm, chances are your baby barracuda's aggressive feeding habits may be at least partly responsible for this painful inflammation.

Mastitis usually starts when germs (often from a baby's mouth) enter a milk duct through a crack in the skin of the nipple. Since cracked nipples are more common among first-time breastfeeding moms—not surprisingly, since their nipples are tender newbies, too—so is mastitis.

The symptoms of mastitis include severe soreness, hardness, redness, heat, and swelling over the affected duct, with generalized chills and usually fever of about 101°F to 102°F—though occasionally the only symptoms are fever and fatigue. Since it's important to get prompt medical attention for mastitis, call your practitioner right away if you notice these symptoms, even if you're not sure what the cause is. You'll probably be prescribed lactation-safe antibiotics, bed rest, pain relievers (especially for before feeds), and heat applications. It's always wise to take probiotics during a course of antibiotic treatment to prevent a yeast infection from developing (though don't take the probiotics within two hours of the antibiotics).

Nursing from the infected breast can be extremely painful, but not only is it safe for your baby to feed from it (those were probably his germs to begin with), keeping that milk flowing will prevent clogging and further problems. If your baby doesn't do a thorough job draining the breast at each feeding, empty it by hand or with a pump.

Delay in treating mastitis could lead to the development of a breast abscess, the symptoms of which are excruciating, throbbing pain; swelling, tenderness, and heat in the area of the abscess; and temperature swings between 100°F and 103°F. Treatment generally includes antibiotics and, frequently, surgical drainage under local anesthesia. If you develop an abscess, feeding on that side will have to stop temporarily, though you should continue to empty it with a pump until healing is complete and nursing can resume. In the meantime, baby can continue feeds on the unaffected breast.

“My baby hardly ever wants to feed on my right breast—she only seems to want the left one for some reason. And now my breasts look totally lopsided.”

Some babies play favorites. It could be that your baby's more comfortable cradled in the arm you're more comfortable cradling her in, so she developed a taste for the breast on that side. Or that you got into an early habit of starting her on the left side so that your right hand was free to eat, text, or make another to-do list (or the reverse, if you're left-handed). Either way, a breast that's skimped on can soon become skimpier in size and production—which means there's less in it for baby, who then skimps on it even more. And it sounds like that's the cycle your breasts and baby are caught in.

Whatever the reason, if your baby plays favorites, one of your breasts is bound to come up short—which means you're bound to end up looking pretty lopsided. Though you might try to increase production on the less favored side by pumping daily and/or starting every feeding with it, it's not likely that your breast or your baby will take the bait—typically, once a favorite, always
a favorite. The lopsidedness between your breasts will even out after weaning, though a slightly bigger-than-normal difference may always continue.

“I think I'm coming down with a bug. Can I still breastfeed my baby without her getting sick?”

Not only can't your baby catch a bug through your breast milk—she's actually less likely to catch one because of it. Breast milk doesn't carry germs, but it is packed with powerful antibodies that help your little one defend her brand new immune system from bugs of all varieties.

The rest of you, however, is a different story. You can pass germs along to your baby through other contact with her, a good reason to be even more hyper about hygiene when you're sick. Wash your hands before you touch your baby or her stuff, as well as before feeds—and don't forget to cover sneezes and coughs with a tissue (not your hand). And keep the kisses away from her sweet mouth—and the tiny hands that will find their way into it. If she ends up getting sick despite your best efforts, see the treatment tips starting
here
.

To speed your own recovery as well as keep up your milk supply and your strength while you're down with a cold or other bug, drink extra fluids, continue taking your prenatal vitamin, eat as well as you're able, and take any opportunity you can to get some rest. Check with your doctor before you take any medication, even your standard over-the-counter or herbal remedies.

“I just got my first postpartum period, even though I had my son only 3 months ago. Will getting my period so early have any effect on my milk or my supply?”

Many breastfeeding moms do get a much longer period reprieve—sometimes a year or longer. But almost a third get a break as brief as 3 months before their cycles reset, and that's just as normal.

The start of your periods doesn't mean the end of breastfeeding, or even the beginning of the end. You can expect breastfeeding business pretty much as usual, even while you have your period. Though you may notice a temporary drop in production during your period, continuing to nurse your baby frequently, particularly during the beginning of your cycle, may help give your supply the boost it needs. If not, your supply will return to normal as soon as your hormone levels do.

Some extra-picky babies aren't fans of the slight change in the taste breast milk can pick up when mom has her period, and may be slightly off their feed for a few days. They may nurse less often or less enthusiastically, reject one breast or both, or just be a little more fussy than usual, but that's nothing to stress about. Other babies don't miss a breastfeeding beat during mom's cycle. Another way your cycle may affect breastfeeding: You may find your nipples are more tender during ovulation, during the days before your period, or at both times.

“Now that my baby is 6 weeks old, I'd like to go back to my old workout. But I've heard exercise will make my milk taste sour.”

What you've heard is old news. The new, improved news? Moderate to high-intensity exercise (such as an aerobic routine four or five times a week) doesn't turn milk sour. What's more, a reasonable amount of working out doesn't affect the composition of milk or the production of it.

So by all means, hit the running trail (or the step climber, or the pool). Just be careful not to overdo it, since exercising to the point of exhaustion might increase lactic acid levels enough to sour your milk. To play it extra safe, try to schedule your workout for immediately after a feeding, so that in the very unlikely event that lactic acid levels reach milk-souring heights, they won't affect baby's next meal. Another advantage to exercising right after a feeding: Your breasts won't be as uncomfortably full. If for some reason you can't fit in a feed before an exercise session, try to pump and store your milk ahead of time, and then feed the preexercise milk in a bottle when your baby is ready. And since salty milk doesn't taste any better than sour milk, if you're breastfeeding after a workout, hit the showers first (or, at least, wash the remnants of salty sweat off your breasts).

Keep in mind that if you exercise excessively on a regular basis, you might have trouble maintaining your milk supply. This may have more to do with persistent motion of the breasts and excessive friction of clothes against the nipples than the actual exertion of the exercise. So be sure to wear a firm sports bra made of cotton any time you work out. Also, since strenuous arm exercises can cause clogged milk ducts in some women, pump iron with caution.

Finally, remember to drink a glass of water (or other liquid) before and after a workout to replace any fluid lost while exercising, especially during hot weather.

“I know all about the benefits of breastfeeding, but I'm not sure I want to breastfeed my daughter exclusively. Is it possible to combine breastfeeding and formula feeding?”

Full-time breast may be best for baby, but it isn't always realistic—or even possible—for mama. Sometimes it's the logistics (a busy work schedule, frequent business trips, or other time-consuming obligations) that make exclusive breastfeeding too much of a challenge. Sometimes it's physical—either for mom (maybe multiple breast infections, chronically cracked nipples, or supply issues have taken their toll) or for baby (maybe she's not thriving, despite mom's best efforts, and the doctor has prescribed supplementary formula). And sometimes, full-time breastfeeding just isn't a commitment that a mom feels comfortable taking on.

Either way, there's good news. Breastfeeding isn't an all-or-nothing proposition, as many moms assume—which means a mom who wants to breastfeed her baby (but can't or doesn't want to breastfeed her exclusively) can … by doing the combo. Combining breast milk and formula isn't only possible, for some moms and their babies it provides the best of both feeding methods—and is definitely better by far than giving up on breastfeeding altogether.

There are important things to remember, however, if you're going to “do the combo”:

Put off the bottle.
Try to delay giving your baby a formula bottle until breastfeeding is established—at least 2 to 3 weeks. This way, your milk supply will be built up and your baby will be used to breastfeeding (which takes more effort) before the bottle (which takes less effort) is introduced. The exception: If baby is not thriving and supplementing with formula is medically necessary, putting off the bottle is not wise.

Go slow.
Don't switch to the combo abruptly—instead, make the transition slowly. Introduce the first formula bottle an hour or two after a breastfeeding session (when baby's hungry but not starving). Gradually build up to more frequent bottles and decrease nursing sessions, preferably allowing a few days in between each new bottle addition, until you are offering a bottle instead of a breast every other feeding (or as often as you choose). Taking the slow approach to eliminating a breastfeeding session may help prevent the development of a clogged duct or a breast infection.