Mother's milk - Breastfeeding 101 - Part II (Cracked Nipples)

BREAST FEEDING 101

When things start to go awry, as they do and eventually will. Remember this...

"This too shall pass... 

only to give way for the next crappy thing to happen... but eventually that too will pass and you'll be breastfeeding with the best of them!"

With that I will attempt to draw from the deepest trenches of my memory all the things that went wrong first on the path to breastfeeding my baby...

CRACKED NIPPLES

 

 

hypothetical pictures of cracked nipples... not mine thankfully

This horrible affliction started rearing its ugly head around day 4. It isn't easy to recognise at first because new mom's tend to feel like sore nipples are a right of passage and so don't act at the first warning sign of pain. A baby's suck should not be painful, and if it is, you are about to get cracked nipples. Someone did tell me this before but I think the difficulty arises when you're really not sure what to do or when the pain is bad enough to start panicking.

These are the steps I was taught to follow eventually:

1. Correct your latch Correct your latch Correct your latch (see http://hushabymom.blogspot.com/2012/03/mothers-milk-breastfeeding-101-part-i.html )

2. Start using the correct nipple cream. Not every nipple problem will be sorted by using a bit of Lansinoh or Bepanthen, though most will be helped, sometimes you need an antibiotic cream, a cortisone cream or an antifungal cream. What I needed was a combination, a cream called All Purpose Nipple Cream  It has to be prescribed by your doctor, though most have never heard of it. I sent the recipe to my doctor and had him write me a script. I used the cream after every feed till my nipples started healing then alternate feeds and eventually once a day. There is no need to wipe it off before a feed as the dosages of steroid or antibiotic is so low, it won't affect your baby. I also used Calendula pillules in homeopathic concentration as well as homeopathic Herbaforce Graze and Weeping powder (usually used for keeping baby bellybuttons clean and dry)

3. Try to feed baby on the other side for a bit first, before feeding on the cracked nipple. Babies will suck more gently if they're less hungry, easing the strain on the nipple.

4. Air your breasts. I spent the better part of 2 weeks walking around my home topless, holding a bra under my breasts to catch the leaking milk. At night I slept topless with a towel around my waist and linen savers on the bed. Alternatively buy something called breast shells. They cover your nipples under your bra and even catch milk to be used later if you want.

5. If it is unbearable and you're bleeding everywhere, including your baby's mouth. rest your nipples by using a breast shield while feeding. Do not be tempted to buy a cheap one. I tried 4 different kinds and eventually the best one was the large Medela brand. Wearing it is supposed to take the pain away completely but cannot be worn for too long. So after about 3 days rest, take the shield off for alternate feeds for a day or 2 before weaning completely off.

6. If you are able to, get to a physiotherapist or get one to come to you with a lazer machine. I had mine lazered twice in hospital before I was discharged and then again after the cracked nippled recurred a few days later. Feeding will be painless after lazer, but if you don't correct that latch, it will be back in full force very quickly. My physiotherapist was Ruth Katzman, as you will read, I recommend her with all my heart.

7. Alternative feeding. Obviously you want to avoid this as long as you can while you baby is still learning to latch correctly, but if things get so bad that you become depressed or can't handle the pain, give your nipple a break for a day or 2. Luckily I only had one cracked nipple so I fed with the good side then at the next feed I rested and gave expressed milk, then fed the good side again at next feed. ask dr sears has an excellent article about alternative feeding methods. Remember that all equipment used to feed must be sterilised first.

I started by cup feeding, using the top of a small bottle. Baby really struggled and fought the cup. We also tried a proper feeding cup that was given to me by our physiotherapist, that was only slightly better. I then tried to feed her with a syringe, the difficulty with that was that I couldn't control the amount of milk being forced out and ended up spilling most of the milk and baby nearly choked. If you do try syringe feeding, I would recommend using a very small syringe, even an insulin size one (without the needle of course) and feeding slowly through the corner of baby's mouth.I also attempted spoon feeding, but it took too long and we spilled so much of the milk that I had to express more than double what I needed. I finally resorted to having to bottle feed, but only did this once a day and used a nipple shield for the rest of the day. Please read my entry on bottle feeding before choosing this route, as tempting as it may be, be sure it's something you want to risk.

8. Take drugs! Pain restricts healing and is a definite trigger for depression. The best kind of over-the-counter relief is Ibuprofen. Don't be tempted to use anything with Codeine, it's favourite side effect, constipation is a fate worse than death at this stage (especially if you've had an episiotomy or vaginal tear) Ibuprofen is fine in lactation and is a very effective anti-inflammatory. I used Voltaren in conjunction with Paracetomol every 8 hours.

9. Try different feeding positions. Another position could ease the strain on your nipple, but that still doesn't mean you shouldn't work hard at correcting your latch!

9. If things still don't get better, see your doctor. You may have a deep nipple infection that the antibiotic ointment cannot sort out. This could lead to mastitis so don't ignore it if you have pus or a lot of redness around the crack.

Remember this....

Cracked nipples are no reason to stop breast feeding! It won't harm baby, not even if you or have an infection and not even if she's swallowing some blood, the only thing that may harm her is if she isn't getting enough milk, so be sure to get the help you need when you need it.

Don't forget to share your breastfeeding make or break moments in the comment box

“I know what I have given you... I do not know what you have received.”
― Antonio Porchia