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Breast pain - help!

Posted by on Dec. 20, 2012 at 10:22 PM
  • 22 Replies
1 mom liked this

Friday morning update:  I nursed this morning on the left side using the biological position.  There was no immediate pain like there has been, but as the nursing session went on, the pain started to develop and now about an hour after the session has ended, i am feeling pain in the breast (none right now in the nipple).  The position didn't keep her from coming off the breast, but I was rather full so I don't know if that contributes to that.  It sounds like she is still getting a poor latch, but I am unsure how to correct this.  Any support/suggestions would be helpful.


I am nearly 8 weeks pp and I am having a lot of pain in my left breast.  Let me get you up to speed.

I had a HORRIBLE latch in the beginning.  both nipples scabbed, but healed within the first week.  I was having no problems on the right side.  However, on the left side it was still painful.  I went to a bf support group at my hospital when DD was 3 weeks old and they couldn't find a problem, but thought that it could just be residual pain from the poor latch, as her latch looked fine.

A friend was here 2 weeks ago and I mentioned how it still hurt a little on the left side and she said it sounded like a bad latch and gave me some pointers.  So I worked on that.  I *think* the reason for the bad latch is that she comes off multiple times during a feeding due to strong letdown.  So she comes off and goes back on, not always easy to get her to latch on correctly each time.

It was feeling a little better until earlier this week when the pain got so bad in my left breast that my DH was going to take me to the ER; however, I wasn't going to take a 5 yo and a newborn to the ER in the middle of the night.  I called my OB office the next morning and spoke to the nurse and made an appointment.  Based on what I told her (no fever or red streaking, just pain) she thought it wasn't mastitis but just a yeast infection and made an appointment for me yesterday to see the (male) dr.

I went yesterday and after a very brief exam, he determined that I didn't have a yeast infection or mastitis and sent me for a breast ultrasound.  The breast ultrasound came back normal and the dr at the breast center said to call my dr if I was still having pain.

So I am turning to you - what *could* this be?  What could I do to help?  I have no fever or streaking still.  I think I am allowing a bad latch to happen since there is pain upon latching and I hesitate and don't put DD on.  The pain when I am latching, even before the poor latching again, was extreme, down to my toes, curling, bad.  It would go away once the nursing got into a rhythm.  The pain is there after I finish nursing and there is some tenderness on my breast.  Any ideas?

by on Dec. 20, 2012 at 10:22 PM
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Replies (1-10):
maggiemom2000
by on Dec. 20, 2012 at 10:36 PM

Is the pain in your nipple, or is it a deeper breast pain?

Have you been on antibiotics recently?

How does your nipple look after baby breastfeeds? Is it flattened on one side?

NHGal
by on Dec. 20, 2012 at 11:05 PM


Quoting maggiemom2000:

Is the pain in your nipple, or is it a deeper breast pain?  Both - pain in my nipple when I start and then deeper breast pain after.

Have you been on antibiotics recently? Nope

How does your nipple look after baby breastfeeds? Is it flattened on one side? I don't think so.  The tip is generally white though, not sure if that matters.


K8wizzo
by Kate on Dec. 20, 2012 at 11:11 PM

Nipple blanching and vasospasm

JULY 27, 2011. Posted in: BF CONCERNS: MOTHER

By Kelly Bonyata, BS, IBCLC

Nipple blanching (turning white) after a feeding occurs when the blood flow to the nipple is limited or cut off. Blanching is most often related to latch problems. Nipple blanching is often, but not always, associated with pain. Because women may describe shooting, burning breast/nipple pain, this can be mistakenly diagnosed as thrush. If the normal color returns after your baby has finished a feeding and there is no pain, then the blanching is not a problem.

Compression blanching | Vasospasm | Treatment options | Resources

Blanching due to compression

The most common reason for nipple blanching is that that baby is compressing the nipple while nursing. This can be due to:

When blanching is due to baby’s compression of the nipple, the nipple is white and often misformed (flattened, creased, pointed, etc.) immediately upon coming out of baby’s mouth. There may be a white stripe across the nipple directly after nursing. Pain may not start until a few seconds to a few minutes after nursing, as the circulation returns to the nipple. If you are experiencing pain with the blanching, then finding and remedying the underlying cause will also eliminate the blanching.

Blanching due to vasospasm

Vasospasm, which is more severe, is a sudden constriction/narrowing of a blood vessel (in the nipple, in this case) that is extremely painful. It might occur a short time after nursing or in between nursings. Vasospasm can have various causes:

Vasospasm can be a secondary response to pain or nipple trauma (damaged nipples orthrush). In this case, the nipple(s) turns white shortly after nursing (rather than coming out of baby’s mouth white and misformed). Mom might notice a white circle on the face of the nipple a few seconds to a few minutes after breastfeeding. Cold often triggers the vasospasm and/or makes it worse. Unlike blanching due to compression, latch and positioning may be fine if the source of any nipple damage has already been fixed. Healing the nipple trauma or other source of pain should eliminate the vasospasms, although they may persist for a short time after the nipple has healed (previously damaged tissue can remain sensitive for a time).

Raynaud’s of the nipple

Vasospasm can also be caused by Raynaud’s Phenomenon (more info here), which causes sudden vasospasms in the extremities. When nipple vasospasm is caused by Raynaud’s Phenomenon (Raynaud’s of the nipple), the nipple turns white, then there is usually a noticeable triphasic color change – from white to blue to red – as blood flow returns. The color change may also be biphasic – from white to blue.

Vasospasm due to Raynaud’s is more likely to occur on both sides (rather than just one nipple), lasts for relatively long periods of time (rather than for a few seconds or a few minutes), and can occur during pregnancy and/or at times unrelated to feeding. Vasospasms may also occur in fingers or toes. Cold typically triggers the vasospasm and/or makes it worse. Nipple trauma (and other causes of compression blanching or vasospasm) can exacerbate the problem. Raynaud’s phenomenon may recur with subsequent pregnancies/breastfeeding, so be prepared to seek treatment quickly if you have experienced this in the past.

Per Anderson et al, “Because the breast pain associated with Raynaud’s phenomenon is so severe and throbbing, it is often mistaken for Candida albicans [yeast] infection. It is not unusual for mothers who have Raynaud’s phenomenon of the nipple to be treated inappropriately and often repeatedly for C albicans infections with topical or systemic antifungal agents.”

Keep in mind that Raynaud’s is not caused by breastfeeding (anyone might have it) — it simply has the potential to affect breastfeeding. For example, any person might have inverted nipples, which might or might not affect a mother’s breastfeeding relationship (as this can make latching or sore nipples more of a challenge in the beginning). Raynaud’s works the same way – anyonemight have it coming into breastfeeding, and it might (or might not) affect the breastfeeding relationship if the vasospasms are triggered by bad latch, a sudden temperature change as baby unlatches, etc.

Some maternal medications have been associated with vasospasm, including oral contraceptives. Fibromyalgia, rheumatologic diseases (eg, systemic lupus erythematosus or rheumatoid arthritis), endocrine diseases (eg, hypothyroidism or carcinoid), and prior breast surgery have also been associated with Raynaud’s phenomenon. Some sources indicate that the antifungal medication fluconazole may be associated with vasospasm, although the manufacturer does not report this as a known complication of fluconazole use. Other sources feel that vasospasms experienced by mothers taking fluconazole are a result of nipple pain/trauma due to thrush (and not due to the medication used to treat the thrush).

Treatment options for vasospasm

  • Avoid cold. Apply dry heat to the breast when needed (this relaxes the “cramping” blood vessels). Some mothers benefit from keeping the entire body warm (warm clothing, warm room, wrap up in a blanket, etc.)
  • Cover the nipple as soon as possible after baby comes off the breast. Some moms say that it is helpful use a wool breast pad or a soft cloth diaper.
  • Apply dry heat immediately after breastfeeding. A rice sock can be useful as a source of dry heat: Fill a sock or a cloth bag with uncooked rice and microwave 45 seconds (or until desired warmth is achieved); hold the rice sock against the nipple (over the cloth or mom’s shirt) until blood flow resumes.
  • Avoid caffeine, nicotine and other vasoconstrictive drugs, as they can precipitate symptoms.
  • Ibuprofen.
  • Dietary supplementation with calcium/magnesium.
  • Dietary supplementation with vitamin B6.
  • Low dose oral nifedipine.

See links below for additional details.

 

Additional information and references

Nipple pain – links 

Nipple compression stripe by Kathy Kuhn, IBCLC

Baby clamps down during breastfeeding by Debbie Donovan, IBCLC

Clampdown Bite Reflex by Mary Jozwiak, from Leaven, Vol. 30 No. 4, July-August 1994, pp. 53-4.

Nipple Vasospasm -A Manifestation Of Raynaud’s Phenomenon and a Preventable Cause of Breastfeeding Failure by Laureen Lawlor-Smith BMBS IBCLC and Carolyn Lawlor-Smith BMBS IBCLC FRACGP

Vasospasm and Raynaud’s Phenomenon by Jack Newman, MD

Nipple blanching: “My nipples turn white” by Debbi Donovan, IBCLC

Nipple vasospasm by Kathy Kuhn, IBCLC

Does nipple vasospasm recur? by Debbie Donovan, IBCLC

Raynaud’s Syndrome and Breastfeeding by Cher Sealy, RN, BSN, IBCLC, LLLL

Seeking Relief by Debbie Granick, from New Beginnings, Vol. 16 No. 3,
July-August 1999, p. 120.

References

Anderson JE, Held N, Wright K. Raynaud’s Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding. Pediatrics. 2004 Apr;113(4):e360-4.

Garrison CP. Nipple vasospasms, Raynaud’s syndrome, and nifedipine (case report). J Hum Lact. 2002 Nov;18(4):382-5.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 2nd ed. Boston and London: Jones and Bartlett 1999, p. 492-493.

Lawlor-Smith L, Lawlor-Smith C. Raynaud’s phenomenon of the nipple: a preventable cause of breastfeeding failure? Med J Aust. 1997 Apr 21;166(8):448.

Lawlor-Smith L, Lawlor-Smith C. Vasospasm of the nipple – a manifestation of Raynaud’s phenomenon: case reportsBMJ. 1997 Mar 1;314(7081):644-5.

Snyder JB. [letter]. J Hum Lact. 1994 Sept;10(3):153.

Escott R. Vasospasm of the nipple: another case [letter]. J Hum Lact. 1994 Mar;10(1):6.

Coates MM. Nipple pain related to vasospasm in the nipple? J Hum Lact. 1992 Sep;8(3):153.

An Overview of Solutions to Breastfeeding and Sucking Problems by Susan Meintz Maher, IBCLC, La Leche League 1988, p 14.

aehanrahan
by Group Admin - Amy on Dec. 20, 2012 at 11:12 PM
Answer these questions so we can have a better idea of what you might be dealing with. You said the pain is at the latch. Does it go away during the feeding or last the whole time?

Quoting maggiemom2000:

Is the pain in your nipple, or is it a deeper breast pain?

Have you been on antibiotics recently?

How does your nipple look after baby breastfeeds? Is it flattened on one side?

Posted on CafeMom Mobile
aehanrahan
by Group Admin - Amy on Dec. 20, 2012 at 11:14 PM
The article that Kate posted above might help.
Posted on CafeMom Mobile
K8wizzo
by Kate on Dec. 20, 2012 at 11:14 PM

answers are in the second comment above... white nipple after feedings makes me think vasospasm

Quoting aehanrahan:

Answer these questions so we can have a better idea of what you might be dealing with. You said the pain is at the latch. Does it go away during the feeding or last the whole time?

Quoting maggiemom2000:

Is the pain in your nipple, or is it a deeper breast pain?

Have you been on antibiotics recently?

How does your nipple look after baby breastfeeds? Is it flattened on one side?


PolishMamma2
by Marta on Dec. 20, 2012 at 11:17 PM

       This... Vasospasms are often missdiagnosed as thrush and due to trauma. Being that you had a bad latch and wounds I would say vasospasm if the Dr ruled out thrush...

Quoting K8wizzo:

Nipple blanching and vasospasm

JULY 27, 2011. Posted in: BF CONCERNS: MOTHER

By Kelly Bonyata, BS, IBCLC

Nipple blanching (turning white) after a feeding occurs when the blood flow to the nipple is limited or cut off. Blanching is most often related to latch problems. Nipple blanching is often, but not always, associated with pain. Because women may describe shooting, burning breast/nipple pain, this can be mistakenly diagnosed as thrush. If the normal color returns after your baby has finished a feeding and there is no pain, then the blanching is not a problem.

Compression blanching | Vasospasm | Treatment options | Resources

Blanching due to compression

The most common reason for nipple blanching is that that baby is compressing the nipple while nursing. This can be due to:

When blanching is due to baby’s compression of the nipple, the nipple is white and often misformed (flattened, creased, pointed, etc.) immediately upon coming out of baby’s mouth. There may be a white stripe across the nipple directly after nursing. Pain may not start until a few seconds to a few minutes after nursing, as the circulation returns to the nipple. If you are experiencing pain with the blanching, then finding and remedying the underlying cause will also eliminate the blanching.

Blanching due to vasospasm

Vasospasm, which is more severe, is a sudden constriction/narrowing of a blood vessel (in the nipple, in this case) that is extremely painful. It might occur a short time after nursing or in between nursings. Vasospasm can have various causes:

Vasospasm can be a secondary response to pain or nipple trauma (damaged nipples orthrush). In this case, the nipple(s) turns white shortly after nursing (rather than coming out of baby’s mouth white and misformed). Mom might notice a white circle on the face of the nipple a few seconds to a few minutes after breastfeeding. Cold often triggers the vasospasm and/or makes it worse. Unlike blanching due to compression, latch and positioning may be fine if the source of any nipple damage has already been fixed. Healing the nipple trauma or other source of pain should eliminate the vasospasms, although they may persist for a short time after the nipple has healed (previously damaged tissue can remain sensitive for a time).

Raynaud’s of the nipple

Vasospasm can also be caused by Raynaud’s Phenomenon (more info here), which causes sudden vasospasms in the extremities. When nipple vasospasm is caused by Raynaud’s Phenomenon (Raynaud’s of the nipple), the nipple turns white, then there is usually a noticeable triphasic color change – from white to blue to red – as blood flow returns. The color change may also be biphasic – from white to blue.

Vasospasm due to Raynaud’s is more likely to occur on both sides (rather than just one nipple), lasts for relatively long periods of time (rather than for a few seconds or a few minutes), and can occur during pregnancy and/or at times unrelated to feeding. Vasospasms may also occur in fingers or toes. Cold typically triggers the vasospasm and/or makes it worse. Nipple trauma (and other causes of compression blanching or vasospasm) can exacerbate the problem. Raynaud’s phenomenon may recur with subsequent pregnancies/breastfeeding, so be prepared to seek treatment quickly if you have experienced this in the past.

Per Anderson et al, “Because the breast pain associated with Raynaud’s phenomenon is so severe and throbbing, it is often mistaken for Candida albicans [yeast] infection. It is not unusual for mothers who have Raynaud’s phenomenon of the nipple to be treated inappropriately and often repeatedly for C albicans infections with topical or systemic antifungal agents.”

Keep in mind that Raynaud’s is not caused by breastfeeding (anyone might have it) — it simply has the potential to affect breastfeeding. For example, any person might have inverted nipples, which might or might not affect a mother’s breastfeeding relationship (as this can make latching or sore nipples more of a challenge in the beginning). Raynaud’s works the same way – anyonemight have it coming into breastfeeding, and it might (or might not) affect the breastfeeding relationship if the vasospasms are triggered by bad latch, a sudden temperature change as baby unlatches, etc.

Some maternal medications have been associated with vasospasm, including oral contraceptives. Fibromyalgia, rheumatologic diseases (eg, systemic lupus erythematosus or rheumatoid arthritis), endocrine diseases (eg, hypothyroidism or carcinoid), and prior breast surgery have also been associated with Raynaud’s phenomenon. Some sources indicate that the antifungal medication fluconazole may be associated with vasospasm, although the manufacturer does not report this as a known complication of fluconazole use. Other sources feel that vasospasms experienced by mothers taking fluconazole are a result of nipple pain/trauma due to thrush (and not due to the medication used to treat the thrush).

Treatment options for vasospasm

  • Avoid cold. Apply dry heat to the breast when needed (this relaxes the “cramping” blood vessels). Some mothers benefit from keeping the entire body warm (warm clothing, warm room, wrap up in a blanket, etc.)
  • Cover the nipple as soon as possible after baby comes off the breast. Some moms say that it is helpful use a wool breast pad or a soft cloth diaper.
  • Apply dry heat immediately after breastfeeding. A rice sock can be useful as a source of dry heat: Fill a sock or a cloth bag with uncooked rice and microwave 45 seconds (or until desired warmth is achieved); hold the rice sock against the nipple (over the cloth or mom’s shirt) until blood flow resumes.
  • Avoid caffeine, nicotine and other vasoconstrictive drugs, as they can precipitate symptoms.
  • Ibuprofen.
  • Dietary supplementation with calcium/magnesium.
  • Dietary supplementation with vitamin B6.
  • Low dose oral nifedipine.

See links below for additional details.

 

Additional information and references

Nipple pain – links 

Nipple compression stripe by Kathy Kuhn, IBCLC

Baby clamps down during breastfeeding by Debbie Donovan, IBCLC

Clampdown Bite Reflex by Mary Jozwiak, from Leaven, Vol. 30 No. 4, July-August 1994, pp. 53-4.

Nipple Vasospasm -A Manifestation Of Raynaud’s Phenomenon and a Preventable Cause of Breastfeeding Failure by Laureen Lawlor-Smith BMBS IBCLC and Carolyn Lawlor-Smith BMBS IBCLC FRACGP

Vasospasm and Raynaud’s Phenomenon by Jack Newman, MD

Nipple blanching: “My nipples turn white” by Debbi Donovan, IBCLC

Nipple vasospasm by Kathy Kuhn, IBCLC

Does nipple vasospasm recur? by Debbie Donovan, IBCLC

Raynaud’s Syndrome and Breastfeeding by Cher Sealy, RN, BSN, IBCLC, LLLL

Seeking Relief by Debbie Granick, from New Beginnings, Vol. 16 No. 3,
July-August 1999, p. 120.

References

Anderson JE, Held N, Wright K. Raynaud’s Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding. Pediatrics. 2004 Apr;113(4):e360-4.

Garrison CP. Nipple vasospasms, Raynaud’s syndrome, and nifedipine (case report). J Hum Lact. 2002 Nov;18(4):382-5.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 2nd ed. Boston and London: Jones and Bartlett 1999, p. 492-493.

Lawlor-Smith L, Lawlor-Smith C. Raynaud’s phenomenon of the nipple: a preventable cause of breastfeeding failure? Med J Aust. 1997 Apr 21;166(8):448.

Lawlor-Smith L, Lawlor-Smith C. Vasospasm of the nipple – a manifestation of Raynaud’s phenomenon: case reportsBMJ. 1997 Mar 1;314(7081):644-5.

Snyder JB. [letter]. J Hum Lact. 1994 Sept;10(3):153.

Escott R. Vasospasm of the nipple: another case [letter]. J Hum Lact. 1994 Mar;10(1):6.

Coates MM. Nipple pain related to vasospasm in the nipple? J Hum Lact. 1992 Sep;8(3):153.

An Overview of Solutions to Breastfeeding and Sucking Problems by Susan Meintz Maher, IBCLC, La Leche League 1988, p 14.

 

K8wizzo
by Kate on Dec. 20, 2012 at 11:22 PM

I have Raynaud's Syndrome and had blanching and pain early on in nursing until I figured out the tricks that work for me.  First, I can NOT let myself get cold.  I have to keep my shoulders, my stomach, and the top of my breast covered, so I usually do the 2-shirt method (nursing tank underneath, shirt on top).  Second, I close up shop as soon as we're done nursing or when he takes a break so that my breast and nipple aren't exposed to cold air.  Third, I take a multivitamin everyday that contains calcium, magnesium, and b6. :)

For you, the most important thing to do is to fix that latch.  Does she have any evidence of a tongue tie?  Resolving overactive letdown will be helpful as well. One nursing position may help with both of those problems: biological nursing.  Basically, you are reclined and you put baby on top of you, tummy to tummy.  Gravity will work against your overactive letdown so that the milk doesn't come flying out as fast, plus it will also help your baby to get a good, deep latch.  http://www.biologicalnurturing.com/

K8wizzo
by Kate on Dec. 20, 2012 at 11:22 PM

Tongue tie info:

Is My Baby Tongue-tied?

Now that more mothers are breastfeeding, tongue-tie (ankyloglossia) is on the forefront of medical research again. Some tongue-tied babies breastfeed without difficulty, others cause their mother pain, don't get enough milk, or have difficulty swallowing properly and are very unhappy during and after feeding.

If you are concerned that your baby may be tongue-tied, the following may help you decide if you need more help. An IBCLC (International Board Certified Lactation Consultant) can help with breastfeeding, and many different dentists and doctors can help if your baby needs treatment for tongue-tie. Seehttp://www.lowmilksupply.org/frenotomy.shtml for a list of doctors and dentists who are particularly good at diagnosing and treating tongue-tie.

The first thing to assess is whether your baby can stick out his or her tongue. If you touch your baby's lips, he will probably open his mouth. You can then touch the front of his lower gum with your fingertip. This makes him stick the tongue out. We want to see the tongue come out flat over the lip, without dipping down or pointing down. If your baby can only stick his tongue out when his mouth is closed, that can indicate a posterior (further back) tongue-tie.


Next, we want to see if your baby can lift her tongue way up to the roof of the mouth. All the way up is perfect, half way is enough for most babies to be able to breastfeed. Again, her mouth should be wide open. Most tongue-tied babies can only lift their tongues when their mouths are mostly closed.


Obvious and Sneakier Tongue-ties:

This baby (figure 3) has an obvious tongue-tie. You can see the membrane right at the front of the tongue, and you can see how it makes it hard for him to lift his tongue up.

figure 3

The baby in figure 4 is also tongue-tied. If you run your finger along the outside of a baby's lower gum, her tongue will try to follow. If the tongue twists like this, it's a sign of tongue-tie.

figure 4

The baby in figure 5 has a sneaky (posterior) tongue-tie. You can see that it is difficult to get a finger under the tongue. If you press on the front of the little membrane under the tongue (the frenulum), a tied tongue will pull down in the center like this. This shows that the frenulum is tight and does not allow the tongue to move well. This diagnostic trick is called the Murphy Maneuver after Dr. Jim Murphy of California.

figure 5

Figure 6 shows a very sneaky tongue-tie - a posterior or submucosal one. The frenulum (membrane holding the tongue down) is hiding behind the floor of the mouth (the oral mucosa). You can see that the tongue doesn't lift very well, and that the floor of the mouth is tented out a little.

figure 6
figure 7

Notice how when the baby in figure 6 tries to lift her tongue (figure 7), nothing at all is visible except the limited ability to lift the tongue up.

Again, some babies with posterior or submucosal tongue-tie can breastfeed, others have a lot of difficulty. Moms breast and nipple shape and milk supply can make things easier or more difficult for the baby.

The best way to diagnose a posterior tongue-tie is to lift the tongue with a grooved director. Doctors who treat tongue-tie usually have one.


The final thing to do is watch your baby cry. If only the edges of the tongue curl up like in figure 9, that's a sure sign that the frenulum is tight.

figure 9

Now that you have an idea whether your baby has normal tongue movement ability or not, you can decide what kind of help may be most useful.

A guide to latching your baby

Snuggle your baby against your body so he is tummy to tummy (front to front) and lean back comfortably. Most mothers like to hold the baby with the same side arm as they are nursing from, or with both hands. The more you lean back, the more gravity helps hold baby, and the less strain on your arms.


Babies find the breast by feel and smell. Cuddle your baby in a comfortable position so your nipple touches that cute notch right above her upper lip, and her chin snuggles against your breast.


She will then open her mouth wide.


It will look like she won't be able to get her upper lip past the nipple.

She'll tilt her head back a little bit and lunge in for a good mouthful. If her nose is blocked, snuggle her bottom close to your body and slide her a little toward your other breast.



If this doesn't work for you, try leaning even farther back, so your nipple points up in the air. Then turn your baby so he is laying on your chest, with his face aligned to the breast the same way as in the latch photos above.


If you need to shape your breast a little to define a better mouthful, you can do this with one finger above or below the nipple, or a finger above and a finger below.


If these things don't work, express milk very frequently (at least 8 times a day) to feed your baby, and get in-person help!

K8wizzo
by Kate on Dec. 20, 2012 at 11:23 PM

Overactive letdown info:

Forceful Let-down (Milk Ejection Reflex) & Oversupply

AUGUST 20, 2011. Posted in: SUPPLY WORRIES

By Kelly Bonyata, BS, IBCLC

 Is forceful let-down the problem?

Does your baby do any of these things?

  • Gag, choke, strangle, gulp, gasp, cough while nursing as though the milk is coming too fast
  • Pull off the breast often while nursing
  • Clamp down on the nipple at let-down to slow the flow of milk
  • Make a clicking sound when nursing
  • Spit up very often and/or tend to be very gassy
  • Periodically refuse to nurse
  • Dislike comfort nursing in general

If some of this sounds familiar to you, you probably have a forceful let-down. This is often associated with too much milk (oversupply). Some mothers notice that the problems with fast letdown or oversupply don’t start until 3-6 weeks of age. Forceful let-down runs the gamut from a minor inconvenience to a major problem, depending upon how severe it is and how it affects the nursing relationship.

What can I do about it?

There are essentially two ways you can go about remedying a forceful let-down: (1) help baby deal with the fast flow and (2) take measures to adjust your milk supply down to baby’s needs. Since forceful let-down is generally a byproduct of oversupply, most moms will be working on both of these things. It may take a couple of weeks to see results from interventions for oversupply, so try to be patient and keep working on it.

Help baby deal with the fast milk flow

  • Position baby so that she is nursing “uphill” in relation to mom’s breast, where gravity is working againstthe flow of milk. The most effective positions are those where baby’s head and throat are above the level of your nipple. Some nursing positions to try:
    • Cradle hold, but with mom leaning back (a recliner or lots of pillows helps)
    • Football hold, but with mom leaning back
    • Elevated football hold – like the football hold, but baby is sitting up and facing mom to nurse instead of lying down (good for nursing in public).
    • Side lying position – this allows baby to dribble the extra milk out of her mouth when it’s coming too fast
    • Australian position (mom is “down under”, aka posture feeding) – in this position, mom is lying on her back and baby is on top (facing down), tummy to tummy with mom. Avoid using this positioning frequently, as it may lead to plugged ducts.
  • Burp baby frequently if she is swallowing a lot of air.
  • Nurse more frequently. This will reduce the amount of milk that accumulates between feedings, so feedings are more manageable for baby.
  • Nurse when baby is sleepy and relaxed. Baby will suck more gently at this time, and the milk flow will be slower.
  • Wait until let-down occurs, then take baby off the breast while at the same time catching the milk in a towel or cloth diaper. Once the flow slows, you can put your baby back to the breast.
  • Pump or hand express until the flow of milk slows down, and then put baby to the breast. Use this only if nothing else is working, as it stimulates additional milk production. If you do this, try to express a little less milk each time until you are no longer expressing before nursing.

Adjust your supply to better match baby’s needs

  • If baby is gaining weight well, then having baby nurse from only one breast per feeding can be helpful.
  • If baby finishes nursing on the first side and wants to continue nursing, just put baby back onto the first side.
  • If the second side becomes uncomfortable, express a little milk until you’re more comfortable and then use cool compresses – aim for expressing less milk each time until you are comfortable without expressing milk.
  • Avoid extra breast stimulation, for example, unnecessary pumping, running the shower on your breasts for a long time or wearing breast shells.
  • Between feedings, try applying cool compresses to the breast (on for 30 minutes, off for at least an hour). This can discourage blood flow and milk production.
  • If nursing one side per feeding is not working after a week or so, try keeping baby to one side for a certain period of time before switching sides. This is called block nursing.
  • Start with 2-3 hours and increase in half-hour increments if needed.
  • Do not restrict nursing at all, but any time that baby needs to nurse simply keep putting baby back to the same side during that time period.
  • If the second side becomes uncomfortable, express a little milk until you’re more comfortable and then use cool compresses – aim for expressing less milk each time until you are comfortable without expressing milk.
  • In more extreme cases, mom may need to experiment a bit with time periods over 4 hours to find the amount of time per breast that works best.
  • Additional measures that should only be used for extreme cases of oversupply include cabbage leaf compresses and herbs.

Even if these measures do not completely solve the problem, many moms find that their abundant supply and fast let-down will subside, at least to some extent, by about 12 weeks (give or take a bit). At this point, hormonal changes occur that make milk supply more stable and more in line with the amount of milk that baby needs.

Sometimes babies of moms with oversupply or fast let-down get very used to the fast flow and object when it normally slows somewhere between 3 weeks to 3 months. Even though your let-down may not be truly slow, it can still seem that way to baby. See Let-down Reflex: Too Slow?for tips.

 

 Additional Information

Too Much Milk? by Becky Flora, IBCLC

Oversupply by Kathy Kuhn, IBCLC

Tips for taming a monster milk supply by Kathy Kuhn, IBCLC

Gaining, Gulping, and Grimacing? by Diane Wiessinger, MS, IBCLC

Oversupply: Too Much Milk by Anne Smith, IBCLC

Colic in the Breastfed Baby by Jack Newman MD, FRCPC

Am I making too much milk? from La Leche League International

Fighting the Battle Against Oversupply  by Vanessa Manz

Finish the First Breast First by Melissa Vickers (LEAVEN, September-October 1995, p. 69-71)

Overactive Let-Down: Consequences and Treatments by Mary Jozwiak (from LEAVEN, September-October 1995, pp. 71-72)

Common Side Effects of an Overactive Let-Down by Mary Jozwiak (from LEAVEN, September-October 1995, p. 69)

Too Much of a Good Thing by Kate Drzycimski, from New Beginnings Vol. 19 No. 9, July-August 2002, p. 129.

PDF Resolution of Lactose Intolerance and “Colic” in Breastfed Babies by Robyn Noble & Anne Bovey, presented at the ALCA Vic (Melbourne) Conference on the 1st November, 1997

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