King Edward Memorial Hospital
Breastfeeding Centre of WA
Common breastfeeding issues
Your milk will come in around 24 to 72 hours after birth. A degree of fullness may be experienced at this time. After a feed at least one breast should feel soft and light (well drained).
Engorgement is caused by a build-up of blood, milk and other fluids in the breast. This occurs if the breasts aren’t drained well during a feed.
- Ensure baby attaches correctly to the breast
- Feed your baby often without limiting the time at the breast
- Ensure your baby drains the breast well at feeds
- Avoid use of dummy or complimentary feeds
If your breasts are very full, you may need to express a little milk to soften the areola so your baby can attach well.
Engorgement will occur if your baby is not feeding and attaching well. Less commonly it may occur if your body is making more milk than the baby has needed.
- Ensure your baby is attached well when breastfeeding.
- Feed your baby frequently at least 8 to 12 times per 24 hours.
- Do not limit time at the breast.
- Express to soften areola to attach your baby to the breast.
- Use cool gel packs from refrigerator – NOT FREEZER – for comfort.
- If the breasts are full and heavy 24 hours after the milk comes in, a one-off complete drainage of the breast is necessary. This is done by using a hospital grade electric pump if possible. Women who have delivered at KEMH can access an electric pump at the KEMH Breastfeeding Centre or Emergency Centre. Ensure a correct size breast shield is used when expressing.
- Seek professional advice to ensure the condition resolves.
A blocked duct presents as a lump that is tender or painful. It is a result of milk building up behind the blockage.
- Ensure correct positioning and attachment.
- Frequent drainage of the breast.
- Alter position during feed to include underarm position, cradle position or lying on your side.
- Check for a white ‘bleb’ on the nipple as this may be blocking the milk duct.
- Sudden long gaps between breastfeeds or expressing for your baby.
- Tight or restrictive clothing e.g. bra.
- Pressing or holding one area of the breast too tightly, especially close to the nipple.
Management of blocked ducts
- Feed frequently from the affected side first.
- Gently stroke towards the nipple during the feed. This may assist the let-down reflex.
- For comfort and to reduce swelling from excess fluid apply a cold cloth or cool gel pack.
- Express after feeding.
- If a white ‘bleb’ is present - soak the nipple with a warm moist cloth and rub or scratch off the ‘bleb’ with a sterile needle to allow the milk to flow again.
- Use paracetamol or anti-inflammatory tablets according to directions until the lump clears.
- If the lump has not cleared after the next breastfeed, therapeutic ultrasound treatment (by a physiotherapist) of the affected breast may help clear blocked ducts – contact the Breastfeeding Centre to arrange.
- It is important the breast is well drained within 20 minutes of having the ultrasound treatment. This may be either by breastfeeding or expressing the breast.
- Seek professional help if a blocked duct hasn’t cleared within 24 hours
Mastitis occurs when there is a blockage in a milk duct causing the milk in the duct to enter the surrounding tissues. These tissues become inflamed.
The blockage of milk can lead to inflammation of the ducts and mastitis may occur.
Signs and symptoms
- The breast has a red, painful area.
- An aching flu-like feeling such as a fever, feeling shivery and generally unwell.
Seek medical help if fever lasts more than six hours.
- Drain the breast frequently. Attach your baby to the affected side first.
- You may need antibiotics for 10 to 14 days.
- Keep the breast drained by expressing the affected breast after each feed.
- Cool gel packs from refrigerator (NOT FREEZER) or cool cloths can relieve discomfort and pain.
- Anti-inflammatory medication e.g. ibuprofen, will reduce the inflammation and pain.
- Paracetamol may be taken to ease discomfort.
- It is important to get extra rest. You may need household help to achieve this.
- If it is too painful to feed, express your milk using a hospital grade electric pump if possible.
- Seek advice from a lactation consultant to determine a cause and prevent a reoccurrence.