What to do about milk stasis, mastitis, and more?

A mother, who gently and blissfully smiles while breastfeeding her content baby – this is how breastfeeding is usually depicted. However, this image does not always reflect reality: especially at the beginning, breastfeeding often does not go smoothly right away, and many women encounter difficulties such as engorgement at least once during their breastfeeding journey. For some breastfeeding issues, only a bit of time and calm are needed, and for many others, a solution can usually be found with some support. We have compiled symptoms, causes, and treatment options for the 8 most common breastfeeding problems for you.

1. Pain during breastfeeding

Symptoms:

• Swelling and tightness of the breasts in the first days after birth

• Pain-sensitive nipples

Possible causes:

• After birth, the body releases oxytocin. The so-called "milk hormone" promotes the involution of the uterus and triggers the milk let-down approximately three to five days after birth ( initial breast swelling ) out

• The increased blood circulation and the beginning of milk production can be uncomfortable or painful at first

• The nipples need to get used to sucking first

Treatment:

• Initial pain when breastfeeding usually disappears within the first few days on its own

• Continued breastfeeding: Frequent nursing triggers the Milk Ejection Reflex out, the breast milk flows more easily and the pressure decreases. A breast massage has the same effect

• Warm the breasts before breastfeeding to help the milk flow more easily. Warm cloths or a hot shower can assist with this.

• Cool the breasts after breastfeeding. You can use either a gel pack wrapped in a cloth, a quark compress, or white cabbage leaves placed directly in your bra.

2. Sore nipples

Symptoms:

• Cracks, skin abrasions, formation of scabs, signs of inflammation such as pain, redness, swelling or warmth of the nipples

• Rare cases of nipple bleeding

Possible causes:

• Incorrect latch: If your baby does not surround the nipple optimally with a wide-open mouth and can manipulate the breast with the jaw, tongue, and lips so that the milk begins to flow, a strong vacuum can develop, leading to injuries to the nipple.

• Anatomical conditions that favor incorrect sucking, such as a shortened frenulum, cause your baby to be unable to easily grasp the breast with their mouth

• Sucking confusion: If your little explorer is fed with a bottle alongside breastfeeding, requiring little active effort, he may "forget" his innate sucking reflex and no longer latch onto the nipple properly.

• Enhanced need for security: Your baby does not suck strongly and frequently for nourishment, but because breastfeeding provides closeness and security ( non-nutritive sucking )

Treatment:

• Correction of the breastfeeding position and latch: An overview of what to consider when latching on can be found in our article "Proper Latching: 7 Basic Rules for Breastfeeding". If you're unsure how your baby should be positioned at the breast, it's best to consult your breastfeeding counselor or midwife for advice.

• Use nursing pads and change them regularly to prevent bacteria from spreading in the moist-warm environment

• Massages and warm chest compresses stimulate milk flow and make sucking easier

• Use of silver caps: The small caps made of antibacterial silver can be placed between breastfeeding sessions under your clothing on your nipples. The silver caps promote healing of acutely inflamed nipples, but can also be used preventively.

• Low Level Laser Therapy to support wound healing: Various breastfeeding consultations offer laser therapy to support wound healing. It is best to inquire with your midwife or your doctor whether this therapy is suitable for you.

• If you experience persistent discomfort and severe pain, you have the option to pump breast milk and feed your baby with a bottle.

3. Milk Stasis

Symptoms:

• Hard, painful spots on the breast that do not soften even through breastfeeding and are sensitive to touch

Possible causes:

• Blockage of one or more of the milk ducts, preventing the breast from being adequately emptied and causing pain from accumulated milk

• Incorrect setup

• Psychological factors such as stress or exhaustion

Treatment:

• Pain relief through heat: A warm washcloth, a relaxing bath, or five minutes under the infrared lamp can work wonders

• Continued breastfeeding: An additional, gentle breast massage during breastfeeding or pumping helps to relieve congestion and stimulate milk flow. Tip: You can also use a vibrator or an electric toothbrush for the massage by placing it directly on the hardened area.

• Breastfeeding in the all-fours position: The milk can flow in the direction of natural gravity, and you can additionally turn your baby so that it presses against the hardened area with its jaw. To learn exactly how breastfeeding in the all-fours position works, read our article “ The ABCs of Breastfeeding Positions “

• If needed, pump additional milk after breastfeeding sessions to fully empty the breast and keep the milk ducts clear. However, first consult with your breastfeeding counselor or midwife to determine if pumping is appropriate for you.

• If your breast is red and painful, and you are experiencing a fever, body aches, or headaches, or suspect that the lump in your breast is not related to breastfeeding, consult your doctor in any case. For example, mastitis could be the cause of your symptoms. She/He can also prescribe medication for pain relief if needed.

• Give yourself and your baby rest and relaxation

4. Mastitis

Symptoms:

• The chest is red, hot, and tender

• Flu-like symptoms such as alternating hot/cold sensations and joint pain

• Body temperature above 38.5° Celsius

• The taste of your breast milk has changed and is salty

Causes:

• An inflammation of the breast tissue caused by bacteria entering the breast through the milk ducts of the nipples

• Triggered by incorrect latch, too long intervals between breastfeeding sessions, or psychological factors such as stress or exhaustion

• Sore nipples, a milk stasis, or too much milk can lead to mastitis if not treated

Treatment:

• Contact your doctor in any case. They can prescribe a suitable pain reliever and, if necessary, an antibiotic.

• Continue breastfeeding. The milk is harmless to your baby, and through milk flow and gentle massages, blockages can be relieved. Offer the affected breast first and cool it after breastfeeding to reduce inflammation.

• Be kind to yourself: Rest, warmth, adequate fluids, and a healthy diet help your body fight the inflammation

5. (Supposedly) too little milk

Symptoms:

• Your baby is often restless while feeding, quickly lets go of the breast or demands it more frequently

Causes:

• Medical causes such as retained placental tissue in the uterus, anemia, diabetes, hormonal imbalances, various medications, or injury to the mammary gland tissue, for example through surgery

Many nursing mothers mistakenly believe they are not producing enough milk. However, most women produce enough milk to breastfeed their baby. Usually, other reasons are behind this:

• Incorrect setup

• Anatomical reasons such as a shortened frenulum

• Your baby is going through a growth spurt and is therefore feeding more often

• Non-nutritive Sucking: Your baby seeks the breast more often for comfort

Treatment:

• If you have insufficient milk production due to medical issues, you should contact your doctor or a breastfeeding consultant

• Your child's increased thirst may give the impression that you are not producing enough milk

• Do not feed with infant formula directly: As long as your little explorer is thriving and his digestion continues to be regular, keep offering him the breast to stimulate milk production

• Feed your baby on demand and not on a schedule to ensure they are full

• Get help from your midwife or your breastfeeding consultant if you have questions or uncertainties

• Your body needs energy for milk production. Therefore, pay attention to a healthy, balanced diet with enough fluids and at least one warm meal a day.

• Frequently switch between breasts during the regular feeding times to stimulate milk production evenly on both sides

• Bonding with your baby: Spend a day skin-to-skin with your baby in bed. The close contact releases the breastfeeding hormone oxytocin, which stimulates milk production.

6. Too much milk (hyperlactation)

Symptoms:

• Swollen, tense breasts, excess milk simply leaks out, the milk ejection reflex is painful

• Mastitis and breast infections often occur

• Your baby is restless or passive while breastfeeding

• Has difficulty grasping the nipple properly

• Frequently chokes, spits out, and gags

Causes:

• You produce more milk than your child can drink

• In some cases, increased milk production is hereditary, but usually your body automatically adjusts to the needs of your child within the first few weeks.

Treatment:

• Express or pump some milk before breastfeeding to lessen the milk ejection reflex during latch-on

• Choose the correct breastfeeding position : With Laid-Back Nursing, not too much milk flows at once, allowing your baby to drink calmly

• Be patient: Most of the time, milk production stabilizes on its own after a few weeks

• Tandem breastfeeding: Do not switch breasts with every feeding, but only offer your baby the other breast every three hours. This prevents additional stimulation of milk production.

7. White bubbles on the nipple

Symptoms:

• One or more white blisters on the nipples

• Occurs frequently in the first days of breastfeeding

• Causes pain during breastfeeding in some cases, but can also be painless

Causes:

• Incorrect application: If no pain occurs, the blisters are probably caused by too high a vacuum during sucking

• The opening of a milk duct is blocked: A thin membrane (milk blister) prevents the milk flow and causes pain

Treatment:

• For painless blisters:

  • no treatment necessary, they usually disappear on their own

• In case of painful constipation:

  • Place a warm washcloth on the nipple immediately before breastfeeding or pumping to open the blocked milk duct. The painful plug will then either dissolve on its own during breastfeeding or can be targetedly opened by gentle wiping with the hand.

  • If it does not open on its own, your doctor can carefully remove the plug with a sterile needle. Afterwards, you should empty the breast promptly.

8. Yeast infection (thrush) or bacterial infection

Mother's symptoms:

• The nipples are sensitive to touch, burning, itching, and pain

• The pain persists during and after breastfeeding

• The nipples and areolas are pink or dark, may be dry and flaky in some cases, or may have a white rash

Symptoms Baby:

• White coating on the tongue

• White spots on the cheeks

• Bright red pimples and rash on the buttocks

Causes:

Yeast infection (thrush) or a bacterial infection that often occurs during the course of breastfeeding and does not appear at the beginning like many other complaints

Treatment:

• Weaning is not necessary, but the infection should definitely be treated

• Your doctor can determine with a swab of the nipples whether it is a yeast infection or another infection and prescribe the appropriate medication.

• Pay attention to hygiene: wash your hands before and after breastfeeding and diapering, let your nipples dry after breastfeeding, change your nursing pads regularly, and wash your laundry for you and your baby at a high temperature

That the start doesn't always go entirely smoothly and that difficulties can occasionally arise during the course of breastfeeding is nothing unusual. So don't put yourself under pressure if it doesn't work out immediately. Together with your baby, you'll soon find out what works best for both of you. You don't have to grit your teeth and endure pain while breastfeeding – a breastfeeding consultation or your midwife are always there to support you with experience and advice. Many problems with breastfeeding can be quickly resolved with the right guidance, so there's nothing standing in the way of a loving breastfeeding experience that both you and your baby can enjoy.