What to expect when you're expecting (178 page)

Heal with milk. Breast milk can actually help heal sore nipples. So let whatever milk is left on the breast after a feeding dry there, instead of wiping it away. Or express a few drops of milk at the end of a feeding and rub it on your nipples, letting your nipples dry before you put your bra back on.

Rub it on. Nipples are naturally protected and lubricated by sweat glands and skin oils. But using a commercial preparation of modified lanolin can prevent and/or heal nipple cracking. After nursing, apply ultrapurified medical-grade lanolin, such as Lansinoh, but avoid petroleum-based products and petroleum jelly itself (Vaseline), as well as other oily products. Wash nipples only with water—never with soap, alcohol, or wipes—whether your nipples are sore or not. Your baby is already protected from your germs, and the milk itself is clean.

Try tea for two. Wet regular tea bags with cool water and place them on your sore nipples. The properties in the tea may help soothe and heal them.

Treat them equally. Don’t favor one breast because it is less sore or because the nipple isn’t cracked; the only way to toughen up nipples is to use them. Plus, for both breasts to become good producers, they both have to get equal stimulation time.

If one nipple is a lot more sore than the other, nurse from the less tender one first because the baby will suck more vigorously when he or she is hungry. Try to do this only as long as you absolutely have to—and for no more than a few days—because it could keep the sore breast from getting the stimulation it needs and ultimately affect your milk supply. Fortunately, the worst of the soreness shouldn’t continue longer than this (if it does, contact a lactation consultant; improper positioning may be the problem).

Chill out before feeding. Relaxation will enhance the letdown of milk (which will mean that baby won’t have to suck as hard), while tension will inhibit it.

Seek relief. Take acetaminophen (Tylenol) before you nurse to ease soreness.

Keep a watch. If your nipples are cracked, be especially alert to signs of breast infection (see next page), which can occur when germs enter a milk duct through a crack in the nipple.

Once nursing is established, it’s usually a smooth ride until baby’s weaned. But once in a while, there’s a bump or two along the way, among them:

Clogged milk ducts.
Sometimes a milk duct clogs, causing milk to back up. This condition—characterized by a small, red, and tender lump on the breast—can lead to infection, so it’s important to resolve it quickly. The best way to do this is to offer the affected breast first and let your baby empty it as completely as possible. If baby doesn’t finish the job, express any remaining milk by hand or with a breast pump. Keep pressure off the duct by making sure your bra is not too tight (avoiding underwires for now may help) and by varying nursing positions to put pressure on different ducts. Applying hot packs or warm compresses before nursing and gentle massage may also be helpful (baby’s chin, if correctly positioned, can provide a clogged duct with an excellent massage). Do not use this time to wean the baby because discontinuing nursing now will only compound the clog.

Breast infection.
A more serious and less common complication of breastfeeding is mastitis, or breast infection, which can develop in one or both breasts, most often during the early postpartum period (though it can occur anytime during breastfeeding). The factors that can combine to cause mastitis are failure to drain breasts of milk at each nursing, germs (usually from baby’s mouth) gaining entrance into the milk ducts through a crack in the nipple, and lowered resistance in mom due to stress and fatigue.

The most common symptoms of mastitis are severe soreness or pain, hardness, redness, heat, and swelling of the breast, with flulike symptoms—generalized chills and a fever of about 101°F to 102°F. If you develop such symptoms, contact your doctor right away. Prompt medical treatment is necessary and may include bed rest, antibiotics, pain relievers, increased fluid intake, and moist heat applications. You should begin to feel drastically better within 36 to 48 hours after beginning the antibiotics. If you don’t, let your practitioner know; he or she may need to prescribe a different type of antibiotic.

Continue to nurse during treatment. Since the baby’s germs probably caused the infection in the first place, they won’t be harmful. The antibiotics prescribed for the infection will be safe, too. And draining the breast will help prevent clogged milk ducts. Nurse (if you can; it may be quite painful) on the infected breast, and express whatever baby doesn’t finish with a pump. If the pain is so bad that you can’t nurse, try hand pumping or using a manual breast pump on your breasts (whichever hurts less) while lying in a tub of warm water with your breasts floating comfortably; you can let the milk drip into the water. (Don’t use an electric pump in the tub.)

Delay in treating mastitis or discontinuing treatment too soon could lead to the development of a breast abscess, the symptoms of which include excruciating, throbbing pain; localized swelling, tenderness, and heat in the area of the abscess; and temperature swings between 100°F and 103°F. Treatment includes antibiotics and, generally, surgical drainage. The drain may stay in place after surgery. Breastfeeding on that breast usually can’t continue in most cases, but you can keep nursing with the other breast until you wean your baby.

How soon you can breastfeed your newborn after a surgical delivery will depend on how you feel and how your baby is doing. If you’re both in good shape, you can probably introduce baby to breast in the recovery room shortly after the surgery is completed. If you’re groggy from general anesthesia or your baby needs immediate care in the nursery, this first nursing session may have to wait. If after 12 hours you still haven’t been able to get together with your baby, ask about using a pump to express your premilk (colostrum) and get lactation started.

You’ll probably find breastfeeding after a C-section uncomfortable at first. It will be less so if you try to avoid putting pressure on the incision with one of these techniques: Place a pillow on your lap under the baby; lie on your side; or use the football hold (
page 438
), again supported by a pillow, to nurse. Both the afterpains you experience as you nurse and the soreness at the site of the incision are normal and will lessen in the days ahead.

Breastfeeding, like just about every aspect of caring for newborn multiples, seems as though it will be at least twice as challenging. However, once you’ve fallen into the rhythm of nursing your multiples (and you will!), you’ll find that it’s not only possible but doubly (or even triply) rewarding. To successfully nurse twins and more, you should:

Eat well—and eat up.
Fulfill all the dietary recommendations for lactating mothers (see the Breastfeeding Diet,
page 442
), with these additions: 400 to 500 calories above your prepregnancy needs for each baby you are nursing (you may need to increase your caloric intake as the babies grow bigger and hungrier or decrease it if you supplement nursing with formula and/or solids, or if you have considerable fat reserves you would like to burn); an additional serving of protein (for a total of four) and an additional serving of calcium (six total) or the equivalent in calcium supplements.