Complications of lactation

Flat nipples

Quite often, both medical personnel and mothers consider flat nipples a significant obstacle to breastfeeding. However, when properly attached, the baby will take in part of the breast tissue located under the areola in addition to the nipple, creating a "pacifier" in which the nipple occupies only a third. Therefore, with flat nipples, it is important to take into account the ability of the breast tissue to stretch.

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Nipples are retracted

This is a more complicated situation. When trying to pull the nipple out, it may even retract even more. Such nipples, fortunately, are rare. Tactics for flat and inverted nipples:

• antenatal treatment is ineffective and not always possible;
• after childbirth:
  • reassure the mother, explain that breastfeeding is possible because the baby is not sucking on the nipple, but on the breast;
  • organize skin-to-skin contact, help the mother to most comfortably attach the baby to the breast, using different positions;
  • Explain to the mother what needs to be done to make the nipples protrude more before feeding (syringe method);
• If your baby cannot suckle effectively in the first week, you should:
  • express milk and feed the baby from a cup and spoon;
  • express milk directly into the baby's mouth;
  • hold the baby close to the breast more often and for longer (skin-to-skin contact);
  • as a last resort, use a nipple shield for a while.

Long nipples

Long nipples are rare, but they can create certain difficulties when feeding a child. When applying a child to the mammary gland, you need to adhere to the main principle - the child's mouth captures not only the nipple, but also part of the mammary gland tissue, located mainly under the areola.

Cracked nipples

Nipple cracks occur mainly when the baby is not attached to the breast correctly. This is especially common when pre-lactation feeding or supplementary feeding of the baby from a bottle with a nipple ("nipple confusion") is used, as well as when the baby is not attached to the breast correctly. Frequent (before and after feeding) treatment of the mammary glands, especially with soap, can also cause cracks.

Measures to take in case of cracked nipples:

• calm the woman down;
• reassure her that she can continue to breastfeed successfully;
• provide advice on proper hygienic care of nipples;
• lubricate the nipple with colostrum or “late” milk after feeding, do air baths, dry with a hair dryer;
• in case of deep infected cracks, take a break from feeding the affected breast (be sure to express it), treat the nipple with a solution of potassium permanganate (1:5000), etonium ointment, Kalanchoe, or an oil solution of vitamin A.

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Milk let-down (breast filling)

Most often, this is observed on the 3rd-4th day after birth, the only measure is frequent and sufficiently long feeding of the child on demand, but necessarily adhering to the correct feeding tactics. Sometimes there may be a need to express milk. After 1-2 days, with such tactics, milk production will meet the needs of the child and all the above-described phenomena disappear.

Breast engorgement

Engorgement of the mammary glands is observed on the 3rd-4th day after birth and is associated not only with the flow of milk, but also with an increase in the content of lymph and blood, which significantly increases the pressure in the mammary gland and interferes with the formation of milk. One of the reasons for the development of engorgement of the mammary gland is the weakness of the oxytocin reflex, which causes a discrepancy between the production and removal of milk.

The difference between breast fullness and breast engorgement

Breast filling	Breast engorgement
Hot but not hyperemic	Hot, may be hyperemic
Dense	Dense, especially the areola and nipples
Solid	Swollen, shiny
Painless	Painful
Milk leaks when pumping or sucking	Milk does not leak when pumping or sucking
There is no increase in body temperature	The body temperature is elevated

The main factors that contribute to breast engorgement are:

• delay in starting breastfeeding;
• incorrect attachment of the baby to the breast;
• rare emptying of the breast from milk;
• limiting the frequency and duration of breastfeeding.

The first and foremost condition for treating breast engorgement is to remove milk from the breast. Therefore, during this condition, "the breast should not rest":

• if the baby is able to suck, then he needs to be breastfed frequently, without limiting the duration of feeding, adhering to the correct breastfeeding technique;
• if the baby cannot latch on to the nipple and areola, you need to help the mother express milk. Sometimes it is enough to express a small amount of milk to soften the gland, after which the baby is able to suck;
• Some authors recommend the use of physiotherapeutic methods, in particular ultrasound;
• Before feeding or pumping, you need to stimulate the mother's oxytocin reflex: apply a warm compress to the mammary glands or a warm shower; massage the back or neck; lightly massage the mammary glands; stimulate the nipples; sometimes oxytocin 5 IU is prescribed 1-2 minutes before feeding or pumping; help the mother relax;
• After feeding, apply a cold compress to the mammary glands for 20-30 minutes to reduce swelling;
• It is very important to reassure the mother and explain that this is a temporary phenomenon and that she will be able to successfully breastfeed her baby.

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Blocked milk duct, mastitis

When a milk duct is blocked (for example, by a milk clot), part of the mammary gland is not emptied, and a local, moderately painful, hard mass appears. Milk expression is difficult. The general condition of the woman in labor is not disturbed, and her body temperature is normal. The condition in which milk is not removed from the breast, associated with a blocked milk duct or engorgement of the gland, is called lactostasis. If milk is not removed from the gland in a timely manner, a rather serious complication develops - mastitis.

Mastitis may not be of infectious etiology (especially at the beginning of the disease). The cause of inflammation may be a "breakthrough" or reflux of milk from the milk ducts under high pressure into the surrounding interstitial space with subsequent autolysis of tissue by both milk enzymes and released cellular enzymes of the gland itself. The addition of infection leads to the development of infectious mastitis (in the etiology of mastitis, the leading place is occupied by pathogenic staphylococcus - Staphylococcus aureus). However, in practice it is very difficult to distinguish the presence or absence of an infectious process.

Causes of Clogged Milk Ducts and Mastitis

Causes of Clogged Milk Duct	Causes of Mastitis
Insufficient drainage of part or all of the breast	Not breastfeeding often or for long enough Ineffective sucking Pressure from clothing or fingers (during feeding) A very large breast that is difficult to drain:
Cracked nipples	Pathway for bacteria to enter
Chest injuries	Damage to breast tissue (rough massage and pumping, congestion)
Stress, excessive physical activity of the mother

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Symptoms of Mastitis

• increased body temperature (38.5-39 °C);
• fever;
• weakness, headache;
• enlargement, compaction, swelling, hyperemia of the gland;
• palpation of individual very dense painful areas of the gland;
• Milk is difficult to express.

Serous mastitis with insufficient or ineffective treatment within 1-3 days turns into infiltrative. This is the most common clinical form. The purulent stage of mastitis has an even more pronounced clinical picture: high body temperature - 39 °C and above, fever, loss of appetite, enlargement and soreness of the inguinal lymph nodes.

Treatment of inflammation of the mammary gland

• improve gland drainage;
• ensure that the baby is correctly attached to the breast and that feedings are frequent;
• eliminate pressure from clothing or the influence of other factors on the mammary glands;
• ensure the correct position of the mammary gland;
• stimulate the oxytocin reflex;
• start feeding with a healthy breast, change feeding positions;
• promptly begin complex antibacterial and detoxifying therapy, which should last for a sufficient period of time (at least 7-10 days):
• antibiotics - penicillin-resistant cephalosporins (ceftriaxone 2 g per day), macrolides (erythromycin 500 mg every 6 hours, rovamycin 3 ml every 8 hours). flufloxacillin 250 mg orally every 6 hours;
• infusion therapy (rheopolyglucin, rheomacrodex);
• analgesics (paracetamol, aspirin no more than 1 g per day);
• desensitizing drugs (suprastin, diazolin);
• bed rest, complete rest (if treated at home - help from family members).

It is necessary to explain to the mother that she should continue to breastfeed frequently enough, performing all the above measures.

Contraindication to breastfeeding is purulent mastitis. Additional mammary glands appear most often in the armpit area on one or both sides in the form of painful dense formations, often with a lumpy surface. They increase in size in parallel with the arrival of milk. Treatment measures:

• warm-up and massage are absolutely contraindicated;
• cold compress or compress with camphor oil locally on the area of additional glands (if they are large and painful). As a rule, all clinical manifestations weaken and disappear after a few days with proper case management.

Breast scars

Breast scars are observed in women after breast surgery for mastitis, tumors (for example, fibroadenoma), for cosmetic purposes, and after burns. An individual approach (taking into account the location of the scar or scars, the degree of damage to the breast tissue) with consultation with a mammologist is advisable.

Plastic surgery on the mammary gland to improve its shape. The question of the possibility of breastfeeding is agreed with the surgeon who performed the operation. It should be remembered that feeding with one mammary gland is possible.