When breastfeeding isn’t as idyllic as the midwives promise

Everybody knows that breastfeeding is the ideal choice for you and your baby. It's natural and gives your little one the best possible nutritional start in life, not to mention saving money, time and effort spent on formula, bottles, sterilising machines and bottle warmers.

However, as most mums will tell you, breastfeeding isn't always a walk in the park. Here are some common breastfeeding problems and some tips on how to ease the situation.


Engorgement occurs when the milk first 'comes in' – within 24-36 hours of giving birth. If you think your breasts swelled during pregnancy, then you ain't seen nothin' yet!

Engorgement makes your chest feel hot, heavy and sore. Your breasts change from a relatively soft texture (which will have already become considerably firmer during pregnancy) to a hard, and sometimes bumpy consistency. For a first-timer, it's an incredibly alien feeling, and with all those hormones flying around, it's perfectly normal to feel tearful and panicky.

The only way to relieve engorgement is to express milk, whether that means feeding your baby, or using an electric or battery operated pump. It's also possible to express milk by hand, although that's a slow process and is quite a difficult technique to master during this highly emotional time. You will see and feel your breasts 'deflate' after milk has been expressed, and the relief will be considerable, although be aware that it will build up again. Over the next few days, your breasts will naturally adjust to produce just the right amount of milk for your baby, and this initial shock will pass.

Please note that during engorgement, it's safe to take paracetamol to help combat the feverish, achy feeling.

Sore nipples

Engorgement aside, while you're adjusting to the physical demands of breastfeeding, the pain of sore, cracked and sometimes even bleeding nipples can seriously interfere with your enjoyment of nursing. It's really important to take good care of your nipples, as if they're cracked, this might lead to infection and mastitis.

First of all, you need to make sure your baby is correctly positioned and 'latching on', with the entire areola in his mouth (not just the nipple). If engorgement makes that awkward because of the swollen shape of your breast, express a small amount of milk prior to feeding.

After each feed, expose your nipples to the air for a little while. You may like to investigate a few products to moisturise your nipples if they are cracked – there are plenty of balms, lotions and compresses readily available in pharmacies and larger supermarkets. Alternative instant homemade relief can be provided by cold wet tea bags, although take care to avoid staining your clothes!

We recommend Lansinoh HPA Lanolin Cream and Medela Purelan Nipple Cream.

During this period, avoid washing your breasts with any soap-based products, which might contain irritants to your skin. You can protect your nipples from rubbing against your underwear by using breast 'shells' that sit inside your maternity bra – again these are available from many chemists and online. Also, if you're wearing nursing pads to soak up excess milk, make sure to change them frequently so that your nipples won't be unnecessarily exposed to moisture for long periods of time.


Mastitis affects around one in ten women and occurs when the milk ducts become blocked or infected, often within the first three months of breastfeeding. It usually only affects one breast, which will become hot, sore and inflamed – sometimes you'll be able to see a defined lump where the problem duct is located. You might also experience flu-like symptoms, such as feverishness, aches and chills.

If you suspect you have mastitis, visit your GP who may well prescribe antibiotics to clear up the infection. Your doctor might also advise you to wear as tight a bra as you can bear to encourage the swelling to go down. You can take paracetamol for the pain and may find hot baths or ice packs help ease your discomfort. In the olden days, women used to keep chilled cabbage leaves in the fridge then put them in their bras to soothe away the hotness. Nowadays you can buy especially shaped cool packs that have much the same effect. Some people also experience relief from gently massaging the affected area – whatever feels right for you.


If you're suffering from persistent cracked nipples that never seem to properly heal, or particularly pink and shiny nipples with little white spots, it could be that you have thrush. Thrush is caused by a common fungus present in all our mouths, and sometimes the physical act of your newborn's mouth being in contact with cracked nipples for such a long time can make it spread.

Other symptoms of thrush include unusually itchy or hot nipples, or sharp, stabbing pains in your breasts. If your nipples are badly cracked it is possible that the infection has passed through them to your milk ducts, which is known as ductal thrush.

It's very important to consult your GP if you suspect you may have thrush, because until you take the appropriate medication, the infection will continue to pass back and forth between you and your baby, and you will soon see the same sore pink and white patches in his mouth. If thrush is confirmed, you will need to take extra care with family hygiene, sterilising all baby equipment, washing clothes at 60 degrees and washing hands and toys often to prevent reinfection.

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