Tag Archive | cracked nipples

TIME – the Most Precious Commodity of All

breastfeeding momMost mothers are stressed when they have a new baby. I absolutely remember how tiring it is to be a mother – and especially when you’re a breastfeeding mother. Being tired is on my mind right now, because in the midst of working with a new breastfeeding mother of a six-day-old, she flat-out told me that, “this breastfeeding thing is taking way too much of my time.” I was left flabbergasted and flap-jawed. What I wanted to say and what I did say were two very different things. What I wanted to say was “Well, what were you expecting? Did you think you were going to drop the baby in the umbrella stand on the way in and out of your front door?” What I actually said is “Tell me how I can help you.”

The mom went on to explain that nursing every two hours was beginning to grate on her nerves. I went on to explain that babies had tummies the size of golf balls and that breast milk was a “perfect food” that made it digest and move through the stomach very rapidly. I quoted how each DROP of colostrum had 3 million cells (the majority being immune cells). Breastfeeding is as much nurturing as nourishing (hoping the old adage would help). I also described cluster feeding as being analogous to a camel getting ready to cross the desert; feed, feed, feed and then you get the big sleep (maybe 4-5 hours max). In my first book “Start Here; Breastfeeding and Infant Care with Humor and Common Sense” I tried to call the hours between 6-10PM the “arsenic hours,” but the publisher opted for something safer like “the witching hours.” I guess that “every hour on the hour” cluster thing is what put this new mother “over the edge.”

So, here are some suggestions I’ve come up with to help you save time during your busy breastfeeding days.

  • If you have an exceptionally sleepy baby (or just have to get the show on the road once in a while), I find that you can feed on one side while you simultaneously pump on the other: Tarzan Pumping (at least that’s what I call it). That trick alone can save you up to a half hour per feeding and maximize your milk supply. Your body will react as it you’re feeding twins (because both sides are going at the same time) and perhaps even increase supply a bit. It will also expedite your feeding and have your baby feel as though a bigger, stronger twin was on the other breast helping him or her out. Now you’ll want to feed that milk to your baby at some point (perhaps during cluster feeding time), as when I previously instructed another mom to do this, she was giddy with her new frozen stash; problem was the baby hadn’t gained any weight in a week…whoops; I should have been more clear with my instructions.
  • Anyone who tells you to sleep when the baby sleeps probably doesn’t shower, do laundry, use the bathroom, open the mail or eat; I never understood that suggestion. I mean, that’s the only time you have to do ANYTHING, isn’t it? So, ALLOWING others to do things for you will help put time back in your day. You shouldn’t feel as though you’re not a good mother if you don’t do everything and do it well (do as I say, not as I do/did). I remember 28 years ago how I came creeping out of my house to get the mail and was spotted by my neighbor. She promptly sent her “nanny” over to my house with instructions to “help that poor woman out.” Problem is that I wouldn’t let the well-meaning nanny in! As I look back on it, I was afraid that I’d be found out; that I’d be “exposed” and my neighbor would know how I wasn’t really holding things together as a mother “should.” In my experience, many mothers feel that same way. They’re overwhelmed but think that they’re the only mother experiencing that. I’m here to tell you that MOST mothers feel overwhelmed in the beginning and if they tell you otherwise, I’d be wary.
  • Remember the saying “time is fleeting,” so are these stages!  Many times these cluster feeds will pass quickly and after a couple days you’ll have an entirely new baby.  It’s important to keep in mind that babies patterns change quickly and you won’t always be feeding around the clock. 

When I heard this mother complaining about time, as I think more about it, I’m suspicious there might be something else going on. Is she depressed? Is she lonely and needs to get out of the house for companionship, does she simply have cabin-fever, or are her expectations unrealistic as to how much time infants take out of a mothers day? What do you think?

Blog written by  Kathleen F. McCue, DNP, FNP-BC, IBCLC-RLC, 

Owner of Metropolitan Breastfeeding

What is Thrush?

Thrush/nipple yeast and vaginal yeast are caused by the one-celled organism, Candida albicans. It is a fungus that thrives in moist, dark environments (like the nipples, milk ducts, mother’s vagina, baby‘s mouth and/or baby’s diaper area). The use of antibiotics by mom or baby is a contributing factor in the occurrence of yeast. A cracked or sore nipple can also contribute to yeast occurrence.

Here are a few questions to help you determine if you or your baby has a yeast overgrowth. A consultation with your health care provider is also important. If you answer yes to one or more of these, you may have thrush.

  • Have you noticed white spots in your baby’s mouth?
  • Does your baby have a bright red, pimply diaper rash?
  • Is your baby gassy, fussy or not nursing well due to oral thrush?
  • Is the area around your nipple pink, red, itchy, flaky or shiny?
  • Do you feel a burning sensation on your nipples either during or between feedings?
  • Do you have a cracked nipple that won’t heal? 
  • Do you feel shooting pains in your breast (different from the sensation of let-down)? Some women describe the feeling as “a piece of glass” or “stabbing”.
  • Have you or your baby completed a recent course of antibiotic treatment?
  • Did you have a cesarean birth or were you diagnosed with a vaginal Strep-B infection?

**Note: It is rare for a mom to have a red rash or white spots on her nipples with a nipple yeast infection.**
Here are some common treatment for thrush:

It is very important that both mom and baby are treated at the same time, even if only one of them show signs of yeast. Yeast/thrush is highly contagious, and if not treated together, they will keep passing it back and forth to each other. Be sure to continue treatment for at least 2 WEEKS after the signs of thrush/yeast have gone away.

Your health care provider can prescribe a prescription of Nystatin for you and baby -a cream for mom to use on her nipples and oral liquid for baby. Make a run to the store for yogurt containing live, active cultures (especially l. acidophilus). The yogurt cultures (acidophilus) will help get rid of the yeast. If your baby is old enough, you can offer him some, too.

Acidophilus supplements. This does the same thing as the yogurt. You should be able to find acidophilus in the health food section of your grocery store/pharmacy or at a natural foods store. This can also be crushed (or, if you have the caplets, opened) and sprinkled directly on your nipples. If you wish, you can do this just prior to feeding so your baby gets a dose of acidophilus, too.

Gentian Violet. You should be able to find this in your local health food/natural foods store or in the natural food or vitamin section of your store. Using a clean cotton swab, rub some on each nipple. In order to treat baby, also, it works best to put some on your nipple and then latch baby on to nurse. It will coat baby’s mouth while he is nursing. It is a bit messy, so you’ll want to make sure you are wearing clothes you won’t mind get-ting purple stains on. This should only be used for 3 days.

Grapefruit Seed Extract. (not grape seed extract, ACTIVE INGREDIENT MUST BE “CITRICIDAL”), 250 mg (usually 2 tablets) three or four times a day orally (taken by the mother), seems to work well in many cases. If preferred the liquid extract can be taken orally, 5 drops in water three times per day (though this is not as effective). Oral GSE can be used before trying fluconazole, instead of fluconazole or in addition to fluconazole in resistant cases.

Dr. Newman’s All Purpose Nipple Ointment (from his Candida protocol handout): Mupirocin 2% ointment (15 grams), Betamethasone 0.1% ointment (15 grams), and miconazole powder so that the final concentration is 2% miconazole. This combination gives a total volume of just more than 30 grams. This cream requires a prescription.

The combination is applied sparingly after each feeding (except the feeding when the mother uses gentian violet). “Sparingly” means that the nipple and areola will shine but you won’t be able to see the ointment. Do not wash or wipe it off, even if the pharmacist asks you to. I used to use nystatin ointment or miconazole cream (15 grams) as part of the mixture, and these work well enough, but I believe the use of powdered miconazole (or even clotrimazole powder) gives better results. These ointments can be used for any cause of nipple soreness (“all-purpose nipple ointments”), not just for Candida (yeast). Use the ointment until you are pain-free and then decrease frequency over a week or two until stopped. If you are not having less pain af-ter 3 or 4 days of use, or if you need to be using it for longer than two or three weeks to keep pain free, get help or advice.

Vinegar Wash: 1 cup water and 1 tablespoon of vinegar. Use at least 4 times per day, after nursing. Use a clean cotton ball/swab to apply every time and let air-dry.

Cut back on your sugar intake. Yeast loves sugar, so the less that is in your body, the less the yeast has to thrive on.

Sterilize anything that goes into your baby’s mouth or has contact with your nipples. This is necessary to kill the yeast that is on those items and prevent it from reinfecting you. This includes any toys, pacifiers, bottle nipples, breast pump parts and your bras.

Wear disposable breast pads. Change them with each nursing and just toss them out. This way, you’re not sterilizing your bra every night.

Some moms have found swimming in a chlorinated pool to clear up their nipple yeast very quickly.

Diflucan/fluconazole is a prescription medicine that is commonly used to treat vaginal yeast infections. It has been shown to be effective against nipple yeast/thrush, especially when the yeast has survived all other treatments or it is a ductal yeast infection (meaning it is in your milk ducts, not just in the nipple area). The dosage for proper treatment is: 400mg loading dose on day one, then 200 mg per day for 13-28 days after, depending on what your health care provider designates as course of treatment.

What is Mastitis? Cause, Treatment and Prevention

Mastitis occurs when bacteria enter your breast through a break or crack in the skin of your nipple or through the opening to the milk ducts in your nipple. Bacteria from your skin’s surface and baby’s mouth enter the milk duct and can multiply — leading to pain, redness and swelling of the breast as infection progresses.

Mastitis is often caused by Staphylococcus aereus and Escherichia coli bacteria. It is an unwelcome guest, especially to first time moms who have a difficult enough time trying to establish a breastfeeding routine with their baby. It is also unwelcome to those of you who have already experienced cracked nipples, have thin or sensitive skin, engorgement or a weakened immune system. Mastitis is often preceded by engorgement, plugged milk ducts or cracked and bleeding nipples.

Symptoms of mastitis include:
• A red, sore spot or “hot spot” on your breast
• Breast tenderness or warmth to the touch
• Swelling of the breast
• General malaise, or feeling ill
• Overall, flu-like symptoms
• Fever of 101 degrees F or 38.3 C or greater
• Red lines following the troubled milk duct’s path

Because many healthcare providers will prescribe antibiotics, it is up to the mother to find, in addition to the antibiotics, other remedies and comfort measures to help shorten the episode of mastitis, ease the pain and help to continue to breastfeed your baby.

Self-care remedies. Resting, continuing breast-feeding and drinking extra fluids can help your body overcome the breast infection. If you are prescribed an antibiotic, the course of therapy will usually be ten to fourteen days of antibiotics. Even though you may feel better after 48 to 72 hours of taking the antibiotics, be sure to finish the antibiotic regimen to ensure your breast infection is resolved.

To relieve your pain and discomfort:
• Maintain your breastfeeding routine-Yes; you can still breastfeed your baby with a breast infection. It is safe for you and for your baby. It is also recommended by the La Leche League to continue breastfeeding on the affected breast through mastitis to help shorten the episode of the infection and avoid abscesses. Mastitis need never be the reason to discontinue breastfeeding your baby
• Avoid prolonged engorgement before breastfeeding your baby. The mother needs to reduce the fullness as much as possible at each feeding to ease the inflammation and expel any milk plugs that may be present. Some babies may be reluctant to breastfeed on the infected breast because of elevated sodium content in the milk. If the baby cannot be persuaded to nurse, the mother needs to express milk to keep her breast soft.
• Use different positions to breastfeed your baby; sometimes the same position causes pressure points on a certain area of the breast, thus causing a plugged duct which can lead to mastitis. Be sure you are in a good and comfortable position before your baby latches on
• Drink plenty of fluids! Did I mention this before? This is important enough to repeat!
• If it is too painful to breastfeed on the affected breast and/or your breast is too sore to have babe latch on, you can pump and hand expressing your milk
• If you have difficulty emptying a portion of your breast, apply warm compresses to your breasts, take a warm shower, or kneel in your tub filled with warm water and submerge your breasts before breastfeeding your baby or pumping
• Wear a good supportive bra
• While waiting for the antibiotics to take affect, take a mild pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Motrin, Advil, others)

Minimize your chances of getting mastitis by fully draining the milk from your breast while breastfeeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses only a few minutes on the second breast, or not at all, start breastfeeding on that breast at your next feeding.

Alternate the breast you offer first at each feeding, and change the position you use to breastfeed from one feeding to the next. Make sure your babe latches on properly before each feeding. If your baby is not latched on properly, break the suction with your finger. If baby fusses a few seconds, that is okay. This is better than you developing cracked nipples that can lead to mastitis.

Finally, do not let your baby use you as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they are not hungry.

Breastfeeding your baby is the most fulfilling action in the mother-infant bonding process. It should be pain free and fulfilling.

by Angel J. Miller, MSN, CNM

Excerpts from Mayoclinic.com on Breastfeeding problems; La Leche League (lll.org)