Engorgement

—Uncomfortable overfilling of the breasts with milk

• Early engorgement occurs with the onset of milk production, about 2 to 5 days after delivery.
• Late engorgement can result from missed feedings or the inability to empty the breasts completely.

Symptoms

• Swollen breasts
• Firm or hard breasts
• In some cases, tender or painful breasts

Management

• Feeding the baby or pumping the breasts (Do not use breast pump on high intensity or for longer than 10 minutes each side.)
• Massaging breasts and emptying with each feeding or pumping
• Cool compresses or ice packs to relieve discomfort.
• Mild pain relievers (for example, acetaminophen or ibuprofen), which are considered safe

Ineffective Treatments

• Heat application
• Use of breast pump for longer than 10 minutes
• Cabbage leaves or cabbage extract

Sore or Cracked Nipples

—Injury to the nipple(s) that often results from incorrect breastfeeding technique with poor positioning of infant or ineffective latching, or traumatic pumping if breast pump is set to too high of intensity or a duration of longer than 10 minutes per breast

Symptoms

• Nipple abrasion
• Nipple bruising
• Cracks in the nipples
• Blisters on the nipples

Management

• Express a few drops of milk and rub on nipples after feeding to benefit from natural healing properties of the milk.
• Air-dry nipples after feeding.
• Change nipple pads often to avoid trapping moisture.
• Wash breasts using only water (soaps can be too drying).
• Use purified lanolin to promote healing.
• May use breast shields to protect nipples between feedings.

• Fever and/or chills
• Red spot with streaking
• Increased pain
• Bloody or green nipple discharge
• Flu-like symptoms, including body aches and malaise

Plugged Ducts

—Localized area(s) in one or more milk ducts that become plugged due to a collection of milk

• Poor latching
• Ineffective positioning of infant to breast
• Failure to empty the breast completely

Symptoms

• Lump(s) under the skin (may be able to follow the lump along the duct)
• Breast pain or tenderness

Management

• Change infant’s feeding position with each feeding.
• Breastfeed or pump frequently.
• Massage the affected area.
• Apply heat.

NOTE: Plugged ducts increase the risk for mastitis. If the plugged duct does not resolve within 72 hours, contact your health care provider.

Inadequate Milk Supply

—Mother’s supply of milk is not sufficient to support infant’s demand for feeding, which can result from insufficient milk production or failure to completely empty the breasts, resulting in decreased milk production

NOTE: It is important to remember that milk supply varies from woman to woman, and from pregnancy to pregnancy. Additionally, infant demands vary from infant to infant.

Contributing Factors

• Maternal fatigue
• Lack of sufficient nutrition or fluid intake by the woman
• Infrequent feeding or pumping
• Feedings that are too short
• Poor latching
• Maternal-infant separation
• Use of supplemental feedings

Management

• Increase rest/sleep time.
• Maintain a healthy diet and adequate water intake.
• Increase frequency and duration of breastfeeding (if needed).
• Thoroughly empty breasts with each feeding/pumping.
• Avoid use of infant formula or cereal (unless otherwise directed by your health care provider or pediatrician), which may reduce infant’s demand for breast milk.
• Talk with your health care provider about possible ”off label” use of prescription medication(s) to enhance milk production.

Source: Cibulka NJ, Barron ML. Guidelines for Nurse Practitioners in Ambulatory Obstetric Settings. New York, NY: Springer Publishing Company; 2013:134-138.