Complications of lactation

Flat nipples

Quite often, flat nipples and medical personnel, and mothers are considered a significant obstacle to breastfeeding. However, when properly applied, the child will grasp the mouth of a piece of breast tissue located under the areola, except for the nipple, creating a "nipple" in which the nipple occupies only a third. Therefore, with flat nipples, it is important to consider the ability of the breast tissue to stretch.

[1]

The nipples are drawn

This is a more complicated situation. When trying to pull the nipple, it can even be drawn even more. Such nipples, fortunately, are rare. Tactics for flat and retracted nipples:

• antenatal treatment - ineffective, not always possible;
• after childbirth:
  • soothe the mother, explain that breastfeeding is possible, because the baby does not suck the nipples, but the breast;
  • organize skin-to-skin contact, help the mother most conveniently to put the baby to the chest, using different positions;
  • explain to the mother what to do so that before the nipples are fed more (syringe method);
• If a child can not effectively suck in the first week, you need:
  • express milk and feed the baby from a cup and spoon;
  • express milk directly into the baby's mouth;
  • more often and longer keep the baby near the breast (contact "skin to skin");
  • in the extreme case, some time to apply a patch on the nipple.

Long nipples

Long nipples are infrequent, but can create certain difficulties in feeding the baby. Applying the baby to the mammary gland, we must adhere to the main principle - the child's mouth captures not only the nipple, but also a part of the tissue of the mammary gland, located mainly under the areola.

Cracked nipples

Cracks in the nipples arise mainly when the child is not correctly applied to the breast. This is especially often when using pre-lactation feeding or feeding a baby from a bottle with a pacifier ("nipple confusion"), and also when the baby is placed incorrectly against the breast. The cause of cracks can also be frequent (before and after breastfeeding) treatment of mammary glands, especially with soap.

Measures in the presence of cracks in the nipples:

• to reassure the woman;
• convince her of the possibility of continuing successful breastfeeding;
• give advice on proper hygiene care for nipples;
• lubricate the nipple with colostrum or "late" milk after feeding, make air baths, blow dry with a hairdryer;
• at deep infected cracks to make a break in feeding the patient with a mammary gland (necessarily it or her to express), to process a nipple a solution of potassium permanganate (1: 5000), ointment etonija, Kalanchoe, an oil solution of vitamin A.

[2], [3], [4], [5]

Tide of milk (breast filling)

More often it is observed on the 3rd-4th day after childbirth, the only measure is frequent and sufficiently long-term feeding of the baby on demand, but always adhering to the correct feeding tactics. Sometimes there may be a need for expressing milk. After 1-2 days with this tactic milk production will meet the child's needs and all the above described phenomena disappear.

Breaking of mammary glands

Breast engorgement is observed on the 3rd-4th day after childbirth and is associated not only with tidal milk, but also with an increase in lymph, 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 breast engorgement is the weakness of the oxytocin reflex, which causes a discrepancy between production and elimination of milk.

The difference between filling and engorgement of the breast

Breast Filling	Breast engorgement
Hot, but not hyperemic	Hot, can be hyperemic
Thick	Dense, especially areola and nipples
Solid	Swollen, shiny
Painless	Painful
Milk flows when you pour or suck	Milk does not flow when you pour or suck
There is no rise in body temperature	Body temperature increased

The main factors that contribute to engorgement of the breast:

• delay in the initiation of breastfeeding;
• improper application of the baby to the breast;
• rare emptying of the breast from milk;
• limiting the frequency and duration of breastfeeding.

The first and main condition for treating breast engorgement is the removal of milk from the breast. Therefore, during this state, "the breast should not rest":

• if the child is able to suck, then it should often be breastfed, not limiting the duration of feeding, adhering to the correct technique of breastfeeding;
• If the child can not grab the nipple and areola, you need to help the mother to express the 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 physiotherapy methods, in particular ultrasound;
• before feeding or decanting, the oxytocin reflex should be stimulated in the mother: a warm compress to the mammary glands or a warm shower; do a back or neck massage; do an easy massage of the mammary glands; stimulate the nipples; sometimes prescribed oxytocin 5 ED for 1-2 minutes before feeding or pumping; help the mother relax;
• after feeding, put a cold compress on the mammary glands for 20-30 minutes to reduce swelling;
• it is very important to calm the mother and explain that this phenomenon is temporary and she will be able to successfully breastfeed her child.

[6], [7]

Blockage of the milk duct, mastitis

When the milk duct is obstructed (for example, by a clot of milk), part of the mammary gland is not emptied, a local, moderately painful, firm formation appears. Expressing the milk is difficult. The general condition of the mother is not broken, the body temperature is normal. The condition in which milk is not removed from the chest, associated with the obstruction of the milk duct or engorgement of the gland, is called lactostasis. If you do not remove milk from the gland in time, a serious complication develops - mastitis.

Mastitis can be non-infectious etiology (especially at the beginning of the disease). The cause of inflammation can be a "breakthrough" or reflux of milk from the milk ducts under high pressure into the surrounding interstitial space, followed by autolysis of the tissue with both milk enzymes and the released cellular enzymes of the gland itself. Accession of infection entails 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 obstruction of the duct and mastitis

Causes of obstruction of the milk duct	Causes of mastitis
Insufficient drainage of part or all of the breast	Inadequate and prolonged breastfeeding Ineffective sucking Clothing pressure or fingers (during feeding) Very large mammary gland in which it is difficult to provide drainage:
Cracked nipples	Path to penetrate bacteria
Breast Injury	Damage to the breast tissue (rough massage and pumping, stagnation)
Stress, excessive physical stress on the mother

[8], [9], [10]

Symptoms of mastitis

• increase in body temperature (38.5-39 ° C);
• fever;
• weakness, headache;
• enlargement, compaction, edema, glandular hyperemia;
• palpation of some very dense painful sections of the gland;
• milk is difficult to express.

Serous form of mastitis with insufficient or ineffective treatment within 1-3 days becomes 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 higher, fever, loss of appetite, an increase and soreness of inguinal lymph nodes.

Treatment of inflammation of the breast

• improve the drainage of the gland;
• ensure proper attachment of the baby to the breast, frequent feeding;
• to eliminate the pressure of clothing or the influence of other factors on the mammary glands;
• ensure the correct position of the breast;
• stimulate the oxytocin reflex;
• start feeding healthy breasts, change the position when feeding;
• timely start complex antibacterial and detoxification therapy, which should last for a sufficient time (not less than 7-10 days):
• antibiotics - penipillinase-resistant cephalosporins (ceftriaxone 2 g throughout the day), macrolides (erythromycin 500 mg every 6 h, rovamycin 3 ml every 8 h). Fluflokeacillin 250 mg orally every 6 hours;
• infusion therapy (reopoliglyukin, reomacrodex);
• analgesics (paracetamol, aspirin, not more than 1 g per day);
• desensitizing drugs (suprastin, diazolin);
• bed rest, complete rest (for treatment in the home - help of family members).

It is necessary to explain to the mother that she should continue to breastfeed often enough, performing all of the above activities.

Contraindication to breastfeeding is purulent mastitis. Additional mammary glands appear most often in the axillary region from one or both sides in the form of painful dense formations, often with a tuberous surface. Increase in parallel with the arrival of milk. Healing, activities:

• absolutely warm-up, massage;
• Cold compress or compress with camphor oil locally on the zone of additional glands (with significant dimensions and pain sensations). As a rule, all clinical manifestations weaken and disappear after a few days with proper management of the case.

Scarring of the breast

Scars of the breast are observed in women after a surgery on the mammary gland for mastitis, tumors (eg, fibroadenoma), for cosmetic purposes, and after burns. Individual approach is advisable (take into account the location of the scar or scars, the degree of damage to the breast tissue) with mammal consultation.

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