POSTPARTUM: BREAST ENGORGEMENT AND SORE NIPPLES
PROBLEM
Engorgement causes swollen, tender breasts, which may have palpable nodular areas.
CAUSE
Engorgement may develop because of inadequate suckling by your baby.
PREVENTION
A.At first, nurse your baby every 2 hours.
B.Make sure your baby latches on to as much as possible of the areola (darkened area around the nipple). The baby suckling on the tip of the nipple does not provide the stimulation necessary to let down the milk and can make your nipples sore and cracked.
C.Always break the neonate’s attachment of the areola and nipple before removing them from the breast. To break the neonate’s attachment, place your finger in between the neonate’s mouth and breast to break the suction. If your baby is not well attached to the breast, detach the baby and make sure he or she opens the mouth wide to accommodate most of the areola.
D.Wear a supporting nursing bra (avoid underwire bras, as they can exert pressure on certain areas of the breast and cause milk stasis, which is a good medium for bacterial growth and infection); make sure that your bra does not squeeze your breasts too tightly.
E.Making sure that the baby is properly attached to the nipple helps to avoid cracking of nipples that can predispose you to an infection of the breast called mastitis.
F.After the baby feeds, express some milk and apply it to the nipple and areola.
G.Purified lanolin can also be very helpful for sore nipples and can prevent further cracking and infection. Apply routinely after each breastfeeding session for the first several days of nursing and longer if tender or cracked nipples occur. If the lanolin is purified, there is no need to wash it off prior to feedings.
TREATMENT PLAN
A.Engorgement:
1.Treatment of engorgement includes the application of heat, breast massage, and expression of milk for comfort only.
2.A warm moist washcloth or a warm shower before massaging the breast decreases discomfort.
3.Massage breast by making several gentle but firm stroking movements with the fingertips along the swollen ducts, moving toward the nipple. This should be done around the entire breast.
4.After massaging, milk should be expressed or pumped until the breast softens enough for the baby to latch well. The baby should then be allowed to nurse from both breasts.
5.The best strategy for engorgement is frequent breastfeeding (at least every 1/2 to 2 hours until engorgement resolves).
B.Sore nipples:
1.Sore nipples are usually caused by the improper positioning of the baby on the nipple.
2.Ensure your baby is grasping the areola when sucking and not just the nipple.
3.Always break the neonate’s attachment of the areola and nipple before removing him or her from the breast to prevent sore nipples.
4.Continuous suction pressure at the same spot of the nipple can be painful.
5.Change the position of the baby to change the latching on
position of your baby’s mouth.
6.If nipples become sore or cracked, start feeding on the less affected breast first.
7.Apply purified lanolin to nipples after each feeding.
8.Prevent mastitis with the following personal hygiene measures:
a.Avoid using soap on nipples.
b.Avoid decrusting the nipples of dried colostrum or milk.
c.Change breast pads frequently.
d.Wash hands before handling your breast and before breastfeeding.
Activity: As tolerated, extra rest is recommended after delivery.
Diet:
A.Breastfeeding mothers need extra liquids for milk production.
B.Drink 10 to 12 glasses of liquid a day.
C.Use caffeine in moderation (eliminate if possible).
D.Continue your regular diet and add about 500 extra calories per day.
E.Avoid gas-producing foods that may upset your baby’s stomach.
Medications: Continue your prenatal vitamins while breastfeeding.
You Have Been Prescribed: Acetaminophen 500 mg or ibuprofen 600 mg every 3 to 4 hours for discomfort.
You Need to Notify the Office If You Have:
A.Temperature of 100.4°F or higher.
B.Pain that is not controlled with Tylenol or ibuprofen.
C.Flu-like symptoms (fever, chills, malaise).
D.Red streaks on breast.
E.Headache with the symptoms listed here.
F.Other: ___________________________________________________________
Phone: ____________________________
PATIENT TEACHING GUIDE