Challenges you may encounter while breastfeeding

While breastfeeding/chestfeeding is natural and healthy for you and your baby, it can still be very challenging. Here are some common challenges and how to support you through them. We offer many resources at your clinic as well, including one-on-one help from our lactation specialists and group visits and support groups. It is normal to need help during this time, so let us know how we can help you. 

Challenges you may experience are highlighted within this article. 

Breast engorgement

Engorgement is another word for swelling. It is normal for your breasts to have swelling as your milk is “coming in.” 

This usually happens 3 to 5 days after you give birth to your first baby or 2 to 3 days after if you’ve had previous children. The feeling of fullness is caused by the normal swelling of the breast tissues as milk production increases. Generally, your chest will feel more comfortable by the end of your baby’s first week as the swelling decreases. When engorgement improves, it doesn’t mean you’re making less milk.   

Engorgement can also happen when your baby is older, such as if you’re unable to feed them for a long period or you’ve pumped a lot and created an oversupply of milk. 

With engorgement, your breast or chest become tender to the touch, warm, enlarged, and painful, which can make latching more difficult. The nipple may also become enlarged. This discomfort may also extend to the armpit. 

If you have engorgement, you can use several home care techniques to help yourself feel better:

• Apply cold compresses to the breast before and after each feeding. To protect the skin, apply an ice bag wrapped in a cloth for 10-15 minutes.
• Before latching your baby gently massage to help stimulate the flow of milk.  
• Before breastfeeding, hand-express milk or pump for 2 to 3 minutes to soften the breast; this may also help the baby latch deeper. 
• If the baby does not feed long enough for the breast to be softer at the end of the feeding, "consider hand expressing or "pumping for comfort” with a breast pump.
• Wear a supportive bra/clothing that’s not too tight. Avoid underwire bras
• Take a pain medication that’s recommended by your clinician.

You can help prevent breast engorgement by:

• Alternating which breast you offer your baby first.
• Ensuring your baby latches on correctly and is feeding effectively and getting milk 
• Using different feeding positions.
• Do not pump unless the baby is taking the extra milk.
• Do not pump to store in the first month of breastfeeding/chestfeeding.
• Avoid skipping feeds, even at night. 
• Avoid tight bras/clothing 

If you are having trouble with latching, you can try these methods: 

• Hand express milk or pump for 2 to 3 minutes to soften the breast. You can do this just before the baby latches or at other times to feel relief. 
• Perform “reverse pressure softening.” Place the pads of your index and middle fingers on either side of the nipple, gently pressing swelling away from the nipple. Do this on all sides of the nipple. This will reduce the swelling of the areola so the baby can latch. 

Oversupply of milk

Some people struggle to make enough milk, while others produce more than enough. The goal with time is to match how much milk your body makes with how much your baby needs. At first, your breasts or chest may make too much, and you will leak a lot. You can worsen an oversupply by regularly pumping in addition to feeding the baby. This includes using a suction pump, pumping after or between feeding, or routinely pumping an extra session daily. Any milk removed from the breast routinely signals the body to replace the milk as the baby is eating it.

To help manage leaking, try:

• Cross your arms tightly across your chest and apply pressure to your breasts. Apply gentle pressure until the leaking stops. You can also use a towel to help stop milk flow.
• Using nursing pads in your bra. These pads absorb any leaked milk. Change pads whenever they get wet. Avoid using any pads with plastic liners — these can trap moisture and cause other problems, like sore nipples.

Sore nipples

Sore nipples are a common challenge when you’re breastfeeding or chestfeeding your baby.  Your nipples may be sore for the first few days or weeks of breastfeeding. However, as you continue to breastfeed, this discomfort should go away. Fortunately, there are many ways to help prevent and relieve the pain.  

If your nipples are sore, first make sure your baby is latched on properly. If their latch starts out well and then begins to hurt, it’s possible your baby slipped down the nipple, and the latch has become shallower. In this case, take them off gently to relatch. 

Breast pumps can also cause injury to the nipple. To prevent this, choose the correct flange size and don’t pump too long or with too high suction. Learn more about pumping comfortably. 

Soreness prevention

In general, it’s important to make sure your nipples aren’t too dry or too moist. To do this, we recommend you: 

• Wear 100 percent cotton bras, not ones made from synthetic fabrics like polyester or nylon. 
• Avoid washing your nipples with harsh soap or body cleansers that can make them dry. 
• Apply your breast milk or olive oil to your nipples if you like. 

Plugged Ducts

If a milk duct in your breast becomes narrowed or “plugged,” milk can’t freely flow through the duct.

A plugged duct is an area of the breast where milk flow is blocked, usually by inflammation around the ducts where milk travels. This causes the duct to narrow. It is not actually a “plug” that you need to pop out. 

If you have a plugged duct, you may have the following symptoms breast or chest: tenderness, heat, redness in one area, and sometimes a palpable lump. 

Why do plugged ducts happen?

Plugged ducts may occur for a variety of reasons. If the milk being produced isn’t fully removed on a regular basis, congestion can happen. This can lead to swelling around the ducts, making it difficult to drain milk through the ducts. As the swelling resolves, the milk can start flowing again. 

Common situations that can lead to recurrent plugs include: 

• Overproduction of milk. 
• Irregular breastfeeding or pumping patterns. 
• Taking herbs or medications that increase milk production when not necessary. 
• Relying on a breast pump. Pumping is often less effective at emptying milk than feeding the infant at the breast. 
• Using a nipple shield, which makes it difficult for the infant to remove milk from all areas mild ducts. If shields are needed, it's important to make sure adequate milk removal is happening. 
• Dietary factors. Very occasionally, people find that eating a diet high in animal fats (whole milk, cheese, ice cream, red meat) increases the frequency of plugged ducts. 

How can I treat and prevent plugged ducts?

To help treat and prevent plugged ducts, you can: 

• Continue feeding on demand – without aiming to “empty” the breasts.  
• Avoid pumping or feeding more often than usual, as this may increase milk production in the region with congestion or swelling.  
• Avoid the use of nipple shields if possible. 
• Try gentle massage, sweeping up from the nipple toward the armpit to help drain any extra fluid and reduce inflammation. 
• To reduce inflammation or pain, you can take over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Advil). 
• Apply ice to the affected breast to decrease pain and inflammation. An ice pack or crushed ice wrapped in cloth can be applied every hour or so as often as needed.
• Taking Sunflower or soy lecithin 5-10 grams daily divided 2-3 times a day by mouth may be taken to reduce inflammation

What should I NOT do when I have a plugged duct?

Some commonly given advice can do more harm than good. We recommend you avoid: 

• Massaging deep or aggressively or using vibrating tools on the breast.  
• Pumping on higher settings or pumping to express extra milk.  
• Using Epsom salt or other drying agents on the breast or chest area. 

If you have a “bleb” on the nipple (a white spot or blister), treat it gently. It may help to place a warm compress or wet washcloth over the blister before breastfeeding or pumping. Don’t try to open or pop the bleb yourself. If it doesn’t go away, talk with your doctor about possible treatments. 

Mastitis

Mastitis is an inflammation in the breast/chest. Mastitis can be caused by several factors, including excessive milk production and poor milk flow from the breast. When milk builds up in a breast, it leaks into the nearby breast tissue causing inflammation. Infection can also develop if the inflammation is not resolving. Nipple damage may also lead to mastitis. Mastitis can produce flu-like symptoms, such as:

• Aching muscles
• Extreme tenderness, swelling, redness, and heat in one area of the breast
• Fever
• Chills
• Rapid Heart rate

Tell your clinician if you think you have mastitis. They can determine what is causing the inflammation and if you need antibiotics to treat it. You can help to manage mastitis by:

• Apply a cool compress for 15 minutes to decrease swelling. 
• Wearing a supportive bra/cothing that isn’t too tight but comfortable. 
• Resting with your feet up, getting extra sleep, and reducing stress. 
• Drinking plenty of water. 
• Taking ibuprofen or acetaminophen if desired to reduce symptoms. 
• Taking prescribed antibiotics. Antibiotics are safe to take while breastfeeding and may be recommended if your symptoms do not don’t improve with the treatments listed above. 

To care for yourself at home:  

• Don’t massage the breast or squeeze the inflamed area. 
• Don’t soak the breast in Epsom salt or apply castor oil. 
• Keep in mind that milk production may go down a bit if you have mastitis.
• Request advice from a lactation specialist if you’re having trouble with your milk supply. 
• Be careful not to overstimulate your breast and cause overproduction. This increases the incidents of clogged ducts and mastitis.

You can still nurse your infant from the breast that has mastitis. This promotes healing and won’t hurt your baby. If your breast or chest is too tender to feed, you should hand express or pump milk. This helps prevent engorgement. Many moms notice a decrease in milk production on the infected breast. Continue to nurse your baby or pump as usual, as the milk supply will recover.

When to call your clinician

Contact your clinician or lactation specialist immediately if you notice:

• Temperature of more than 100.4F, chills, or body aches
• Breast engorgement that’s interfering with breastfeeding. 
• Increased pain in one area of your breast.
• Increased redness or red streaks spreading out from part of your breast.
• Pus leaking out from your nipple.

Note: Kaiser Permanente recognizes that some parents who have birthed babies or who lactate may not identify with the terms “woman” or “mom.”  This includes transgender, nonbinary people, or others who have dealt with the impacts of gender dysphoria in their lives. Some parents might prefer a different term than "breastfeeding," such as “chestfeeding.”  In this article, although  we use the word “breastfeeding” primarily, this content is intended to support all parents in feeding their infants.