Once a woman has given birth, her estrogen and progesterone levels rapidly fall. By around three days after birth, the colostrum or “first milk” which had previously been yellowish in color, becomes diluted and changes to a whiter color.
Around this time, milk begins to leak from the breasts and when the baby feeds, nerves in the breasts send messages to the mother’s brain that more milk is required. The mother may find that milk then leaks from the breasts in response to the baby crying or when the breasts have become full.
The breast changes that occur during pregnancy are needed to prepare them for breastfeeding. It is entirely a mother’s decision whether or not to breastfeed, but there is strong evidence to support the benefits of breastfeeding for both the mother and the baby.
Research has shown that breastfeeding over a period of time can lower the risk of breast cancer and the breast milk contains antibodies that help to protect the baby from infection. The closeness felt during breastfeeding can also help the mother and baby to bond.
The breast milk contains all of the nutrients and fluid a baby requires to survive early on in their lives and the Department of Health advises that women breastfeed exclusively for the first six months after birth. After that period, breastfeeding along with the introduction of solid foods is recommended for as long as possible.
When the mother’s body starts to produce milk rather than colostrum, this is referred to as the milk “coming in.” When this occurs, it is not uncommon for women to experience difficulties with their breasts for a few weeks afterwards.
The problems may be caused by infection or inflammation in the breast, although many women do not experience any difficulties at all. Some of the problems that may occur are described in more detail below.
Cracked, sore nipples
The nipples may become sore and cracked if the mother has difficulty with the baby latching on correctly. The baby may try to suck only the nipple, rather than the whole areola area, which can make the nipple sore and cracked if the baby’s tongue or the roof of their mouth rubs on the nipple too much.
Guidelines recommend that if one nipple is less sore than the other, the mother uses that nipple first, so that if she needs to swap to the other nipple, she only does so when the baby’s urge to suckle is less strong. If the nipples are particularly sore, the mother may wish to use nipple shields, which are protective nipple-shaped sheaths that can be placed over the areola area while the mother feeds her baby.
Milk flows through holes in the tip of the shields to reach the baby.
Engorgement refers to when the breast become overfilled with milk. A few days after birth, the breasts become heavy and swollen as they fill with milk. If a baby does not feed enough to remove as much milk as the breast produces, the breasts can start to feel heavy and throb.
This can also occur if the baby fails to attach properly or if a mother chooses not to breastfeed. Approaches to resolving engorgement include feeding the baby on demand, adjusting positioning during feeding and expressing any milk that remains after feeding using the hand or a breast pump.
Sometimes, massaging the breast in a circular motion can help move the milk down towards the nipple while the baby feeds and help to ensure the breast is fully emptied. Also, ice packs placed on the breast after feeding can help to reduce inflammation.
Blocked milk ducts
Milk ducts in the breast can sometimes become blocked during or after feeding. This can cause a small, hard lump to develop that may be painful or lead to a bruised feeling. More frequent feeding and position changes can help to ensure the breasts are drained more fully and sometimes massaging the lump in the direction of the nipple can help to unblock the duct. Placing a warm flannel on the breast may also be helpful.
Mastitis refers to inflammation of the breast, which occurs as a result of infection. The condition is characterized by pain, redness and swelling of the breast and it may happen if engorgement or a blocked milk duct continue to be a problem. The breast may also become infected as a result of a cracked or grazed nipple. Women may experience fever, headache, chills and a high temperature.
This condition may need to be treated with anti-inflammatories or antibiotics. The infection may sometimes be cleared if the woman continues to breastfeed, which is not harmful to the baby because any bacteria are destroyed inside the baby’s stomach.
Placing a warm flannel on the affected area, prior to feeding, may also help to increase milk flow and applying ice packs after feeding may help relieve any swelling or pain.
If mastitis is not treated, a woman may find that an abscess starts to form, although this is not common. An abscess usually needs to be drained, which is generally performed at hospital using a needle and syringe.
For large abscesses, an incision may be made in the breast to enable pus to be drained. After the abscess is treated, mothers should continue to breastfeed or express the milk using a breast pump.
Reviewed by Yolanda Smith, BPharm