Yahoo Lifestyle Breastfeeding problems - overcoming the booby traps
For years your boobs have just been there, performing no particular biological function, then one day bub comes along and everything changes: it’s time for breastfeeding. But with breasts coming in all shapes and sizes – big and small, long and flat nippled, natural and augmented – you may be wondering whether your own unique set will be up to the job.
The very general answer to this is that when it’s their time to shine, most breasts do. But certain physical characteristics and other factors can present mum and bub with some challenges. Here’s what you need to know…
Large breasts
While the size of your breasts often doesn’t relate to how much milk you make, very large breasts can be more uncomfortable, particularly during breastfeeding, says lactation consultant Dr Virginia Thorley, who has a Medal of the Order of Australia for her services as an author, counsellor and consultant on breastfeeding.
“Position is important for all women who breastfeed, but for those with very large breasts, it’s important to find a position which works for both mother and baby,” she says. “Many women will look at breastfeeding pictures and be tempted to hold their breasts and baby higher to feed. That will quickly become uncomfortable. It can also be hard for these mums to actually see their baby latch on.”
Best advice: “Many women with large breasts find a semi-reclining position works well with feeding. It extends the lap area and allows the baby to come from under the nipple, which is ideal,” says Dr Thorley, who also recommends finding a lactation consultant with experience in dealing with larger breasts.
Small breasts
No matter how plentiful your bosom, the ability to produce breastmilk lies in breast tissue. Women with small breasts often have the same amount of breast tissue – that is, milk-producing cells – as large-breasted women. “I have seen women with ‘microscopic’ breasts feed easily and well,” says Dr Thorley. “The glandular tissue is still there in these women,” she explains, “it’s just that they may not have as much fat.”
The only real difference between big boobs and smaller ones may be the storage capacity, with smaller-breasted women sometimes needing to feed a bit more often.
Best advice: Relax – small breasts are just as good at making milk as larger ones.
Breast augmentation
Having implants “does not change a woman’s ability to breastfeed”, says Dr Graham Sellars, president of the NSW chapter of the Australian Society of Plastic Surgeons. “Usually implants are placed behind the breast glands and incisions are made under the fold of the breast or through the armpit, which shouldn’t cause any damage to feeding ability,” he says.
Best advice: Dr Sellars says he would advise women contemplating breast augmentation to wait until after they’ve finished having kids because of the changes that happen to breasts during pregnancy and breastfeeding.
Breast reduction
This surgical procedure is likely to change a woman’s ability to breastfeed, says Dr Sellars. “I would say that one third will not be able to breastfeed, one third will be able to but not adequately, and the other third will have no problems. I advise every woman planning this procedure to expect not to be able to breastfeed successfully.”
The reason for the change in feeding ability is that some of the breasts’ glandular tissue is removed to reduce the size of the breasts.
Best advice: If you’ve had a reduction pre-bub, then seek advice from a lactation consultant about the best ways to establish breastfeeding. Pumping, massage and sometimes herbal or prescription substances for promoting milk supply may be used.
After radiotherapy for breast cancer
Most women who have had radiotherapy after breast-conserving surgery find they cannot breastfeed from the treated breast because it does not produce milk, according to Cancer Australia.
“However, a few women find that they are able to breastfeed from their treated breast,” says Dr Helen Zorbas, CEO of the organisation. “In these cases, there is no evidence to suggest that breastfeeding from the treated breast will be unsafe for you or your baby. You can safely breastfeed from your untreated breast if you have had radiotherapy.”
Best advice: Give it a go. Remember that the untreated breast is likely to enlarge and sufficient milk can be produced to allow your baby to be fully breastfed.
Inverted or flat nipples
In basic terms, a nipple is considered inverted if, even when the areola is gently pinched at the edges, the nipple retracts or dimples inwards. This is due to adhesions at the base of the nipple binding the skin to the underlying tissue.
In women who are pregnant for the first time, it’s very common for the nipple to not protrude fully. It’s estimated that about a third of mums-to-be will experience some degree of inversion, but as the skin changes and becomes more elastic during pregnancy, only a small percentage will still have some inversion by the time their baby is born.
The degree of inversion is also likely to become less with each subsequent pregnancy. And more good news is that for many women with inverted or flat nipples, breastfeeding will not be a problem, says Dr Thorley, because the nipple is only part of the feeding apparatus.
“The baby draws the nipple and some surrounding breast tissue into her mouth to form the nozzle or teat. The baby doesn’t just suck on the nipple,” she says, adding that vigorous feeding by bub will often manage to draw out many inverted or flat nipples. In almost all cases, the inversion will lessen as bub grows bigger and stronger and learns to feed more efficiently.
Best advice: If you think you have inverted or flat nipples, see a lactation consultant early – if possible during pregnancy, when techniques to ease the inversion can begin.
There are lots of things you can do to tease out flat or inverted nipples. There are gadgets to wear in your bra, sucking devices you can buy at many chemists and a range of manual techniques your lactation consultant can show you. Even ice cubes can be handy!
“Sometimes using a breast pump on a breast with an inverted nipple shortly before feeding can bring the nipple out, too,” Dr Thorley says.
Large nipples
Some nipples can occasionally be a bit too much of a mouthful, particularly for small or premature babies. If that’s the case, you may be encouraged to pump and feed by bottle at the beginning, according to Dr Thorley.
Best advice: Be patient. “This will be a very temporary measure, as babies grow very quickly and will soon be able to manage larger nipples,” Dr Thorley says.
Hypoplasia
There is an exception to the rule about breast size and shape generally not affecting breastfeeding ability, and that’s if you have insufficient breast glandular-tissue.
Called breast hypoplasia or hypoplastic breasts, this means the breasts don’t contain enough milk-producing cells, so supply will often be low and inadequate to fully feed a baby. The condition is quite rare, estimated to affect less than one in 1000 women.
Breastfeeding can still be possible, but some use of formula will nearly always be required. Despite this, Dr Thorley says she has seen mothers with hypoplastic breasts successfully maintain breastfeeding with supplementation for two years and beyond.
Signs of possible hypoplastic breasts include having widely-spaced breasts, tubular breast shape (which look almost like empty sacks), disproportionately large areolas, no breast growth during pregnancy and no engorgement after bub’s birth.
Best advice: Remember that this is a physical condition and it does not affect your ability to be a mother. A lactation consultant can provide advice on how to maximise your milk production.
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