DIFRAX: What are your tips for avoiding or treating mastitis?
HEATHER: Mastitis is bad luck, so it's hard to avoid and there's no blame if it happens to you. It can happen in the first week, last week, or any time in the middle of your breastfeeding journey. It doesn't happen to most breastfeeding women and is usually a once-off occurance. Some unlucky women get it more than once. If not treated proactively it can deteriorate to become an abscess. To avoid mastitis, you want to have a good latch, so your nipples are comfy and happy. With a poor latch the breast often doesn't drain well, and damaged nipples are an entry point for infection. If you're tired and run down, you are more prone to mastitis (the fact is that there are no young mums who aren't on the near side to exhaustion, and most of us don't get mastitis...so, again, it’s mostly just bad luck!). Regarding treating mastitis, you must first recognise it. If you feel achy, feverish, fluey, and you have one sore breast, which is hot, hard, and tender in a quadrant, then you most likely have mastitis. Treat it with antibiotics if the fever is above 38,5 or the symptoms have not improved after 24 hours. The breast should be drained by baby or a pump every two to three hours in the day. Anti-inflammatories help with pain and fever and heat and massage as tolerated, which will help drain the breast. Cold packs after feeds help reduce pain and inflammation.
DIFRAX: How do you know when a baby is consuming enough milk?
HEATHER: The breast feels softer after a feed, and the baby has been feeding actively at the breast, in a regular motion, usually both breasts at each feed. The baby is content and sleepy after the feeds (at least for the first couple of weeks) and there are wees with every feed and upwards of three to four poos a day. Most importantly, the weekly weigh-in confirms that your baby is thriving. Weekly weigh-ins for the first 4 to 6 weeks are super important for confirming all is well.
DIFRAX: What are your top tips for cracked nipples?
HEATHER: If you notice any pinching or pain in your nipples when you first start breastfeeding, you can get a lactation specialist in to help you achieve a comfortable latch before you leave the hospital, if the nurses can’t help you achieve a comfy latch. Nipples don't toughen up if the latch isn't improved. They become cracked or bleed and cause great pain and suffering. There is no nipple preparation that will prevent damaged nipples and many of the nipple creams do more harm than good, making the nipple and areola too slippery for the baby. A warm hairdryer on your nipples will sooth them after a feed. Nipple shields are often used to protect nipples, but don't always achieve this, and I see several babies latching poorly with the shields, not accessing any milk at the breast through them. So use them in conjunction with expert advice and guidance.
DIFRAX: What are the best feeding positions?
HEATHER: Most common positions are across mum's abdomen/chest, called cross-cradle. Twins who feed in tandem will usually feed in the rugby ball position, or this position can be easier for very small babies, or engorgement of the breast in D3 to D6.
DIFRAX: What is your advice to moms who are beating themselves up when their baby doesn’t latch, and you have to resort to expressing and bottle feeding?
HEATHER: Just don't. Put your best friend on your shoulder and chase away your critic. Breastfeeding is a two-person activity, and your baby may not be an A-student in the breastfeeding department, but with coaching and time your baby may excel, while some never get good at it. If you love pumping, then grab some help and exclusively pump for your baby. If you don't love expressing, then let's talk about our options. Life is too short to spend hours a day away from your baby, not enjoying the fun side!
For more on Heather and her practice visit www.heatherwood.co.za and www.thulababy.co.za.