You may experience some bumps along your breastfeeding path. Don't worry; these can often be overcome. And remember, you don't have to go it alone. The moment you suspect a problem, you can call your nurse or provider, baby's provider, or a lactation counselor or consultant.


Engorgement

After about 3 days, your milk will, as they say, "come in." This means that your colostrum has transitioned into breast milk, and chances are good that you'll know when it's happened. Your breasts will be larger and feel much fuller, and there is a good chance you will become engorged. Engorged breasts are full of milk. They can feel heavy and swollen, may be a bit bumpy, and may start to leak milk.

Mama, this is uncomfortable. Not exactly painful, but definitely not "normal" feeling.

The best thing to do with engorged breasts is to nurse your baby or use a breast pump, which many hospitals will rent out to patients if you don't have your own. International Board Certified Lactation Consultant (IBCLC) Sharen Medrano recommends trying manually expressing before using the pump because pumping "tends to take longer to get the milk out because it can't get as deep behind the areola or do the work that your hand can." Reminder: We'll get into pumping and all of the related information in the next chapter (see "Pumping and Bottle-Feeding" on page 405).

Medrano also advises that you alternate applying cold and warm compresses to your breasts when they are engorged, using mainly warm ones if you're having trouble getting the milk out.

Plugged or Clogged Duct

Sometimes milk can get obstructed in one of the ducts (the highways that transport the milk from the lobes to the nipple). When this happens, it is usually on one side and can cause a painful, hard, warm, red lump.

To relieve it, try taking a warm shower or applying a warm compress and massaging it. And nurse your baby—a lot. While it may take some acrobatics, I have seen success when women position the baby so that their chin is pointing toward the clog because that is where they are most efficient at removing milk. You can also try "the dangle," where you place baby flat on their back on the floor and then position yourself on all fours over them, dangling the breast with the clog for them to nurse from. If these tricks don't work, call a lactation consultant or your provider.

Mastitis

If bacteria enter the breast where there is unmoving milk, an infection called mastitis can occur, and mama, it stinks. In addition to the symptoms of a clogged duct, you will usu- ally feel generally sick, much like you have the flu, with chills, body aches, and a fever. These symptoms warrant an immediate call to your provider (yes, even at 2:00 a.m.). They can sometimes even diagnose you over the phone.

Mastitis is treated using oral antibiotics, and it is almost always safe to continue breast- feeding (your provider will guide you here). It's actually the best thing to do, as it will help prevent the condition from worsening.

To prevent clogged ducts and mastitis, try not to skip a feeding or suddenly go much longer between feeds, as this can lead to a buildup of milk that can cause a problem. A study also found that stress and lack of sleep (both common for new mamas!) may make you more prone to mastitis because they can weaken your immune system. And sometimes it just happens despite your best efforts, so don't be hard on yourself if it does.

Thrush (Candida or Yeast Infection)

Thrush can develop in your breasts, in the baby's mouth, or both. Babies naturally get a white tongue when they breastfeed. If you can scrape the white off with your fingernail, it's likely milk, but if you can't, it could be thrush. The baby may also develop a bumpy diaper rash.

You might know that you have thrush if your nipples burn, or when the baby latches, you get a sharp, shooting pain in your breast. Thrush is usually treated with an antifungal medication for you (often a cream for your nipples) and the baby (often a gel that is applied in their mouth).

Some women choose to avoid prescription medications by using traditional remedies instead. Historically, gentian violet (a blue dye) was applied to the mouth and breast to treat thrush, but it can cause ulcers and should not be swallowed, so speak with your provider before trying this. Some women have had success applying a combination of vinegar and baking soda, yogurt, or probiotics to the breasts and baby's mouth, but these have not been studied well.

To prevent thrush, wash your hands well before breastfeeding. Try to minimize sugar in your diet, and up your intake of foods with healthy bacteria, such as yogurt, sauerkraut, and kombucha (which contains a small amount of alcohol, so discuss with your provider first). And just like mastitis, sometimes thrush is simply unavoidable.