Common problems during lactation

Common problems during lactation

Breast engorgement

The three basic components of breast engorgement are:

congestion/increased vascularization, accumulation of milk

and edema caused by the congestion and obstruction of lymphatic drainage.It is important to distinguish between physiological and pathological engorgement. The former is discrete and is a positive sign that milk is coming in. It requires nointervention. In pathological engorgement, there is excessive tissue distension, causing great discomfort, sometimes accompanied by fever and malaise. The breast is bigger, painful, with diffuse shiny reddish areas, and edema. Nipples become flat, hampering proper latch-on, and milk sometimes does not flow normally.

This type of engorgement often occurs around the third to fifth day after delivery and usually is associated with one of the following factors;

late initiation of breastfeeding, infrequent

breastfeeding, restriction on the duration and frequency

of breastfeeding, use of complementary foods, and babies with poor suck.

Prevention

The following recommendations are useful for the

prevention of breast engorgement:

start nursing as soon as possible

breastfeed on demand;

use a proper breastfeeding technique;

avoid the use of supplements.

Sore nipples/nipple trauma

At the beginning of breastfeeding, most women feel a

mild pain or discomfort, and this may be considered to be normal.

Prevention

use a proper breastfeeding technique;

avoid products that remove the natural protection of

nipples, such as soaps, alcohol or any drying agent;

breastfeed on demand . infants who are put to the

breast as soon as they show they want to feed feel less

hungry and tend not to suck vigorously on the breast

Nipple infection caused by
Staphylococcus aureus

Secondary nipple infection is quite common, especially that which is caused by Staphylococcus aureus.

Candidiasis

Breast infection caused by Candida albicans in the

puerperium is quite common. Candida infection often is characterized by itching,

burning sensation and twinges in the nipples, which persist after breastfeeding. The nipples usually have a reddish and shiny appearance. Some mothers complain of burning and twinges in the breasts.

Raynaud's phenomenon

Raynaud's phenomenon, an intermittent ischemia

caused by a vasospasm that often occurs in the fingers

and toes, can also affect the nipples. In general, it occurs

in response to cold temperature exposure, abnormal

compression of the nipple in the infant.s mouth or severe

nipple trauma.

Plugged ducts

Lactiferous ducts are plugged when the milk produced in

a certain breast area does not drain properly for some

reason (solid obstruction is not necessary). This often

occurs when the breast is not properly emptied, which may

occur when breastfeeding is infrequent or when the infant

has a poor suck.

Mastitis

Mastitis is an inflammatory process of one or more

breast segments (the upper left quadrant is most commonly

affected) that may or may not progress into bacterial

infection. It usually occurs in the second and third weeks

after delivery, and very rarely, after the twelfth week.4

Initially, the intraductal pressure rises due to milk stasis (a

plugged duct often is the precursor of mastitis), with

consequent flattening of alveolar cells and development of

spaces between the cells.

Breast abscess

In general, breast abscess is caused by untreated

mastitis or results from late or inefficient treatment. It

affects 5 to 10% of women with mastitis. Improper emptying

of the breast affected by mastitis, which often occurs when

feeding is discontinued on that breast, favors the development

of breast abscess.

Galactocele

Galactocele is the cystic formation observed in lactiferous

ducts containing milky fluid. The liquid, which is initially a

fluid, becomes thick, and may leak from the nipple.

Galactocele is believed to be caused by a plugged duct. On

palpation, it feels like a smooth and round-shaped mass, but

the diagnosis is established by aspiration or ultrasonography.