Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
Underarm position
Side lying position
Figure 11.1. Two positions for breastfeeding. (WHO, 1993)
Management
• Build the mother's confidence.
• Improve attachment and continue breastfeeding.
• Reduce engorgement; suggest frequent feeding and express breast milk if needed.
• Treat for Candida if the skin is red, shiny, flaky; if there is itchiness or deep pain; or if
soreness persists.
• Advise the mother:
o Not to wash her breasts more than once a day and not to use soap or rub hard with a
towel. Breasts do not need to be washed before or after feeds; normal washing as for
the rest of the body is all that is necessary. Washing removes natural oils from the
skin and makes soreness more likely.
o Not to use medicated lotions and ointments because these can irritate the skin, and
there is no evidence that they are helpful.
o To rub a little expressed breast milk over the nipple and areola with her finger after
breastfeeding; this promotes healing.
o To expose her breasts to the air for brief periods.
o To start the feed on the unaffected breast. This may help if the pain seems to be
preventing the oxytocin reflex. Change to the affected breast after the reflex starts
working.
o To breastfeed the baby in different positions at different feeds.
• If breastfeeding is difficult, help the mother to express the milk.
Breast Engorgement
Breast engorgement is an exaggeration of the lymphatic and venous engorgement that occurs
prior to lactation; it is not the result of over-distension of the breast with milk. Engorgement may
occur between days 2 and 4, causing the breast to become hard and tense and the nipples to
become taut, shiny, and hard; this usually resolves spontaneously in 24 to 48 hours.
Symptoms of engorgement
• breast pain and tenderness
• symptoms occurring 3-5 days after delivery
• hard enlarged breasts
• both breasts affected
Integrated maternal and newborn care
Basic skills course
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