Breastfeeding Pain Diagnosis and Treatment: Yeast Infection and Thrush

I would love to tell you that breastfeeding is always easy, but unfortunately that is not always the case.  When you look up the word tenacious (te·na·cious) in the dictionary, I picture the nursing mother who has been tried by the challenges that sometimes come with breastfeeding.

Today, I am addressing a challenge that literally tries a mom by fire, yeast infections.  Yeast on nipples often exhibits itself as a burning sensation and sharp shooting pains in the breast even in-between feedings.   If you have pain only during the feeding, you need to address the latch.  Yeast naturally occurs in our bodies, but the overgrowth of yeast often as a result of oral or IV antibiotics can be a real challenge.  The good news is that it is fairly easy to diagnose and curing the overgrowth is manageable, especially if you know how to avoid a recurring incidence.

Lets start with the diagnosis.  As I said, the mother with yeast will normally have burning sensation on her nipples and sharp shooting pain in her breast during and in-between feedings.  Yeast is highly contagious so if you are experiencing these symptoms, check your baby for thrush in the mucosa lining of the mouth, not just white patched on the tongue which could be milk.  The baby might also have a bright red diaper rash.  NOTE:  Mom's nipples might not be red nor have a white spot and baby may have absolutely no symptoms and mom can still have a yeast infection if she has the burning, sharp shooting pain.  In either case if yeast is diagnosed, both mom AND baby must be treated simultaneously even if baby is asymptomatic otherwise the pair continue to pass the yeast infection back and forth and curing it becomes extremely difficult.

There are a few ways to diagnose yeast.  Initially the visual and pain cues I described before can lead you to suspect yeast.  Second, you can see your doctor: but if the thrush is not visible, he may have to test for the fungal bacteria which could delay your treatment.  The easiest way to check for a yeast infection on the nipples is to wash your hands and apply Gyne-lotrimin (clotrimazole) or Monistat (miconazole nitrate) to dry nipples after each feeding for 24 hours to see if your pain is starting to diminish.  You will find this with the vaginal yeast treatment in most drug store and heath and beauty section of grocery stores.  Make sure that the one you are purchasing is not just in suppositories, but has a tube that you can use like a breast cream.  If the pain is beginning to diminish (you are not yet cured) within 24-48 hours, it is most likely a yeast infection.

You have a yeast infection on your nipples.  What's next?

1.  After each feeding, air dry or sun dry nipples before applying the clotrimazole or miconazole with clean hands.  You can air-dry nipples by fanning them with your nursing pad, allowing them to dry naturally or use the sun or even a blow dryer on a cool setting if you are in a hurry.  These anti-fungals absorb in the skin within 15 minutes, so there is no need to wash them off before the next feeding.  It is not advisable to wash your nipples with a washrag when you are breastfeeding as you can actually remove the protective keratin layer on your nipples.

2.  Seek treatment for the baby.  Remember that mom and baby must be treated simultaneously even if one or the other does not have symptoms.  There are over the counter treatments for thrush in the baby such as gentian violet, but it quite messy so I recommend calling the pediatrician for oral Nystatin and following the directions.

3.  Change habits to promote healing.  Always use nursing pads to avoid contaminating your bras and only breathable disposable nursing pads.  We do not sell them, but we recommend Lansinoh and Ameda Nursing Pads as they do not harbor yeast.  Some pads have a plastic lining or are made with products that do not promote breath-ability, so stick to these brands to be safe.  You can find Lansinoh in most stores.  Wash hands frequently and sterilize breast pump parts, bottles, nipples, nipple shields, feeding syringes with each use.  Normally due to the anti-fungal properties of breast milk, you only have to sterilize breast pump parts once per day, but better safe than sorry!
In addition eating habits needs to be curved during a yeast infection.  Mom should eliminate wheat, refined sugar, alcohol and honey to promote a healthier intestinal flora instead of feeding the overgrowth of yeast.


4.  Complete treatment.  Give the Nystatin and Gyne-lotrimin or Monistat a full week to 10 days for treatment.  If both mom and baby are now symptom-free, treat for 3 additional days to know out any residual infection and remove any items that may be prone to harboring yeast.

What do I need to discard to avoid re-occurrence of yeast?

- breast cream 
Moms usually will put breast cream on the second nipple with the same finger they used to apply to the first nipple.  So it is essential to use a clean finger to apply the nipple cream.  Wash hands first and then use a different finger to apply to each nipple so you don't cross contaminate.
- washable nursing pads
You cannot kill yeast by washing or boiling.  The only thing that will kill yeast is an anti-fungal so pitch the washable nursing pads you used while you had symptoms!
- breast pump parts
Any breast pump parts that have come into contact with the breast milk must be scratch-free or non-porous.  If you used a bottle brush to clean your parts, pitch everything.  If you washed them carefully, get rid of valve membranes, duckbill valves, bottle nipples and replace any filters or back-flow protectors as well. Store breast pump parts in an air dry bag that promotes air flow and is machine washable.  Using a ziplock bag to store breast pump parts is an incubator for yeast growing on your breast pump parts.
-sterilize your parts frequently
Keep disposable microwave sterilization bags on hand to make it quick and easy to sterilize your breast pump parts frequently.

- feeding supplies
If you used a bottle brush to clean your bottles, pitch everything.  If they were washed with a soft cloth or in the dishwasher, you can just discard bottle nipples and some brands have rubbery sealing discs.  Even baby feeding syringes have a rubber plunger, so if you used one to feed breastmilk or give medicine, discard it and replace.
- breast milk
Any breast milk that you pumped during your yeast infection must be given to the baby during the first week of treatment.  During the three days that you are treating the yeast to avoid recurrence, only feed the baby directly from the breast, freshly expressed breast milk or milk frozen prior to the initiation of the yeast symptoms.

Here is to putting out the fire!
Tanya

Breastfeeding Secrets Revealed: Position, Hold and Proper Latch

     New moms have told me that they wish they had been given more information on positioning and latch as well as the various holds associated with breastfeeding.  So I have decided to reveal these breastfeeding "secrets" here. 
1.  What is the secret to preparing for breastfeeding?
Holding the breast properly!  The c-hold is the proper way to support the breast when learning to breastfeed and should be practiced by expectant and new mothers because almost every new mom does it incorrectly.  How?  Moms tend to place the thumb on top (correct) but place the bottom fingers in the wrong place.  The bottom fingers need to be near the chest wall.  The index finger usually ends up on the bottom of the areola preventing baby from getting a deep latch.  Whether you are already breastfeeding or still expecting, check your c-hold in a mirror to make sure your fingers are out of the way. Also make sure the flap of your nursing bra is not in the way.  Remember, a new baby cannot support the weight of their own head, let alone your breast so support your breast properly and without hindering the latch.  If you are expectant mom, it is not proper to prepare for breastfeeding by toughening nipples, an antiquated practice that breaks down the keratin layer of the skin and is not helpful.  It is helpful to test nipples for inversion by placing the fingers 1" behind the nipple and gently pinching to see if the nipple inverts, goes flat or protrudes normally.  If it does not, consider using a breast pump to draw out nipples just prior to feeding.  A nipple shield is a last resort as it can cause a decrease in milk supply, but much better than using a bottle.

2.  What is the secret of a good latch? 

We will discuss proper body position in a few moments, but here are the basics of a good deep latch.

          1.  Support the breast in the c-hold discussed earlier.
          2.  Line the baby's nose up with your nipple.
          3.  Use your nipple to tickle the baby's lower lip in a downward motion to elicit the open mouth reflex.
          4.  Wait for a yawn or cry-wide mouth.
          5.  Swoop the baby's entire body towards you.
          6.  Bring the baby's bottom in closer to you.  This will dig in the chin and tilt the head slightly.
          7.  Support the breast for a newborn the entire feeding, but don't forget to relax your shoulders and make sure you have support for your arm as newborns can take 45 minutes to get in 20 minutes of swallowing.

3.  What position is the best to learn to breastfeed? 

The cross-cradle hold gives you the most control, but depending on whether you had a c-section, the football hold may be best for you.  We will address the football hold a little later.  In a proper cross-cradle hold you will hold the baby at the nape of the neck with the hand opposite the breast you are using.  Use a proper c-hold on the breast.  Sit back in the chair, put your feet up on a stationary footrest.  This brings your knees above your hips helping to keep you from the temptation of bringing the breast to the baby.  Always bring the baby to the breast.  Otherwise you end up with a sore back from improperly leaning into the baby.  Latching on in the cross-cradle or any position should be done in a one (1) two (2) motion.  Practice the proper latch techniques previously discussed. 1. Swoop the baby in as soon as you see a yawn or cry-wide mouth.  2.  Pull your elbow towards your ribs bringing the baby's bottom with it.  This draws the baby's bottom close helping him dig in his chin and tilt his head back keeping you from the temptation of pushing the breast tissue away with your thumb.  You shouldn't push down with your thumb as it raises the nipple toward the roof of his mouth causing nipple irritation.  When using a pillow, remember that it is there to support you while supporting the baby.  It is not meant to support the baby without your help, but a nursing pillow is an effective tool to keep mom in the proper position and save her from backache. 

4.  What is the secret to a good football hold? 

Much like the cross cradle hold, mom holds the nape of the baby's neck with her hand, but this time, the same hand on the same side as the breast she is using. Use the c-hold and ensure that the bottom fingers are well below the areola.  Support the breast with your hand or a rolled up burp rag during the entire feeding for a newborn who cannot support the weight of his own head.  Remember that your hand should be on the nape of the neck and not higher on the head for several reasons. One being that baby's tend to arch their back when you touch the top of their head. Sit back in the chair, put your feet up and have a pillow on that side of your lap for support. Your baby should be tucked under your arm like a football. His legs should be in a fetal position or and older baby might have them raised up resting his bottom and legs on the back of the chair. done in a one (1) two (2) motion. Practice the proper latch techniques and the swoop and tuck motion previously discussed.   Nursing pillows are essential in this position unless you have a very wide soft armrest on your chair.



5.  What is the secret to when the cradle hold should be used?
It is best to use the cross-cradle hold instead of the cradle hold when you are first learning to breastfeed because you have more control over the position of the baby's head with your hand than you do in the crook of the elbow.  But many moms are very comfortable in this position so moving to this position after the initial latch on as long as you support the breast for the newborn with a rolled up burp cloth is easy to accomplish.  Or once the baby has more control over his head or you are a smaller busted mom, you can use the cradle hold comfortably.  Just remember the latch positioning discussed previously.  Baby's nose should be on target with the nipple.  He should be tummy to tummy with mom.  His ears, shoulders and hips should be in a straight line as it is hard to swallow with your head turned.  Also remember to bring baby to the breast and not the other way around and to relax your shoulders and use something to support your arm.

6.  Do I need to learn to nurse lying down?

Is it important to learn the side-lying position?  In a word, YES!  The side lying position can be the answer for a stressed sleep-deprived mom or a mom who wants to increase her milk supply!  The proper technique for the side lying position is to have a pillow or two under your head and a pillow between your knees to stabilize your hips.  Baby's nose is on target with the nipple and the baby is drawn close with moms arm that is under her.  The bicep of this arm is partially used to support the breast for a larger busted mom as well.  Remember in all holds baby is tummy to tummy with you and not lying on his back with his head turned trying to swallow.  The side-lying position is perfect for co-sleeping at night or catching a nap with baby.  Taking your baby to bed with you if you perceive a dip in milk supply is a great way to get a boost as well.  

     Breastfeeding should not hurt!  If you have had previous trauma and are correcting an improper latch, there can be discomfort for the first 30-60 seconds, but then it should subside.  If it does not, break the suction by inserting a clean finger passed the gums and turning.  Then start the latch again from the beginning.  Don't let your toes curl and your teeth clench because you are a good mama.  The milk sinuses where the milk pools are located approximately one inch behind the nipple and not on the nipple for a reason.  The nerve ending are on the nipple.  Pain is telling you that your latch is incorrect.  Once the baby is in proper position with a deep latch, he will get more milk and you will have a more comfortable rewarding breastfeeding experience. 

     For more answers to breastfeeding questions visit our breastfeeding tips page or give us a call at 254-728-3627 9-5 M-F CST.

Engorgement: Bowling Ball Breasts

If you are experiencing difficulty with breast pain or latch-on 3 to 5 days postpartum, it is probably due to engorgement. Your breasts can feel as hard as bowling balls making it difficult for your baby to get a good latch.  Most of the time severe engorgement can be prevented by nursing the baby immediately upon delivery and putting the baby to breast every 2-3 hours.  If your baby is sleepy or there is a delay in breastfeeding, engorment can set in heavily.  Advil is safe for breastfeeding and contains an anti-inflammatory that may reduce some swelling and discomfort. Your best friend during this time is a hot compress. Turn the tap water and let it run until hot. Take two disposable baby diaper and swipe it under the tap three or four times. Mold the diapers around your breast. Repeat this procedure before each feeding. Commercial hot packs are also available, but the diapers work just as well so you may want to save your money for a good breast pump. If the areola is still too hard for the baby to grasp, use a quality breast pump for three to five minutes before latching the baby on. If the baby goes to sleep before emptying the breast, finish pumping afterward. Take heart! Engorgement only lasts for 48-72 hours.