1) Sore and Cracked Nipples
In the first few days and weeks of breastfeeding many women will have sore nipples. Even though sore nipple is normal and expected, cracked nipples is not. Just after giving birth, a mother starts to breastfeed very often, every 1.5-2 hours for about 10-15 min on each breast. With that frequency, it is normal to have sore nipples, specially if baby has very strong sucking reflex.
Cracked nipples is caused by wrong breastfeeding position and/or poor latch onto the breast. It is important to have the baby facing the breast at its level and to proper latch on the areola, not on the nipple.
I had them both. My nipples were VERY sore and cracked. I had to stop breastfeeding for about a 1.5 weeks to allow them to heal. Once I was ready to breastfeed again, I started taking classes to learn the proper latch technique and different feeding positions. It was wonderful to realize that I could do it without pain!
2) Thrush or Candida
Candida is a fungus that grows in warm, dark and moist environments. The nipples of a nursing mother and the baby's mouth provide just that. After feeding, some mothers don't wait for their nipples to air dry before putting their bra and nursing pad back on, increasing their chances of developing thrush.
The most common symptoms are shooting pain during and/or after breastfeeding; very sore/burning nipples; white patch on the baby's tongue and/or on sides of the mouth; and recent antibiotic intake (mother and/or baby).
Since it can me transmitted from mother to baby or vice-versa, it is important to have both treated at the same time to avoid recurrence.
I also had thrush! I remember having terrible shooting pain on my nipples even when I was not breastfeeding. It was a constant burning sensation that it wouldn't go away. That was the main reason why I had to stop breastfeeding for 1.5 weeks. The pain was unbearable!
Luckily my daughter didn't get it, but she still had to be treated as well.
3) Plugged Milk Ducts
As the name already suggests, it is a blockage in the milk duct resulting in milk backing up behind it. The mother notices a sore lump or wedge-shaped area of engorgement on the breast.
The best way to avoid it is to empty the breast from milk on each feeding and to breastfeed frequently. If the baby is satisfied, pump the rest of the milk and store it. An underwired bra on any kind of pressure on the breast can also cause a plugged milk duct.
To unplug it, it's recommended to breastfeed very frequently massaging the area and to always start with the breast that has the blockage (as the baby has a stronger suck at the beginning of the feeding). It is also recommended to position the baby's chin pointing to the lump and to change baby's feeding position.
I used to get plugged milk duct almost every other day and it would always be associated with a milk blister as described below.
4) Milk Blister
It is a painful white, clear or yellow dot on the nipple caused by a blocked nipple pore. The blockage can be caused by an obstruction within the milk duct (plugged milk duct) or by a grow of skin over the milk duct opening. The white dot is often a dry clump of hardened milk.
I also had them both. As I mentioned, I was having it almost every other day. I would have a very sore lump on one side of my breast and a very tiny white spot on my nipple on that same side. Sometimes the white spot and the lump would go away when I would apply a hot wet compress on the nipple immediately before feeding. Other times I had to literally soak my breast in warm/hot water to try to open up the nipple pore to release the obstruction.
When both methods wouldn't work, I would do something that I do not recommend anybody to do it at home (Kellymom's site recommend to ask a health care provider for help on doing that). I would sterilize a needle by holding it in a match flame until red hot, wait to cool and start to gently lift the skin at the edge of the tiny white dot to release the clump of hardened milk. As soon as the clump was out, the milk would start spraying out of the nipple pore, the lump on my breast would instantly go down and an instant relieve was felt.
After several weeks going through the same problems, I learned that I should stop wearing an underwire bra and that I should start taking some Lecithin. With the combination of both, I was able to stop with the recurrent episodes.
Lecithin is a safe food additive recommended for recurrent plugged milk ducts and therefore, milk blisters. On Kellymom 's site they recommend "3600-4800 mg lecithin per day, or 1 capsule (1200 milligram) 3-4 times per day. After a week or two with no blockage, mom can reduce the dosage by one capsule. If there is no blockage within another 2 weeks she can reduce it again by one. Mom may need to continue taking 1-2 capsules per day if stopping the lecithin leads to additional plugged ducts."
Mastitis is an inflammation on the breast tissue that can be caused by plugged milk ducts or milk excess. It can become an infection when bacteria (Staphylococcus aureus - most common) from the skin enter the milk ducts through a crack in the nipple or through the opening to the milk ducts in the nipple.
As described by Wikipedia Encyclopedia, "Mastitis typically develops when the milk is not properly removed from the breast. Milk stasis can lead to the milk ducts in the breasts becoming blocked, as the breast milk not being properly and regularly expressed. It has also been suggested that blocked milk ducts can occur as a result of pressure on the breast, such as tight-fitting clothing or an over-restrictive bra, although there is sparse evidence for this supposition . Mastitis may occur when the baby is not appropriately attached to the breast while feeding, when the baby has infrequent feeds or has problems suckling the milk out of the breast."
The symptoms are intense pain on the breast, fever over 101F, chills and/or flu like symptoms and systemic illness.
If there is no infection, the treatment is similar as to plugged milk duct. Beside doing everything it's done when having plugged milk duct, it is recommended to rest, to alternate warm/cold compress on the breast to stimulate circulation and to take an analgesic for pain and fever.
If it tuns into an infection, an antibiotic is prescribed.
I also had mastitis. A VERY scary mastitis experience that I will write about it on my next post.
Picture's source: http://www.flickr.com/photos/goetter/with/1101531528/