Medical reasons for not breastfeeding

Occasionally, there are medical reasons for not breastfeeding e.g. if you have HIV or, sometimes if you're taking certain types of medication that may harm your baby. Under these circumstances when there's no alternative, bottle feeding with infant formula will be recommended. If you're not sure whether you should breastfeed your baby, speak to your midwife or health visitor for information and support.

Why I breastfeed

New mums often talk about the benefits of breastfeeding for them and their babies, and they can give tips on what to do if you have trouble breastfeeding. Sometimes it can be hard to ask for help, but tackling breastfeeding problems quickly will give you more time to enjoy your baby's early days. In many cases, the solution is as simple as changing your baby's position or feeding them more often. 

If your baby is unsettled

If your baby is unsettled at the breast and doesn't seem satisfied by feeds, it may be that they're not attached to the breast correctly. Go to Breastfeeding: positioning and attachment to check that your baby is feeding well. lt can also be helpful to ask a breastfeeding supporter to work with you to improve positioning and attachment of your baby.

Sore or cracked nipples

If your nipples hurt, take your baby off the breast and start again. To do this you can slide a finger gently into the corner of the baby's mouth until their tongue releases. Putting up with the pain could make things worse. If the pain continues or your nipples start to crack or bleed, ask a breastfeeding supporter to help you get your baby attached effectively. Pain is not normal, so ask for help and support.

The following ideas may help:

• Squeeze out a drop or two of your milk at the end of a feed and gently rub it into your skin.
• Let your nipples dry before getting dressed again.
• Change your breast pads at each feed (if possible use pads without a plastic backing).
• Don't use soap, as it dries out your skin.
• Wear a cotton bra so that air can circulate.
• Treat any cracks or bleeding with a thin smear of white soft paraffin or purified lanolin. Put the ointment on the crack (not the whole nipple) to help it heal and prevent a scab forming.
• There's no need to stop feeding. With skilled help you should find that breastfeeding quickly becomes more comfortable again.  

Sore breasts, blocked ducts, and mastitis

An over-supply of milk can build up in your breasts for a variety of reasons. If your baby is not well attached it may be hard for them to take your milk effectively, and some parts of your breast may not be drained during a feed. This is the area of your breast that may feel sore or painful. It is worth checking to see if this is a possible cause so that you can prevent it from happening again. If you're not sure, ask for help. Other common causes include wearing a bra that's too tight, a knock or blow to the breast, and missing a feed.

It's important to deal with a sore breast or a blocked duct as soon as possible so that it doesn't lead to mastitis (inflammation of the breast).

If you have mastitis you're likely to have at least two of the following symptoms:

• breast or breasts that feels hot and tender
• a red patch of skin that's painful to touch
• general feeling of illness, as if you have flu
• feeling achy, tired and tearful
• you may have an increased temperature

This can happen very suddenly and can get worse very quickly. It's important to carry on breastfeeding as this helps to speed up your recovery. If you think you might have a blocked duct or mastitis, try the following: 

• Check and improve the attachment of your baby at the breast - ask your midwife, health visitor or volunteer breastfeeding supporter.
• Feed your baby more often.
• Let your baby feed on the tender breast first.
• If your breasts still feel full after a feed or your baby can't feed, hand express some milk to relieve the fullness.
• Warmth on your breast before a feed can help the milk to flow and make you feel more comfortable. Try warm flannels or a bath or shower.
• While your baby is feeding, gently stroke the lumpy or tender area towards your nipple with your fingertips. This should help the milk to flow.
• Get as much rest as possible. Go to bed if you can.
• If you can, take a painkiller such as paracetamol or ibuprofen.

Mastitis may also be a sign of infection. If there's no improvement within 12 to 24 hours, or you start to feel worse, contact your GP or healthcare professional. If necessary, they can prescribe antibiotics that can be taken while breastfeeding.

Stopping breastfeeding will make your symptoms worse, so ask for help and support early.

Click for additional information, also see attached leaflet!

Tongue-tie

Some babies are born with a tight piece of skin between the underside of their tongue and the floor of their mouth which is known as tongue-tie and it can affect feeding by making it hard for your baby to attach effectively at your breast.  Tongue-tie is easily treated so if you have any concerns, talk to your midwife, health visitor or GP.

The Baby Friendly Initiative provide a list of locations where tongue-tie can be divided.

More information on Tongue Tie can be found here.