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Your milk comes in on the third or fourth day after your baby is born—medicine that stops breast milk from coming in is no longer used. It is very important that you take good care of your breasts. Breast care includes wearing a good support bra and keeping your breasts clean and free from infection and skin problems. The most comfortable support bra is one that lifts the breasts upward and inward. It’s a good idea to get fitted by a professional. Don’t wear underwires as they can cut off the milk ducts and cause sore breasts. Wear bras with wide straps that don’t stretch—these distribute the weight better and won’t cut into your shoulders.
Breast Care If You Are Bottle Feeding
Wear a good support bra 24 hours a day for the first 2 weeks after your cesarean, even while sleeping. Keep your breasts clean and dry until your milk dries up. Although you do not plan to nurse, your breasts will begin making milk, called lactation. Wearing a breast binder or a tight bra, such as your prepregnancy bra, will help stop milk production. It takes about 1 week for your breasts to stop making milk.
You may have a few days of discomfort as your body shuts off the milk supply. Until then, as milk is made and not released, your breasts can become engorged. This usually happens on about the 3rd or 4th day after birth. Do not express your milk for relief. Your body will think you are breastfeeding and more milk will come in.
The discomfort of engorged breasts usually lasts about 48 to 72 hours. Cold compresses for 20 minutes every hour, a good support bra, and Tylenol should relieve the discomfort. Until your breasts stop making milk, avoid exposing your nipples to heat or stimulation. Stimulation can cause your breasts to make more milk, become more engorged and more painful—so don’t rub them or even scratch an itch!
See Mastitis below.
Breast Care If You Are Breastfeeding
Your breasts will be larger than usual for as long as you nurse your baby. Therefore, it is important to wear a nursing bra with good support and without underwires. You may want to buy several different sized bras. Your breasts are larger and more swollen when you first begin breastfeeding. The swelling will go down after about 2 weeks and your breasts will stay about that size while you
are nursing. You will need at least 2 cotton nursing bras so you can wear one while the other is being washed. Also, it is easier to nurse if your bra has f laps that can be let down by using only one hand.
Improper latching-on or improper removal of your baby from your breasts can allow bacteria to get into the breasts through the nipple and may lead to infection. If you are breastfeeding, soreness or infection in your breasts can keep you from wanting to nurse your baby.
Examine both breasts and nipples after each feeding. Finding and correcting problems early can prevent nipple soreness from getting worse and make breastfeeding more comfortable for you. Mild discomfort at the beginning of feedings during the first week is normal and does not require treatment. The following are ways you can prevent nipple soreness.
• Wash your breasts and nipples at least once a day using plain water for the first month; to prevent dryness and cracking don’t use soap when washing your breasts.
• Always wash your hands properly before every feeding to help prevent breast infection.
• After each feeding, express a little milk and rub it onto your nipples. The cream in your milk can prevent dryness and doesn’t have to be washed off before the next feeding.
• Leave the flaps down on your nursing bra and let your nipples air dry for 10 to 15 minutes after each feeding.
• Make sure your baby has latched on correctly and has most of the areola and all of the nipple in his mouth, not just the nipple.
• Nurse your baby often to prevent engorgement of your breasts and vigorous sucking by your baby.
• Proper positioning and latch-on usually prevents sore nipples no matter how long a feeding lasts.
• Break the suction before removing your baby from each breast (See Tip 9).
• Don’t use plastic liners inside your bra; change your bra and nursing pads when they are wet or moist. Allowing your nipples to stay wet allows germs to grow faster and causes the skin to break down.
Nursing should not be painful. If you have nipple pain while nursing, break the suction, remove your baby from your breast, and start over. If the pain is severe or continues after the first week, call your baby’s doctor.
If only one nipple becomes tender or cracked, begin the next several feedings on the non-tender breast. Your baby sucks the hardest at the beginning of each feeding, and this vigorous sucking can be painful for a cracked or tender nipple. Starting on the non-tender breast will give the tender breast time to heal. Feed your baby whenever he wants to be fed, but try to wait at least 2 hours between feedings.
Using nipple shields to relieve sore nipples may make your nipples worse and can cause problems with milk production. The shield prevents your baby’s mouth and tongue from coming in contact with the nipple. This contact is needed for the release of the hormone which promotes milk production. Nipple shields can delay let-down and keep your baby from getting the rich hindmilk that is so important for growth.
Engorged breasts last about 24 hours and may be common while your milk production is adjusting to your baby’s demands. You will get relief when your baby nurses, yet you will have discomfort again when your breasts fill back up with milk. Engorgement can continue for a few days to a few weeks until your breasts adapt to the right flow of milk.
You can relieve engorgement:
• By using warm compresses before each feeding to help your milk flow.
• By gently massaging the firmer areas during nursing.
• By nursing every 2 to 3 hours.
• By wearing a nursing bra with good support.
If your breasts are too engorged for your baby to latch-on, express some milk until your nipple is not stretched so tight.
Mastitis is an inflammation in your breasts caused by not emptying your breast regularly or completely while they are making milk. Even women who do not breast feed can get mastitis until their milk dries up. Mastitis can also be caused by a clogged duct that keeps the milk from coming out. If the milk stays in the breast too long or if there is a crack in the nipple infection may set in.
To prevent mastitis:
• nurse your baby as soon as possible after birth
• start each feeding on a different breast
• nurse your baby every 2 to 3 hours—day and night—or pump out your milk with a breast pump
• don’t wear tight bras or bras with underwires
Symptoms of mastitis include:
• hard, swollen breast(s)
• painful or reddened know on the breast
• flu like symptoms of chills, aches
• fever over 100.4°F
Call your doctor if you have symptoms of mastitis.
• if you’re not breastfeeding, use ice packs to reduce swelling (don’t put the ice directly on your skin)
• if you’re breastfeeding, use warm cloths on your breast before nursing
• take an anti-inflammatory like ibuprophen
• nurse regularly and use a breast pump if you need to
• drink plenty of fluids
• get plenty of rest
Emptying your breast may be enough. You may need an antibiotic if your breast(s) become infected. Make sure you tell your doctor that you are breastfeeding so he orders an antibiotic that is safe for your newborn. Always take antibiotics as prescribed and until you have taken all of the medicine, even if you start feeling better.
If You Need Help
If you have problems breastfeeding, call your lactation specialist or your pediatrician’s office. If you do not have a lactation specialist, ask your hospital, doctor, or HMO if a lactation specialist or perinatal nurse is available for you.
More About Self Care After Cesarean Birth
Introduction to Self-care After Cesarean Birth
Preventive Self Care
Physical Changes and Healing
Vaginal Birth After Cesarean (VBAC)
Activities and Healthy Exercise
Nutrition and Diet
Family Planning and Birth Control
Normal “Baby Blues” or Postpartum Depression
Your Postpartum Check-Up
Get as Much Rest as You Can
When to Call Your Doctor
Engorgement is the feeling of tension in your breasts as they become hard and swollen. Your breasts may be tender, feel warm to the touch, and look flushed.
Avoid nicotine, alcohol, caffeine, and other drugs that can be passed through your milk and harm your baby.
Any medicine you take while you are breastfeeding gets into your milk. If you call your doctor for medicine, be sure to let him know that you are breastfeeding. If your medicine makes you drowsy or slows down your reflexes, be extra careful holding your baby after you take it.
You can break the suction by gently inserting your finger in the corner of your baby’s mouth and between the gums. Then keep your finger between your baby’s gums while you move him away from your breast to keep him from biting your nipple.
La Leche League
Call the La Leche League (1-800-LA-LECHE) for more information on breastfeeding.