Hand express milk or use a breast pump to start the milk flow and soften the nipple/areola area if your breasts are very full and your baby is having a hard time latching-on. This prevents sore nipples and relieves the pain of engorgement. Use cold washcloths or ice packs (bags of frozen peas or corn work well) on your breasts between feedings to decrease swelling and provide comfort. Acetaminophen or Ibuprofen may be taken for pain. Unrelieved engorgement is a breastfeeding emergency which may result in a loss of milk supply if untreated. You need to call for help if you are not getting better using these hints.

Comfort Measures for Sore Nipples
Make sure your baby is in good position and is latching-on right. Express some milk to start the milk flow before feeding. Breastfeed on the least sore side first. Try different positions so pressure from your baby's mouth will be on different places on your nipple. Use of relaxation techniques before feeding, such as deep breathing or relaxing music, can be helpful. Massaging your breasts while feeding will improve milk flow. After feeding, air dry your nipples, then apply purified lanolin to provide a moisture barrier. Call your lactation consultants if you are not getting better after trying these suggestions.

Leaking Milk (Let-Down)
Tingling or tightening in your breasts are signs your milk is about to start to flow or "let-down." If your breasts start tingling or feeling like your milk is about to let-down and you don't want it to, fold your arms across your nipples and press firmly until the feeling passes. This should stop the leaking before it starts. Some women may notice this "let-down" 2 or 3 weeks after giving birth.

Plugged Ducts:
A plugged duct can occur when milk is not flowing freely from one of your milk ducts, due to poor positioning, missing or delaying a feeding, or a bra that is too tight. This is painful and can turn into a breast infection (mastitis) if not taken care of promptly. You will usually have a tender area, redness, or a sore lump in your breast and a slight fever.

To treat a plugged duct: Apply warm moist heat to the breast a few minutes before feedings. Try showers, warm compresses, or leaning over and soaking your sore breast in a bowl full of warm water. While your breast is still warm, massage the sore area gently with a firm circular motion. Breastfeed every 2 hours, starting on the sore breast. Try positioning your baby's chin in line with the plugged duct. Drink liquid to satisfy thirst, avoiding alcohol and caffeine. Call your doctor or nurse-midwife if your fever is more than 101 degrees or stays above 100 degrees for more than 4 hours.

Mastitis (Breast Infection)
Signs of breast infection are a sudden onset of flu-like symptoms, fever, chills, achiness, headache, and sometimes nausea and vomiting. One breast usually becomes red, swollen, and tender. Call your doctor or nurse-midwife right away if you have these symptoms. The infection involves the breast tissue, not the milk, so it is not harmful to your baby, and your breasts need to continue to be emptied on a regular basis. Follow all the measures listed above for plugged ducts, take all the antibiotics that will be ordered for you, and rest in bed as much as possible. Call you doctor or nurse-midwife back if you are not feeling better after 24 hours of treatment.