Milk Production and Home and Medical Care

Milk Production

• Breast enlargement during pregnancy occurs primarily from the growth of milk-producing glands. Differences in breast size prior to pregnancy are caused more by non–milk-producing fat tissue than by glands. Small-breasted mothers do not produce less milk than do large-breasted mothers.
• The more frequently your infant sucks (correctly), the more milk you produce, until you have both negotiated the proper balance.
  • It is unusual for a mother not to produce enough milk for her baby unless she is not breastfeeding correctly or frequently enough.
  • If your baby is gaining weight properly, then you are probably doing fine.

• Sucking on the breast in the same way as from an artificial nipple is likely to produce sore nipples and a reduced milk supply. This “nipple confusion” is why you should not give bottles to babies during the early weeks when they are still learning to suck properly. If a baby sucks incorrectly on a rubber nipple, the baby still gets rewarded with milk. The baby does not get milk when improperly sucking mother’s breast.

Home and Medical CareHome care

For clogged milk ducts

• You may notice small, red, tender lumps within the breast caused by milk ducts (tubes) that have become clogged (blocked with dried milk or other material).
• The best treatment is to increase flow to open these blocked ducts.
• Increase breastfeeding frequency and offer the affected breast first.
• Pump the breast after breastfeeding if the baby is not emptying the breast.
• Keep pressure off the duct. Make sure your bra is not putting pressure on the duct.
• Do not wean baby at this time, or pain and complications may increase.
• Apply moist heat to the affected area to increase blood flow and healing. (When applying heat, be careful not to burn yourself or the baby. Try 10-20 minute sessions two to four times per day for one to three days. Applying a warm water bottle over a warm, wet washcloth is one method to apply heat.) A warm shower and massaging the area will allow resolution of this problem. 
• Sometimes the baby will refuse the affected breast because the milk develops a sour taste. Pump the breast and empty it as well as possible. Continue to offer that breast to the baby until baby breastfeeds again.

For sore nipples

• Expose sore or cracked nipples to the air as much as possible.
• Use a hair dryer on a low setting to dry nipples after breastfeeding.
• Wash only with water, never with soap, alcohol, benzoin, or premoistened towelettes.
• Unmedicated lanolin may help if nipple cracking is severe, but petroleum-based ointments and other cosmetic preparations should not be used.

Medical careBreast inflammation (mastitis, possibly caused by infection)

• Seek medical care for symptoms or signs of breast infection.
• If you are breastfeeding and experience any of the following, call your health care provider:
  • Increasing pain in the breast
  • Chills
  • Sweats
  • Fever greater than 101°F
  • Increasing breast tenderness
  • Breast swelling and hardness
  • Redness

• Continue to breastfeed. Breastfeeding helps to empty the breast and prevent clogged milk ducts.
• Rest or get in bed at first sign of infection.
• Breastfeed and pump the affected breast as much as possible.
• Pump the breast to express milk on that side.
• Apply moist heat for 10-20 minutes at a time at least four times per day. Heat increases blood flow to the area, aiding in fighting infection. A warm shower with water on the affected breast may help facilitate healing. 
• Watch for additional signs of a localized infection called a breast abscess.
• The baby may not want to breastfeed on the affected side, so pump until the baby accepts the breast again.

• A delay in treating mastitis could lead to a more severe infection and possible breast abscess. If you are experiencing any of the following symptoms, go to a hospital’s emergency department.
  • A localized swelling that generally increases in size
  • Pain
  • Tenderness
  • Possibly warmth and redness if close enough to the skin surface
  • Fever greater than 101° F (May be associated with shaking chills alternating with sweating)
  • Breast abscess (pocket of infection)

• Surgical drainage may be indicated.
• Breastfeeding with the affected breast is generally stopped.
• A breast pump should be used regularly to empty the breast until breastfeeding can be restarted or symptoms could worsen.