Why some mums donâ€™t breastfeed
Unfortunately, some mums cannot â€“ or choose not to â€“ breastfeed and it is important to both understand and respect their decision.
Circumstances when a mum may not breastfeed include if she:
- Is being treated with drugs which are secreted in breast milk (e.g. anticoagulants, anticonvulsants, narcotics, barbiturates or steroids)
- Has the Human Immunodeficiency Virus (HIV)
- Is taking antiretroviral medication
- Has untreated, active tuberculosis
- Is infected with human T-cell lymphotropic virus type I or type II
- Is using or is dependent upon an illicit drug
- Is taking prescribed cancer chemotherapy agents (e.g. antimetabolites) that interfere with DNA replication and cell division
- Is undergoing radiation therapy.
Some mothers cannot breastfeed because of physiological problems that cannot be overcome, while others donâ€™t wish to breastfeed for religious or cultural reasons. Plus, there will be some mums who will just not want to breastfeed or who find it too difficult.
Reasons for stopping
Many mums start breastfeeding after their babyâ€™s birth and then stop either days or weeks later. Some of the reasons for stopping breastfeeding include:
- Not producing enough milk or the milk taking too long to â€˜come inâ€™: babies may not be satisfied after breastfeeding, especially if the mature milk is delayed
- Illness: if the mum has an underlying illness or had a difficult birth, it can make it hard to establish breastfeeding
- Returning to work: this can prevent breastfeeding during the day (unless mum expresses milk).
Common breastfeeding problems
The success of breastfeeding and prevention or relief of problems lies in the latch â€“ i.e. how the baby latches on to the breast. Be familiar with how a baby should latch on and point mums to other services, such as health visitors, local breastfeeding groups and resources, including a video available on the NHS Choices website.
Here are some of the most common breastfeeding problems, and what can be done to overcome them:
Painful or cracked nipples
Some breastfeeding mums may find that their nipples become sore and painful while they are feeding their baby. Firstly, advise them to check that their baby is in the correct position to latch on properly. Other tips include drying the nipples carefully after feeding and keeping a dry breast pad in place until the next feed.
Creams and ointments that are applied to the nipples between feeds (e.g. Kamillosan â€“ chamomile ointment or Lansinoh or Purelan â€“ lanolin) and heated or chilled gel pads can also offer relief. Nipple shields or protectors can be used during feeds to prevent sore nipples becoming worse.
If a mum is producing more milk than her baby needs, her breasts can become tender and feel heavy. Advise mums to feed their baby as regularly as they can and suggest they express some milk before a feed. Mums should also check the fitting of their bra to ensure it is not too tight.
Hard or lumpy breasts
Blocked milk ducts can cause a motherâ€™s breasts to become hard or lumpy, also known as engorgement. This needs to be treated quickly by draining the breast (by feeding or expressing milk). Mums should feed their babies â€˜on demandâ€™ and try to massage the lumps towards the nipple during feeds. Mums can massage out the lumps whilst in the shower and should ensure underwear is not pressing into the breast.
A warm flannel can also be applied to the breasts to soften the lumps. Mums may also need to be shown feeding positions that empty different parts of the breast â€“ suggest they contact a breastfeeding counsellor, who will be able to help with this and offer further advice.
Hot or painful breasts
If mums have painful, red or swollen breasts along with flu-like symptoms (e.g. fever or aches), they may have mastitis (inflammation of the breast). This condition can lead to an infection. Mastitis can occur two to four weeks after giving birth, and affects one in 10 breastfeeding women. Mums who have these symptoms may need to see a GP for a course of antibiotics.
Some of these difficulties can be overcome with help and support. Mums should be encouraged to breastfeed for as long as possible. Information, advice and support are widely available to help mums prolong breastfeeding (see useful websites).
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