Articles

Key takeaways

• Your breasts change in size and shape during pregnancy and after birth.
• Wear a well-fitting, supportive bra to prevent discomfort and problems.
• Proper latching is key to preventing sore nipples when breastfeeding.
• Know the signs of engorgement, blocked ducts, and mastitis.

Understanding breast changes and basic care

Your breasts will change during pregnancy and after birth. In early pregnancy, your breasts grow as they get ready to make milk. Your breasts may feel tender at this time. Some people notice their nipples get darker during pregnancy. This change may be permanent.

Your breasts will get bigger, sometimes as early as week six. This is because hormones cause breast ducts to expand. Your rib cage also expands to make room for your baby. You might go up a cup size or two.

In the first few days after birth, your breasts produce a yellowish liquid called colostrum. Around day three or four, your breasts may feel tight and tender as they start to produce milk.

Choosing a supportive bra

Wearing a supportive bra is important. A well-fitted bra can prevent poor posture, back pain, and neck pain. It should support your breasts and back. It also needs to stretch to fit your growing breasts.

If you plan to breastfeed, consider buying nursing bras before your baby is born. Nursing bras have drop-down cups that open easily for feeding. Practise opening them one-handed. Get measured a few weeks before birth.

Make sure your bra is not too tight. A tight bra can cause blocked ducts. This may lead to mastitis (an inflammation of the breast tissue). Choose breathable fabrics like cotton or silk. These are more comfortable than synthetic materials.

How to check bra fit

• Cup fit – Your entire breast should fit comfortably inside the cup. There should be no bulging above or at the sides.
• Centre front – This part should lie flat against your body.
• Band – The band around the bottom should be horizontal across your back, at the same level at the front and the back. You should be able to pull the band about an inch away from your body.
• Straps – The straps should not carry the weight of your breasts.

When buying a bra in pregnancy, choose one that fits comfortably on the tightest hook. This allows room for further growth.

Underwired bras

Underwired bras are generally okay if well-fitted and checked regularly. However, if breastfeeding, breasts can change size between feeds. Underwire can put pressure on milk ducts. Do not wear an underwired bra if it digs into your breast tissue.

Some women find their breasts heavy or that they can leak milk at night. A sleep bra can provide light support. A tight bra at night can also lead to blocked ducts.

Breast care if you are breastfeeding

Sore nipples are common in the first week of breastfeeding. This is usually because your baby is not latching on properly. A good latch helps prevent sore and cracked nipples.

Nipple care

After a feed, you can express a little milk and massage it onto your nipple. You can also let your nipples air dry before getting dressed. Some people use purified lanolin or white soft paraffin (Vaseline) for cracked nipples. If using creams, apply them after feeds. Most do not need to be washed off before the next feed.

Managing leakage

You may leak milk, so breast pads can help keep your clothes dry. You can use disposable or washable breast pads. Change them frequently to prevent infection. You can also stick breast pads inside a sleep bra to help with leaks.

Achieving a proper latch

Your baby needs to take a large mouthful of breast. This helps them feed effectively without causing you discomfort.

Follow these steps to help your baby latch on:

1. Hold your baby's whole body close. Their nose should be level with your nipple.
2. Let your baby's head tip back a little, so their top lip brushes against your nipple. This helps your baby open their mouth wide.
3. When your baby's mouth is wide open, their chin should touch your breast first, with their head tipped back. This allows their tongue to reach as much breast as possible.
4. Your baby's chin should be firmly touching your breast. Their nose should be clear.
5. Their mouth should be wide open. You should see more dark nipple skin above their top lip than below their bottom lip.

Signs of an effective latch

• Your baby has a large mouthful of breast.
• Your baby's chin is firmly touching your breast.
• Your baby's mouth is wide open.
• Your baby's cheeks look full and rounded while feeding.

Check your nipples after a feed. If they are flattened, wedged, or white, your baby may not be properly attached. If you have sore nipples, ask your midwife, health visitor, or a breastfeeding specialist for help. They can show you how to position your baby. Tongue-tie can also make it harder for your baby to latch properly.

Breast care if you are not breastfeeding

Your breasts will still produce milk after birth, even if you are not breastfeeding. This can cause discomfort.

Managing milk production

• Express for comfort – Express just enough milk to ease discomfort. Avoid expressing more than needed, as this can increase your milk supply.
• Supportive bra – Wear a well-fitting bra.
• Medication – There are medicines that can stop your breasts from making milk; your healthcare team can discuss these options and side effects. This medication is not suitable if you had pre-eclampsia or have high blood pressure.

You do not have to take milk suppression medication if you do not want to. Your maternity team can tell you about all your options.

Navigating common breast problems

Engorgement

Breast engorgement happens when your breasts become overly full. They may feel hard, tight, and painful. This can happen when your milk first comes in. It can take a few days for your milk supply to match your baby's needs. Engorgement can also be worse if you have not fed frequently.

If your breasts are very full, it can be hard for your baby to latch. The nipple can become overstretched and painful.

How to ease engorgement

• Feed frequently – Feed your baby often and responsively. Offer a feed whenever your breasts feel full.
• Express a little – If you cannot feed, express just enough milk to relieve discomfort. Do not express too much, as this can increase your milk supply.
• Soften the areola (the darker area around your nipple) – If your breasts are very full, express a little milk first to soften them. This can make latching easier.

Using reverse pressure softening

Reverse pressure softening is a technique that moves swelling away from the areola, helping your baby get a better latch. To perform it, press gently on the edge of your areola inward towards your chest wall. Hold this pressure while counting to 50, and do this before each feed until the swelling goes away.

This technique may not be suitable if you have certain breast problems like mastitis, so speak to your midwife or health visitor first if you are unsure.

If your baby is not well attached, seek advice from your midwife, health visitor, or a breastfeeding specialist. Untreated engorgement can lead to an inflammation of the breast tissue (mastitis) and can also cause a reduced milk supply.

Blocked ducts

Milk is carried to your nipple through narrow tubes called ducts. A blocked duct can happen if a part of your breast is not drained properly. This can happen if your baby is not attached properly. It can also happen if you switch between expressing and breastfeeding.

Symptoms of blocked ducts

• A hard, painful lump in your breast.

How to manage blocked ducts

• Continue feeding – Do not stop breastfeeding or expressing, as this can worsen symptoms. Your milk is still safe to use.
• Massage – Gently massage the affected area before and during feeding or expressing. Massage the lump towards your nipple while your baby feeds.
• Feed regularly – Breastfeed or express more regularly.
• Warmth – Apply a cloth soaked in warm water to the breast before feeding; a warm shower or bath can also encourage milk flow. Avoid applying too much heat, as this can increase inflammation.
• Cold – Apply a cloth soaked in cold water between feeds to reduce pain.
• Check latch – Make sure your baby is positioning and latching well.
• Avoid tight clothing – Do not wear underwired bras or tight clothes.
• Pain relief – Take ibuprofen if it is safe for you. Check with your healthcare team if you are unsure.

If blocked ducts are left untreated, they can lead to an inflammation of the breast tissue (mastitis). Speak to your midwife, health visitor, or feeding specialist for support.

Mastitis

Mastitis is when breast tissue becomes inflamed. It often happens if a blocked duct is not relieved. It can make you feel very unwell, with flu-like symptoms. Mastitis usually affects one breast.

Symptoms of mastitis

• A breast that feels hot and tender.
• A red patch of skin that is painful to touch.
• A general feeling of illness, like having flu.
• Feeling achy, tired, and tearful.
• A high temperature.
• A swollen area or lump on your breast.
• Burning pain in your breast that is either constant or only occurs during feeding.
• Nipple discharge, which may be white or contain streaks of blood.

If you are breastfeeding, mastitis is usually caused by milk building up faster than it is removed. This can be due to your baby not latching properly or missing feeds. It can also happen if you feed from one breast more than the other. An injury that damages a milk duct or gland can also cause it. If you are not breastfeeding, mastitis can be caused by an infection. This can happen through sore or cracked nipples, or a nipple piercing.

How to treat mastitis

• Continue breastfeeding – Keep breastfeeding, even if it is painful, as stopping can make the blockage worse. Breastfeeding will not harm your baby.
• Check latch – Ensure your baby is positioned and attached properly. Ask your midwife, health visitor, or a breastfeeding specialist for help.
• Feed on tender breast first – Let your baby feed on the tender breast first.
• Express if full – If the affected breast still feels full after a feed, express your milk by hand or using a pump if your baby cannot feed. Only express as much as your baby would usually need.
• Warmth – Apply a cloth soaked in warm water to the breast; a warm shower or bath can improve milk flow. Do not apply too much heat.
• Cold compress – Apply a cloth soaked in cold water between feeds to soothe pain.
• Rest – Get as much rest as you can.
• Pain relief – Take paracetamol or ibuprofen to relieve pain.
• Fluids – Drink plenty of fluids.

What to avoid with mastitis

• Do not wear tight clothes or bras.
• Do not take aspirin.
• Do not stop breastfeeding suddenly.
• Do not apply oils, soaks, or creams to your breast.
• Do not express more milk than your baby needs.
• Do not apply firm pressure to the breast. Any pressure should be gentle.

If your symptoms do not improve within 12 to 24 hours of home treatment, see your GP. You may need antibiotics to clear the infection.