[8 min read] Supporting breastfeeding mothers in primary care

Breastfeeding is widely known to have numerous health benefits for both mother and child; however, for many new mothers, breastfeeding has its challenges. This article will explore some of the difficulties commonly encountered with breastfeeding and how primary care doctors can provide support to overcome these issues.

Nipple pain

breastfeedingOne of the most common problems encountered in breastfeeding is discomfort or pain for the mother, particularly in the first few weeks of breastfeeding. Nipple pain is experienced by an estimated 38 per cent of women in the first eight weeks postpartum and is the most commonly cited reason for discontinuation of breastfeeding.

Often, nipple pain can be attributed to poor positioning and suboptimal latching of the infant. When breastfeeding, positioning should be optimised to prioritise comfort, with the mother in a supported and relaxed position. The infant should be encouraged to take a wide “mouthful” of the breast and be supported along their back.

If the nipple is damaged or too painful, the mother can be counselled on how to manually express the breasts to promote continuous milk production while the nipple is allowed to heal. The temporary use of nipple shields may be beneficial if nipple pain is an ongoing concern.

Nipple infection

Bacterial infection of the nipple is common and characteristically presents with a purulent exudate. Fungal infection of the nipple is also common, typically due to overgrowth of Candida species, and tends to present with burning or redness of the nipple, without exudate. Both bacterial and fungal infections can be treated with topical therapy, and breastfeeding can safely continue. It may be necessary to treat both mother and infant to prevent re-infection.

Mastitis

Mastitis is an infection of the breast tissue, presenting with a red, hot, swollen breast, with or without systemic symptoms such as fever. Mothers presenting with early and uncomplicated mastitis can be managed conservatively by encouraging milk drainage from the breast, use of heat or cool packs, and massage of the affected breast. Non-steroidal anti-inflammatory drugs may be used to alleviate pain and inflammation.

If symptoms persist beyond twenty-four hours, or if there is an obvious skin break allowing for bacterial entry, mastitis should be treated with oral antibiotics. Some women require admission to hospital for intravenous antibiotics if symptoms do not resolve within a couple of days. Complications of mastitis include sepsis and breast abscess.

Milk supply

Many women worry about the volume or quality of their milk supply. In the vast majority of cases, reassurance is all that is required. Provided their infant is well and gaining weight appropriately, changes to feeding pattern, breast consistency, or perceived volume are not a cause for concern.

Resources

Often the woman’s community midwife is best placed to offer in-person advice and support. The Australian Breastfeeding Association (ABA) has a breastfeeding helpline available 24/7 and can provide free counselling and advice on many matters related to breastfeeding.

The Women’s Hospital has a range of fact sheets available for download, which explore matters related to breastfeeding.

The Raising Children Network has useful how-to videos and illustrations providing education about breastfeeding.

Learn more about supporting breastfeeding mothers in primary care with the HealthCert Professional Diploma of Women’s Health program.

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References

  1. Australian Government Department of Health (2021). Protect Breastfeeding – a shared responsibility – World Breastfeeding Week. https://www.health.gov.au/news/protect-breastfeeding-a-shared-responsibility-world-breastfeeding-week
  2. Australian Government Department of Health (2013). Breastfeeding – strong mums strong babies. https://www.health.gov.au/resources/publications/breastfeeding-strong-mums-strong-babies
  3. Australian Government Department of Health (2020). Pregnancy Care Guidelines. https://www.health.gov.au/resources/pregnancy-care-guidelines
  4. COAG Health Council (2019) The Australian National Breastfeeding Strategy 2019 and Beyond. http://www.coaghealthcouncil.gov.au/Portals/0/Australian%20National%20Breastfeeding%20Strategy%20-%20FINAL%20.pdf
  5. Australian Family Physician (2016). Overcoming challenges faced by breastfeeding mothers. https://www.racgp.org.au/afp/2016/august/overcoming-challenges-faced-by-breastfeeding-mothers/
  6. The Royal Women’s Hospital. Breastfeeding Service. https://www.thewomens.org.au/health-professionals/maternity/breastfeeding-service
  7. The Australian Breastfeeding Association. Breastfeeding Helpline. https://www.breastfeeding.asn.au/breastfeeding-helpline
  8. Academy of Breastfeeding Medicine. Protocols. https://www.bfmed.org/protocols
  9. Raising Children Network. Newborns: breastfeeding and bottle feeding. https://raisingchildren.net.au/newborns/breastfeeding-bottle-feeding

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