Breastfeeding is the most natural thing for every mother and is an experience to be cherished. Sometimes, certain problems faced by mothers result in stoppage of breastfeeding or giving of supplements of animal milk/commercial infant formula to the baby. Problems include flat nipples, inverted nipples, breast engorgement, swelling, sore nipples or not enough milk, etc. These problems are preventable if care is taken from the pregnancy period to prepare for breastfeeding.

Some of these problems relate to the shape and size of the nipple and others are related to breast tissues as a whole. Here are the problems.

• Flat nipple
  
  The length of the resting nipple is not important for breastfeeding. However, the areola embedded in the breast tissue beneath should be able to be pulled out to form the teat. The nipple is just a guide to show where the baby has to take the breast. Having flat nipples should not worry you.
  
  
• Inverted nipple
  
  A nipple that does not come out erect and on trying to pull out goes deeper into the breast is an inverted nipple. Fortunately, true inverted nipples are very rare and usually during pregnancy the nipple becomes normal. If they remain inverted, these can be treated in consultation with a doctor.
  
  
• Long nipple
  
  A long nipple may be a common problem as the baby may suck on the nipple only and may not take enough of breast tissue into his mouth. To help, the baby should be brought closer to the breast to enable him to take more breast tissue into his mouth.
  
  
• Sore nipples and cracked nipples
  
  The most common cause of sore nipples in the first few days of feeding is the incorrect position/attachment of the baby at the breast meaning that the baby sucks only at the nipple. If feeding continues in the poor position, it may lead to cracked nipple and later to mastitis and breast abscess.
  
  Treatment: If it pains during breastfeeding, the mother should wait until the baby releases the breast, or put a finger gently into the baby's mouth to break the suction first, so as to avoid injury at the nipple. Then, again start to breastfeed in a correct position and if the child is attached properly it will not cause pain. Breastfeeding should be continued on the affected breast as sore nipples usually heal after correcting the suckling position. For cracked nipples, treatment consists of feeding in correct position, washing the nipple once daily only with water and exposure of nipple to air and sun as much as possible, and application of a drop of your hind milk on the nipple after each feed. Medicated creams are best avoided as they may worsen the soreness and draw away the attention from the crucial issue.
  
  
• Fullness and engorgement of the breast
  
  Fullness of the breast is a frequent problem. Milk production is continuous and, if enough milk is not removed, engorgement of breasts may result. The engorged breast is tight, shiny and very painful.
  
  The common causes of engorged breasts are:
  
  - Other feeds given before starting breastfeeding
  - Delayed starting of breastfeeds
  - Long intervals between feeds
  - Early removal of the baby from the breast while breastfeeding
  - Bottle-feeding and any other restrictions on breastfeeding
  
  If breast is engorged the baby is unable to take feed properly due to poor attachment, inadequate emptying, which further leads to decreased production. Engorgement of the breast can be prevented by avoiding other feeds being given before breastfeeding, keeping the baby with the mother, unrestricted and exclusive breastfeeding on demand and feeding in the correct position.  
  
  
• Blocked duct
  
  If the baby does not suckle well on a particular segment of the breast, the thick milk blocks the milk duct leading to a painful hard swelling.
  
  Treatment for this involves –
  
  - Improving suckling/position - the baby should be fed frequently on the affected breast and in different suckling positions so as to improve the emptying.
  - Massaging the lump towards the nipple to promote emptying of the breast.
  - Rest and wearing loose clothes.
  - Swelling of the breast.
  
  If the blockage of the duct or engorgement continues, infection may supervene. The breast becomes red, hot, tender and swollen. This is called mastitis. An abscess may form or swelling may occur, associated with fever. The treatment is:
  
  - Express the milk frequently and continue breastfeeding.
  - Warm water fomentation may also help alleviate pain.
  - Consult a doctor for pain. Incision to drain the abscess may be necessary sometimes.
  - Restart breastfeeding from the affected breast as soon as possible.
  - Leakage of milk from the breast
   
  Milk leaking is usually the result of an active ejection reflex during first few weeks of lactation. It commonly occurs when it is time for a feed or when intervals between feeds are increased and when you have loving thoughts about your baby. This is due to normal oxytocin reflex.
   
  
• Blood in the milk  
  
  Some mothers notice a little blood in the milk, even in the absence of a nipple fissure. It is usually a harmless and self-limiting condition. The mother should continue breastfeeding.