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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Thursday, March 18, 2010
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Thursday, March 18, 2010
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- I haven't had my menstrual period yet, after having my baby over 3 months ago. Is this normal?
- I am 11 weeks post partum and have been experiencing light spotting to short gushes only after, or very shortly after, I breast fed. Does this sound normal?
- Are there any risks to the baby or yourself if you nurse and have breast cancer?
- I have had difficulty breastfeeding my baby due to cracked nipples. What should I do?
- How can I prepare my nipples for breastfeeding before I give birth, so that they won't get dry and cracked? My nipples are somewhat flat.
- The other morning while pumping, I noticed my breast milk was very light green. Is this cause for concern?
- After I had my baby. I found a lump. When I go hours without breastfeeding, it gets very large, but not sore or red. Once I do feed my baby, it goes back to a smaller size. Is this normal?
- What is a benign lactational adenoma?
- I'm a hepatitis B carrier, but the doctor said that I can breastfeed because my baby was vaccinated within 6 hours of birth and will take his hepatitis shots on time. Is that true?
If your baby is fully/exclusively, or almost fully, breastfed, it is very likely that you are not menstruating due to a different hormonal balance that prevents ovulation. When a woman isn't ovulating, she also doesn't have a menstrual period. (Scientists are not completely certain how this works.) There is even a name for the delay in the return of the menstrual cycle when breastfeeding - lactational amenorrhea. The length of time this lasts depends on how a baby breastfeeds and individual differences in mothers. Many women consider lactational amenorrhea to be one of the biggest benefits of breastfeeding!
Your menstrual period is likely to return within weeks to months after adding other foods to your baby's diet, if not before. However, many mothers don't have a period for months after introducing solid foods. This longer delay may be more common in women who breastfeed before offering their babies other foods at any feeding, so their babies tend to continue to breastfeed frequently.
References:
Grimes, DA & Wallach, M (Eds.) (1997). Modern contraception: updates from the contraception report. Totowa, NJ: Emron.
Lawrence, RA & Lawrence, RM (1999). Breastfeeding: A guide for the medical profession (5th ed.). St. Louis: Mosby.
The hormone oxytocin that triggers the milk-ejection reflex (let-down) also causes the uterus to contract. In the days immediately after giving birth, the oxytocin released when breastfeeding helped control postpartum bleeding. Breastfeeding and any contractions related to oxytocin release don't cause bleeding, but the contractions caused by the brief release of oxytocin during breastfeeding might help the uterus expel any blood that has accumulated in it.
There is no reason to be frightened or to shy away from breastfeeding because of this effect. If bleeding with/after breastfeeding occurs during a menstrual period, which is possible at 11 weeks - especially when a baby has been receiving bottles too, then the uterine contractions caused by oxytocin (during breastfeeding) may be "pushing" out some of the menstrual blood.
If the bleeding is unrelated to your menstrual cycle, breastfeeding (with oxytocin release) still is not the cause. More likely, the breastfeeding is doing you a favor by expelling any blood and bringing your attention to a possible health issue. Bleeding after the birth of your baby should have ended weeks ago, but there are many factors that may contribute to uterine bleeding that is not associated with the menstrual cycle. Your gynecologic health care provider is the one to help you figure out what actually is causing this.
There are several myths about cancer and breast feeding that Dr. Susan Love addresses in her publications. One false notion is that if your child nurses from the breast that has cancer, the child will get your cancer. This has not been found in human studies. Another belief was that a child will not nurse from a breast with cancer. That is not necessarily so, unless the breast produces less milk. Then, by nature the child will nurse best from the breast with more milk. There is no evidence that there is risk to the child who has nursed from a cancerous breast. If breast cancer develops during lactation, the mother usually stops breast feeding for the purpose of treatment, especially during chemotherapy so that the child does not ingest any chemicals.
Cracked nipples are a common problem in the first week after birth but should get better after that. If your nipples have been sore and cracked for longer than 7-10 days, if there is a great deal of redness, or if there is any drainage, you should contact a lactation consultant or your doctor for assistance. You may need an antibiotic ointment.
I will give you some suggestions on things you can try to make breastfeeding more comfortable:
If these suggestions don't seem to help, I'd suggest you see a lactation consultant. She will be able to assess you and will perhaps suggest the use of nipple shields until your nipples heal.
During the prenatal period, there is little you can do to prepare your nipples for breastfeeding. Exercises to promote the elasticity of your nipple should not be done unless directly recommended to you by your health care provider. You should have your breast and nipples assessed for adequacy regarding breastfeeding. In addition to a physical exam of the nipple, you should discuss any previous breast surgery. If you have had breast surgery, it does not mean you can not breastfeed. You should have your surgical record reviewed and make a breastfeeding decision following your health care provider's review and advice.
Your nipples will be assessed for firmness or suppleness, and protrusion. Nipples that are flat may become sore during initial breastfeeding. However, treatment for flat nipples is controversial. Many experts say there is little if anything you should do, others advise treating as inverted nipples. If your nipples are inverted (drawn in, and do not protrude with compression, or when cold) treatment is breast shells. Breast shells are designed to apply gentle pressure to the areola (the brown colored area surrounding the nipple) and push the nipple outward. The shells are worn so that the nipple is centered inside the opening, and then covered with the dome, and the bra is worn over the shell. If the shells are painful, the bra may be to small and therefore applying to much pressure. In that case, a larger bra size may be indicated. Begin wearing the shells in the last trimester for a few hours at a time, gradually increasing the time.
Green milk is unusual but is not usually harmful. The green color may be related to iron supplements, intake of artificial dyes, or ingesting large amounts of green vegetables. If the green milk is only coming from one breast, or is thicker than the usual breast milk pumped, you should contact your health care provider.
While breastfeeding, the milk ducts of the breast fill and empty regularly. This will cause your breast to feel different than when you are not lactating. It is a good idea to do regular Breast Self Examinations each month, including the time you are lactating. Most lumps you feel in your breast while lactating are either milk-filled glands, plugged ducts, an infected duct, a benign tumor or a milk-retention cyst. Only in rare cases are the lumps due to cancer. If the cause is a plugged duct, you might try warm compresses prior to breastfeeding, followed by massage. You could also continue massaging the area while breastfeeding. Position changes are also helpful, and leaning forward toward the baby might help loosen the plug. You should seek the advice of a health care professional who is familiar with lactating breasts. When you go for your exam, be sure your breasts are as empty as possible (breastfeed your baby immediately before the exam) so the lump may be easily felt.
A lactating adenoma also called nodular lactational hyperplasia or a lactating nodule is a benign (non cancerous) breast lesion that is unique to pregnancy and lactation. It is important that you monitor this node, and continue to perform monthly breast self-exam at the same time each and every month. If you notice ANY changes (such as size, and shape) you need to IMMEDIATELY consult you health care provider. If this nodule remains after you have weaned your child you should also consult with your health care provider.
Your pediatrician is correct. Research indicates that breastfeeding does not increase the risk that a baby will contract Hepatitis B when a mother is Hepatitis B positive. The choice to breastfeed still is yours. Possible infant exposure to Hepatitis B during labor or birth via contact with a mother's blood, the amniotic fluid, or vaginal secretions is associated with infant infection with Hepatitis B. Whether your baby is breast or bottle-fed, treatment for possible labor and birth exposure is the same. The recommendation is that he should receive hepatitis B immunoglobulin (HBIG) within 12 hours of birth, followed by the Hepatitis B vaccine (HBV) series of injections--the first injection within the first week, the second at a month, and the third injection at six months. He should also be screened for HBsAg during his first year to determine if he is a carrier. It will be very important for you to make sure your baby receives the HBV injections at the recommended times; without timely treatment he is much more likely to develop active hepatitis and become a chronic carrier.
References:
Riordan, J & Auerbach, K (1998). Breastfeeding and human lactation (2nd ed.). Boston, MA: Jones & Bartlett. Lawrence, RA (1997). A review of the medical benefits and contraindications to breastfeeding in the United States (Maternal and Child Technical Bulletin). Arlington, VA: National Center for Education in Maternal and Child Health.
Last Reviewed: Jun 17, 2002
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Tina Weitkamp, RNC, MSN Associate Professor of Clinical Nursing College of Nursing University of Cincinnati |
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Karen Kerkhoff Gromada, MSN, RN, IBCLC Adjunct Clinical Instructor Parent Child-Health Nursing Department College of Nursing University of Cincinnati |
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