Breast care during pregnancy

From the beginning of pregnancy, the breasts are evolving and preparing for the arrival of the baby. Pregnancy hormones play a vital role and cause a number of changes in the breasts:

• Growth and enlargement – due to the increased blood flow in the breasts, they may feel swollen, sore and tingly.
• Tenderness of the breasts – it usually occurs during the first trimester of pregnancy. It does not happen with all women and sometimes goes unnoticed.
• Darkening of nipples and areolas (the skin around the nipples), due to hormones that affect pigmentation of the skin. Occasionally small pimples or goose bump are also seen in the areola region. These are very common and are considered to be normal.
• Darkened veins along the breasts due to increased blood supply to the breasts.
• The breasts may start leaking a yellowish, thick substance known as colostrum.
• Protruding nipples and the areolas and nipples will grow larger.

Growth and enlargement

For some women this may be something to look forward to, but women with large breasts will be less enthusiastic. The smallest increase can be noticed immediately. The maximum increase takes place during the initial three months.

Women with smaller breasts can avoid wearing a bra during pregnancy. As the bust size increases, a bra should be worn for support and to avoid stretch marks.

A poor-fitting bra can result in clogged ducts and therefore the ideal bra should have:

• Good support
• Deep band beneath the cups
• Wide shoulder straps
• Bra extensions which are very useful when the bra becomes too tight around the ribcage but still fits everywhere else.
• No under wires as they can put pressure on milk glands and interfere with milk production.

• Special maternity bras may be required for breastfeeding. Buy these towards week 34-36. The best maternity bras should have openings under each cup, which will allow easy access to the breast when feeding.

Sensitive and tender breasts

Hormones in the body are preparing the breasts for lactation. The milk ducts are growing and being stretched as they fill with milk early in pregnancy. All this causes the breasts to be more sensitive, particularly the nipples. 

Colostrum

This is known as pre-milk, which is a sweet and watery fluid that is easy to digest. During the second trimester the breasts will begin to produce colostrum. It is thick and yellow at first and as the birth draws near, it becomes pale and almost colourless. Colostrum is very important for the baby as it improves the baby’s immunity and offers protection from jaundice.

Colostrum discharge can be managed by using breast pads in the bra. Change them several times a day and allow the nipples to air dry after each change.

Nipple care

Some nipples become larger and darker during pregnancy and remain like this for up to a year after the baby is born.

Dry nipples can be treated with a good nipple cream.  Do not use soap on the nipples, as dry nipples can crack easily.

Breast care after delivery

Breasts will be filled with milk anytime from day two to five. The breasts may become swollen when the milk first comes in, but should settle down after about 24 hours. After a week or so, most mothers have breastfeeding fairly well established and find that their breasts are comfortable before, during and after feeds.

Sore nipples

It was once thought that prenatal nipple preparations would toughen the nipples and prevent sore nipples. We now know this supple tissue cannot be toughened. The main cause of sore nipples is incorrect positioning of the baby on the breast.  Appropriate latch-on skills after delivery can lessen and often eliminate nipple pain.

Nipples can crack due to improper latch-on. It can also happen if the nipples are too dry, too wet or undergo too much friction. Ensure that the baby latches-on to the breast properly and the biggest part of the areola is in the child’s mouth.

Breast engorgement

Immediately after delivery, the hormones released in the body start producing milk for lactation, whether the mother is breastfeeding or not. If unable to feed well, the breasts may feel uncomfortably full.

To minimise engorgement, frequent nursing or expressing of the extra amount of milk is recommended.

Breast milk leakage

Breast milk leakage can continue for a few weeks to a couple of months depending upon the milk production and the sucking capacity of the child. Wear breast pads whenever necessary and change them often. Keep the nipples and surrounding area clean and dry. 

Breastfeeding

Contrary to popular belief, breast size does not affect milk production. Large breasts have more fatty tissue than small breasts and do not have more milk producing cells. Even the smallest of breasts can produce an enormous amount of milk.

As natural as breastfeeding is, the proper technique is a learned art and many women find it quite easy. Many find it difficult to feed their baby due to pain in their breasts. Breastfeeding should never be painful as only improper feeding techniques lead to pain and discomfort.

Women with any shape breast and nipple size can nurse, but women with flat or inverted nipples should prepare them before baby is born. The nipples can be assessed around the sixth month of pregnancy.

Care of the nipple in preparation for breastfeeding

• Common nipple – about 90% of pregnant women do not need to do any special preparation.
• Flat nipple – a flat nipple does not always stick out. Although pregnancy helps to get this kind of nipple ready, many mothers find that their babies can grasp hold of the nipple more easily if the mothers have done the Hoffman Technique (see below) and worn a breast shell.
• Inverted nipple – an inverted nipple looks like a slit or fold. Many women with inverted nipples have successfully breastfed, but special preparation is helpful.
• Hoffman technique – place the thumbs at the right and left edges of the areola. While pressing inward slightly, the thumbs are pulled firmly apart. This manoeuvre is repeated at least four times and then again with the thumbs at the top and bottom of the areola. It is normal to have some leakage of colostrum during Hoffman manoeuvres.
• Breast shells – breast shells can be worn prenatally by women with flat or inverted nipples.

Precautions

The following precautions during pregnancy and breastfeeding will avoid discomfort:

• Inspection of the breasts should be done on a regular basis.
• Any changes in the colour and appearance should be taken seriously.
• Change the breast cream if it does not suit the skin.
• The breasts should be washed only with water.
• The breasts should not be allowed to remain damp as it leads to cracked nipples.
• Use breast pumps correctly and avoid excessive pumping.

Taking a little time off from daily routine to care for the breasts will help in the long run and lead to successful breastfeeding and a happy baby.