 We are going to discuss about some of the complications that mother may kind of experience, but you know to be frank in like over last 14, 15 years you know once we started learning the correct latching technique, once we started understanding lot of this counselling points I have not seen so many complications so I must confess that, but in case if you find a mother who has say nipple sore or if she has flat nipple or if she has any of those other conditions or even breast conditions so you know if she has say mastitis, if she has a kind of some lump in the breast, if she has any abscess you know we have created to tell them these tools are meant for healthcare workers okay. So we have not gone in detail exactly what to do like you know what medication to give or you know what kind of IND to do, we have not gone into that because this tools are clearly not meant for medical therapies okay or surgical therapies okay, but we have given the overall overview of you know what advice to give. So for example you know I do see in India that lot of this mothers they are given syringes or you know when they are say pregnant or after delivery if a nursing staff or doctor finds that the patient has flat nipple or inverted nipple or a trica nipple they use syringes and believe me I have not used any of those syringes ever many patient have a flat nipple what we do we only focus on the way to hold the breast in a cross cradle hold or any hold we make sure that the fingers of the mothers are parallel to baby's lips so if that is done then you know you do not need to use any syringe the whole areola becomes like a big nipple okay that is what is important you know you just have to contour the breast so the baby can be you know latch on really well so please if anybody is using syringes or nipple shield also you know absolutely no nipple shields on babies or mothers actually mothers areola are no need for any nipple shields okay so thank you so much do watch it and let me know what you think okay thank you welcome to this spoken tutorial on nipple conditions in lactating mothers in this tutorial we will learn about sore or cracked nipples and flat or inverted nipples the first nipple condition is sore or cracked nipples it is a condition where mother develops cracked and bleeding nipples this causes the nipples to become itchy and dry now let's discuss the various causes of sore or cracked nipples which are nipple feeding fungal or bacterial infection habit of cleaning the nipples after every feed and baby with tongue tie let us begin with the nipple feeding nipple feeding is the first and foremost cause of sore or cracked nipples during nipple feeding nipple gets rubbed on to the heart palate of the baby's mouth baby pinches this nipple between the heart palate and the tongue this pinching makes the breastfeeding painful and results into sore or cracked nipple nipple feeding is the result of improper latching therefore correct latching plays an important role to avoid sore or cracked nipples due to nipple feeding note that we have discussed the correct latching technique in another tutorial of the same series remember sore or cracked nipples does hurt during correct latching if the mother continues with the correct latching technique then slowly and gradually it stops hurting next is fungal or bacterial infection if the mother has fungal or bacterial infection she should consult the doctor next some mothers have habit of cleaning the nipples before every feed this causes dryness of nipples thus this routine should be avoided remember mother can clean the nipples once during bath however once a crack nipple has developed mother should clean it after every feed after cleaning mother should apply her hind milk on the wound as hind will contain substances that aids in healing and fighting infection thus preventing the organisms from baby's mouth to lick into the crack of the nipple next is the baby with tongue tie tongue tie is a condition in which the tip of the baby's tongue is attached to the inner bottom part of the mouth it is a very rare condition nipple feeding is commonly observed in baby with tongue tie in case the baby has tongue tie then mere correct latching is not enough and surgery is required thus in such cases mother should always consult the doctor now let's discuss the treatment for sore or cracked nipples if a mother has sore or cracked nipples then the health workers should examine the mother's breast and the nipple tell the mother to express some breast milk with her hand before breastfeeding it will soften the breast and baby will easily attach apart from these expressing will reduce the risk of infections nipple fissure and mastitis then guide the mother to attach her baby correctly to her breast remember breastfeeding frequency is one of the factors which determines the breast milk supply therefore mother should not stop breastfeeding during breastfeeding she should begin to breastfeed on the side that hurts less if breastfeeding is still painful then she can express the breast milk using her hand and feed it to the baby with a spoon or a cup also apply few drops of hind milk onto the affected area after each feed as discussed earlier remember not to use the following on sore or cracked nipples and even on healthy nipples soaps oils lotions bombs and perfumes they may contain irritants it will worsen the condition if a mother has sore or cracked nipples in severe conditions mother should consult the doctor or the health worker for preventing sore or cracked nipples start breastfeeding immediately after birth always make sure that baby is lashed on deeply while breastfeeding the nipple condition that we will discuss next is flat or inverted nipples flat nipples are not protruded from the level of the areola whereas inverted nipples are usually pointed in the inward direction it is very important for the mother to understand the fact that flat or inverted nipple is not a hindrance to breastfeeding since during correct clatching baby latches on to the areola and not on the nipple note that in case of flat or inverted nipples mother requires help in first week of delivery during this period health workers should guide the mother about correct clatching this will build her confidence remember in case a mother has flat or inverted nipples then the best holes for effective attachment are cross cradle hold football hold and semi reclining position as explained in an earlier tutorial in any hold it is of utmost importance that mother should hold the breast in the correct manner where baby's lips and mother's fingers will be in the same direction note that incorrect clatching will result into sore nipples remember do not use feeding bottles or nipple shields it will make difficult for a baby to breastfeed from breasts having flat or inverted nipples mother should provide plenty of skin to skin contact to the baby it helps stimulate oxytocin reflects in the mother and breast milk easily comes out always remember correct clatching is the key to deal with most of this nipple conditions this brings us to the end of this tutorial welcome to the spoken tutorial on the complications of using nipple shields in this tutorial we will learn about nipple shields disadvantages of using nipple shields suggestions for adequate breastfeeding let us begin a nipple shield is used to help with breastfeeding it is a nipple shaped cover made of plastic silicone latex or other materials while breastfeeding it is positioned over the nipple and ariola it is a temporary solution to help the baby latch on to the mother's nipple nipple nipple shields are usually recommended to mothers who have flat nipples they are also recommended to mothers who have inverted nipples they are also used when the baby doesn't latch on or suck the breast properly mothers with cracked nipples also use them to avoid pain however use of nipple shields during breastfeeding has many disadvantages they create a barrier between the infant and the mother's breast they make breastfeeding feel unnatural they reduce the stimulation of the ariola this may interfere with prolactin and oxytocin release in the mother prolactin and oxytocin are hormones needed for lactation prolactin helps in breast milk production oxytocin helps in releasing milk out of the mother's breast therefore nipple shields reduce breast milk supply during breastfeeding this increases the overall time taken for breastfeeding the mother and the baby feel tired after feed on long-time use the infant becomes dependent on nipple shields infants may refuse to breastfeed without a nipple shield this dependency combined with reduced breast milk supply is not good over time it decreases breast milk production therefore it causes early weaning early weaning is found among many mothers who use nipple shields nipple shields prevent the nipple from reaching deep inside the baby's mouth this does not let the baby deeply attach to the mother's breast this might also interfere with the baby learning to suckle correctly the baby's suckling pattern is changed when a nipple shield is used nipple shields increase the baby's sucking speed they also increase the baby's time spent resting during breastfeeding the baby might swallow too much air because of the nipple shield nipple shields often fall off the breast thereby interrupting breastfeeding nipple shields give a feeling of inconvenience to the mother and the baby it is difficult for the mother to clean them later after use hence they increase the chances of passing the infection to the baby a nipple shield with an improper hole gives poor flow of milk this can tire the infant and cause poor growth sometimes nipple shields of improper size or fit are used they can cause choking in infants they can also cause or worsen cracked nipples in the mother nipple injury from squeezing of the nipple and areola is possible nipple shields should not be recommended if the baby is not sucking properly the current research does not yet show safe practices for using nipple shields some experts recommend nipple shields when the baby refuses to breastfeed causes for refusal may include flat or inverted nipples they also include premature birth another cause is the baby not sucking the mother's breast properly other causes are neuromuscular issues or imprinting imprinting is a behavior that happens in the early hours of life ideally the baby naturally attaches to the mother's breast after birth however without early breastfeeding the baby attaches to something else it could be a thumb bottle plastic nipple etc this causes the baby to refuse to breastfeed sometimes a mother may be stressed she may be considering bottle feeding in such cases nipple shields may provide temporary relief to her they may also prevent bottle feeding she must be helped by a lactation expert properly some mothers may wish to use nipple shields for longer periods however they must go for regular follow-ups to check if the shield is helpful here the risk of the baby not feeding directly from the breast is high self-made nipple shields should not be used nipple shields should not be altered for use sometimes a mother may ask about using a nipple shield it is important to first ask her about her breastfeeding technique and problems inquire about her breastfeeding history inquire about her attempts to correct the baby's breast-sucking technique then offer suggestions to correct the mother's breastfeeding technique nipple shields should only be initiated by a healthcare provider they should be an expert in breastfeeding skills they should thoroughly assess the benefits and risk of using a nipple shield they should also plan with the mother for regular follow-ups while using it babies can get used to breastfeeding with a nipple shield later they may refuse to breastfeed directly from the breast without a shield they may also not be able to attach deeply to the mother's breast later therefore follow-up is especially important in the first 48 hours mother should be helped to wean from the use of a nipple shield some healthcare providers cannot help the mother appropriately they should refer her to a lactation expert mothers should always be taught the proper techniques of breastfeeding she should know that babies must attach to the lower areola not to the nipple so it is not mandatory to have a protruded nipple for the baby to attach most often the nipple can protrude naturally with the help of deep latching this happens over a few days due to good sucking by the deeply latched infant the use of nipple shields can make this natural process difficult initiating breastfeeding within one hour of birth is important to do so skin to skin contact must be performed immediately after birth skin to skin contact after birth is explained in another tutorial mother should also learn the correct techniques of breastfeeding cross cradle hold is one of them this hold will help in adequate breastfeeding even if the mother has flat nipples in this hold the mother's fingers on the breast are parallel to the baby's lips this helps the baby latch deeply to the breast cross cradle hold is explained in another tutorial of the same series patients in learning breastfeeding skills must be encouraged repeated attempts must be made to breastfeed without a nipple shield remember exclusive breastfeeding for the first six months of life is crucial breastfeeding must be effective for the baby's growth correct breastfeeding techniques will ensure that the baby gets enough milk milk any artificial product can never replace natural breastfeeding an expert must always guide a mother to learn proper breastfeeding skills this brings us to the end of this tutorial thank you for joining welcome to this spoken tutorial on breast conditions in lactating mothers in this tutorial we will learn about breast engorgement and mastitis let us begin with breast engorgement engorgement occurs most commonly between three to five days after delivery it occurs in both breasts simultaneously mother should not confuse breast engorgement with breast fullness thus now we will discuss the difference between breast engorgement and full breasts in engorgement breast become firm swollen and painfully full of milk it gives shiny appearance and shows dilated veins on the surface mother may suffer from fever that lasts for more than 24 hours and latching becomes hard for the baby whereas full breasts are normal full breasts appear big but they do not give shiny appearance full breasts are not painful and fever is absent during breast fullness now let's discuss the causes of breast engorgement in lactating mothers breast engorgement can occur in the following conditions if mother has not fed the baby soon after delivery mother is not feeding the baby frequently baby has poorly lashed on mother's breast during breastfeeding and mother has stopped breastfeeding suddenly now let's discuss how engorgement can be treated first ask the mother to wash her hands with the clean water then bring the baby closer to the mother so she can see smell and touch the baby if baby is too fuzzy mother can smell the baby's towel after that mother should drink a glass of water then keep wet warm cloth on the breast for five to ten minutes or mother can also take a warm shower it will help the breast milk to come out after that health worker should tell the mother to relax as excess of stress will affect the let down reflex and milk will not come out now either health worker or any family member should massage on the mother's neck and upper back it will help the breast milk to come out since nerves apply towards upper back and breast is same then mother should start gently massaging her breast in circular motion massaging will make her relax and will improve the let down reflex all these things will help in releasing of oxytocin it is known as oxytocin reflex or let down reflex oxytocin is a hormone which helps the breast milk to come out then mother should manually express some amount of milk to soften the areola it will help the baby to latch on the breast correctly during expressing the breast milk mother should apply pressure around the areola after expressing mother should guide the areola in the baby's mouth as it would be difficult for a baby to self attach try to breastfeed on both sides between the feeds mother should keep wet cold cloth on breast for 5 to 10 minutes or mother can keep cold cabbage leaves on breast she can store this cabbage leaves either in refrigerator or in earthen pot it helps in reducing the tenderness and edema in the breast then mother should breastfeed frequently now let's learn how can we prevent breast engorgement first try to understand the hunger signals of a baby such as squirming, increasing rooting reflex in rooting reflex baby turns her head towards anything which touches her cheek or mouth sucking on fingers in late stage the baby starts crying breastfeed the baby whenever she shows early hunger signals and not wait for the baby to cry make sure that the baby is latched on properly and feeding well remember empty one breast completely before you switch to the other side next let's learn another breast condition called mastitis it is a condition where part of a breast becomes red, swollen and hard mother feels severe pain, fever and ill many mothers go through mastitis in first six weeks but it can occur at any time during lactation it is sometimes confused with breast engorgement however engorgement affects whole breast and often both breasts whereas mastitis affects part of the breast and usually only one breast mastitis may develop in an engorged breast or follow condition of block ducts now we will discuss how block ducts develops into mastitis if untreated block duct is a condition where milk is not removed from the part of a breast usually this duct is the part of breast blocked by thickened milk it leads to lump formation this lump is tender and often present with redness of the skin over the lump block duct and breast engorgement causes milk stasis when milk stays in part of a breast in block ducts and breast engorgement it is called stasis if this stasis is not removed it could lead to inflammation of breast tissue it is called non-infective mastitis whereas sometimes breast becomes infected with the bacteria and this is called infective mastitis in following conditions bacteria will easily enter through fissure if fissure is present on the breast mastitis remains untreated and delayed treatment note that breast abscess is a progression of untreated mastitis now let's discuss the causes of mastitis the first and foremost cause of mastitis is infrequent feedings if lactating mother is a working woman then frequent breast feeding becomes challenging other reason for infrequent feedings could be illness in mother or a baby second is nipple feeding in nipple feeding baby will not empty the breast completely third is oversupply of milk fourth is rapid weaning where baby eat other foods apart from breast milk fifth is tight clothes if mother use tight clothes especially in night if mother wears a tight bra it brings pressure on the breast and can block the milk ducts sixth is maternal stress if mother is going through any stressful conditions it will affect the let down reflex seventh is nipple fissure it provides a way for bacteria to enter the breast tissue and may lead to mastitis let's look at the treatment for mastitis first try to identify the cause and then start the treatment mother should use warm compresses before breastfeeding or should take a warm shower she should start breastfeeding from affected breast first if it is increasing the pain or affecting the let down reflex then start with the unaffected breast remember frequent breastfeeding is necessary if the open wound is not on the nipple or on the areola then mother can breastfeed on the affected side remember whenever a mother is feeding to a baby from mastitis breast she should monitor the baby for signs of infection as there will be a risk of infection to a baby since breast milk from affected side will have many harmful bacteria massaging the breast may improve the milk supply it should be a gentle massaging from affected area towards the nipple and mother should take enough rest if symptoms are severe then she should refer to the doctor breast abscess will require surgical drainage of abscess and antibiotics apart from these mother should make a special effort to relax her body and breathe deeply and evenly listen to the soothing music and think about your baby to help in starting the let down reflex remember for preventing mastitis correct clatching is necessary it will avoid blocked dug and baby will get enough milk keys to prevent all these breast conditions are proper attachment and positioning of a baby and frequent breastfeeding this brings us to the end of this tutorial thanks for joining