Dealing with breastfeeding complications

Visit a doctor if your breast is engorged, painful. PHOTO | COURTESY

What you need to know:

  • As we commemorate World Breastfeeding Week under the theme ‘Step up for breastfeeding’, we look at some of the conditions that can hinder a mother’s chances of breastfeeding and offer expert advice on how one can cope.

The World Health Organisation (WHO) recommends that breastfeeding begins within the first hour of a baby’s life and continue as often and as much as the baby wants. Health organisations, including the WHO, recommend breastfeeding exclusively for six months, which means that no other foods or drinks, other than vitamin D, are given.

However, for some mothers, such as Hellen Nakisuyi this is not the case. Although she knew the benefits of breast milk to her baby, she did not have any. 

“My baby would cry to the point of becoming weak. As advised, I would let her suckle in the hope that some milk would come out. For the three days I spent in hospital, all I prayed for and hoped for was for breast milk to start flowing but none did,” she shares. 

Such and more are the pitfalls that hinder the beautiful practice of breastfeeding and experts say a little help from a medical personnel can help make breastfeeding enjoyable. 

Lack of milk 

Dr Castro Kisuule, a gynaecologist/obstetrician, says most new mothers are under pressure to produce milk in the first hours and when little or no milk is produced, they become frustrated. However, she says, with time, the quantity keeps increasing which is why the mother is advised to stimulate the breast by allowing the baby to suckle. 

“Many are discouraged, panic and switch to formula milk. Nonetheless, we encourage mothers to exercise patience and allow the baby to feed on the first milk referred to as colostrum. This milk, which is only available in the first few hours after birth, has lots of antibodies that the baby needs,” Dr Kisuule says.


Breast engorgement is breast swelling that results in painful, tender breasts. It is caused by an increase in blood flow and milk supply in your breasts and it occurs in the first days after childbirth. When not dealt with, the condition increases the risk of the mother getting a bacterial infection. 

“It will cause inflammation, and infections which graduate to abscess (production of pus). The problem is that, some new mothers may think the pain they are feeling is normal thus wait to see a doctor until it becomes worse,” Dr Herbert Ozelle, an obstetrician/gynaecologist, says.

Breast engorgement is the most common cause of a fever, locally known as omusujja gwa nakawere in the first seven days after delivery. Many new mothers have a lot to learn to make this journey enjoyable such as coming up with a breastfeeding routine. 

“When a baby feeds from one breast, there is a stimuli produced by the brain causing the breast to produce more milk. Therefore, when the breasts are not emptied, one after the other, milk accumulates, thus engorgement. A mother is, therefore, advised to feed the baby on demand while interchanging the breasts,” he advises. 

Mothers are also advised to pump and store the extra milk. This will also help when the mother returns to work, especially since breast milk can be frozen for up to six months.

Cracked nipples

Cracked nipples, together with wounds, usually occur when the baby is older and has developed teeth. The areola, as the baby continues breastfeeding, becomes sensitive yet unlike plastic bottles will not rest for the next six months or so. Therefore, should the baby bite the nipple, cracks and wounds will develop. However, Dr Ozelle says, there are nipple creams sold in various pharmacies that can provide relief.

The issue here is that the mother will stop breastfeeding from the cracked nipple which will lead to engorgement, causing mastitis. Because there are creams that sooth the nipples, even when they are cracked, Dr Ozelle says, a mother should continue breastfeeding. 

“If allowing the baby to suck from it is extremely painful, the mother can resort to pumping the milk or using a warm cloth to press the milk out. The idea is to ensure the breast does not get too full. It is important to note that the creams will not harm the baby,” he says.

 “Poor positioning of the nipple in the baby’s mouth is another cause of cracked nipples. This is why help from a health worker is essential, more so in the first few weeks after giving birth,” he adds.

Blocked ducts

This causes the milk flow to drop, leaving the mother with painful breasts. According to Dr Ozelle, this happens once in a while and could be due to an infection or other unknown reasons. The remedy is pressing a warm clean cloth on the breast to unblock the ducts. In extreme cases, Dr Ozelle says, some mothers will have to undergo an operation to remove the blocked tissue.


This is an inflammation of the breast tissue as a result of an infection. There are certain things that will dispose the mother to this condition, one of them being engorged breasts and cracked nipples. The other is poor hygiene (not cleaning the nipples properly may lead to the build-up of bacteria). 


Dr Ozelle says most of these conditions start as something small but when ignored, turn into something more serious. For instance, he says, cracked nipples are wounds which are entry points for bacteria that exposes a breastfeeding mother to infection. Ultimately, when not treated, this will lead to mastitis.

Getting support is a perquisite on this journey since, especially for first time mothers, the start is not easy. Without medical help and guidance, several mothers get frustrated. Some even believe they are not meant to breast feed. 

“A little support, such as teaching them how the baby should latch will ease breastfeeding, making it more enjoyable,” Dr Kisuule says.

For those that give up on breastfeeding and change to formula, the drawback is that the body continues producing breast milk. Without breastfeeding, the milk will fill up the breast and cause infection of the ducts. 

Pumping breast milk should be done on schedule; every after two to three hours. The challenge is when mothers pump at their own convenience and yet the body is programmed to release milk at a particular interval. 


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