See Breastfeeding problems (part one).
Candida
Candida is a fungus normally found on the mucous membranes of the body, especially on the lips, in the gut and in the vagina, where its job is to digest sugars; if the bacterial flora is disrupted, candida multiplies and causes an infection called candidiasis, which in breastfeeding women can appear on the nipples and areola.
Transmission can occur if the woman has the infection around the time of birth, so that the baby's mouth becomes infected while passing through the birth canal, and once latched onto the breast can then infect the skin of the nipple and areola, creating a vicious circle; or it can occur later, especially if the woman has already had candida infections, due to disruptions in the mother's intestinal bacterial flora (from antibiotic use, stress and exhaustion, or a diet high in sugar).
The nipple and areola appear red or pink, shiny and taut, with flaking skin or small blisters; burning and/or itching are felt, along with sharp pains that start at the nipple and shoot through the whole breast as far as the armpit, symptoms that show no sign of easing and tend instead to get worse.
The baby can also contract candida, known as «thrush», which in this case shows up as whitish patches resembling curdled milk on the lining of the mouth, on the tongue and on the gums, or as redness or white or red patches in the genital and anal area.
Management and solutions
- Consult a doctor, who will prescribe local and/or oral antifungal treatment, or Newman's ointment
- Alongside treatment, it is important to follow strict hygiene measures to prevent transmission:
- Keep the breasts exposed to air, since a warm, moist environment encourages bacterial growth, so avoid breast pads as well
- For the same reason, leave the baby without a diaper for part of the day
- Wash hands and nails thoroughly after changing the baby, dry them with disposable cotton pads and avoid using soap
- Change towels and underwear often, preferably white cotton, and wash everything at high temperatures
- Wash and disinfect by boiling daily any items that come into contact with the baby's mouth or with the breast (breast pump parts, pacifiers, toys...) and dry them with disposable paper
Homeopathic remedies
Candida albicans 15 CH, in globule form, can be given, even alongside medication, as one full dose under the tongue once a week. According to the therapeutic concept put forward in the past by Hahnemann, the homeopathic dilution of a substance can counteract the pathological effects caused by that same substance at ponderal doses (that is, much higher ones). This administration could thus be thought of as a kind of «vaccination» able to make the body's immune response to the pathogen more effective.
It should be stressed, however, that candidiasis reflects an imbalance in the microbiota, that is, the community of bacteria and other living organisms that inhabit our body and perform functions that are very important for our health. It is therefore essential to add a probiotic treatment for the mother from the moment (before pregnancy, during pregnancy, or in the postpartum period) she shows any physical symptom attributable to candidiasis.
Vasospasm
Vasospasm is a contraction of the muscles in the blood vessels of the nipple that causes a brief reduction in blood flow.
It shows up as intense, deep pain in the breast and nipple at the end of a feed, together with whitening of the tip of the nipple; the painful sensation appears when blood starts flowing back to the nipple, which regains its normal color, and it gets worse with cold or sudden temperature changes.
The main cause is compression of the nipple by the baby, who clamps it between the gums during latching and sucking.
The pain can also occur outside of feeding and, in more sensitive women, even during pregnancy, caused by the breast rubbing against clothing.
Management and solutions
- Latch the baby on correctly and position them so they feel well supported and are not afraid of losing their hold
- If the baby clamps down with the gums, release the latch
- Breastfeed in a warm place and put something over the shoulders to reduce heat loss
- At the end of the feed, dry the nipple to avoid sudden temperature changes and place a piece of wool cloth warmed on the radiator, or tucked under you, on the breast
- Again at the end of the feed, you can gently pinch the nipple, pulling it forward with thumb and index finger, to get the blood flowing more quickly
- Cut down on coffee and smoking, which cause vasoconstriction
- If the pain is too intense, consult a doctor, who may prescribe painkillers
Tongue-tie
The lingual frenulum is a thin band of tissue found under the tongue that connects it to the floor of the mouth; in newborns it is more prominent, reaching all the way to the tip of the tongue, and it shrinks back as the child grows.
If it is too short, the tongue does not extend far enough over the lower gum ridge, cannot form a channel to let the milk flow, and presses the nipple and areola against the hard palate, producing a clicking sound during sucking. This is not really a medical condition in itself and often does not cause major problems, because the tissue and the tongue are elastic and lengthen over time; however, it can sometimes create difficulties with latching and sucking, causing cracked nipples for example, and in such cases the frenulum can be clipped, on medical advice, in an outpatient procedure that does not require stopping breastfeeding.
Management and solutions
- Offer the baby the breast, shaping it with your hand to encourage a deeper latch
- Help the baby extend their head backward and push their tongue forward
- Switch to finger feeding if the baby struggles to keep hold of the nipple and areola, or try using a nipple shield