Who to call about breastfeeding, and the mastitis signs not to ignore

Somewhere between the birth and the first growth spurt, most breastfeeding mums hit a question they cannot answer alone. Is this latch right? Why is that side so lumpy? Should a feed take this long? Knowing who to ask, and which symptoms mean you should call a doctor quickly, takes a lot of fear out of breastfeeding. Keep this list somewhere easy to find.

Your breastfeeding support team

• Your midwife. In the early days she can watch a feed, check your baby's weight and nappies, and look at your breasts and nipples.
• Your health visitor or clinic nurse. After the first weeks, they can help with feeding questions, weight checks and local support.
• A lactation consultant or breastfeeding specialist. Specially trained in feeding difficulties, including painful feeds, low supply, tongue-tie, and feeding twins or premature babies. Ask your clinic or hospital whether one is available; some services are free and some are private.
• Breastfeeding peer supporters and groups. Mums trained to offer support, often at local groups, community centres, churches or online. Many mums say a group was where they finally felt understood.
• Your doctor. For anything that might be an infection, and for your own health or your baby's.
• Trusted friends and family. Not for medical answers, but for meals, encouragement and an extra pair of hands.

How to ask for help well

• Ask someone to watch a whole feed, from latching on to coming off.
• For a day or two, jot down when your baby feeds, roughly how long, and how many wet and dirty nappies.
• Note what hurts, where and when.
• Say what you hope for, whether that is exclusive breastfeeding, combination feeding or stopping gently.

Blocked duct or mastitis?

A blocked duct often feels like a tender lump in one area of the breast. Mastitis is inflammation of the breast tissue, which can sometimes involve infection. It usually affects one side and may follow engorgement, a missed feed, a tight bra or pressure on one area.

Signs that can point to mastitis include:

• a red, hot, swollen or painful area of the breast, sometimes wedge-shaped (on darker skin, redness can be harder to see, and the area may look darker or simply feel hot and hard)
• a hard lump that does not ease after feeding
• feeling unwell, achy, shivery or feverish, as if you have flu

What to do

• Contact your midwife, health visitor or doctor the same day if you notice these signs, especially if you feel unwell.
• Keep feeding or expressing from the affected side unless you are advised otherwise; removing milk usually helps.
• Rest as much as you can, drink plenty, and ask someone to take over the chores.
• Wear a comfortable, loose bra, or none at all.
• Ask which pain relief is safe while breastfeeding.

Get urgent medical help if you feel very unwell, have a high temperature, the redness is spreading quickly, you have a painful swollen area that may contain pus, or your symptoms are getting worse despite treatment. Continuing to breastfeed with mastitis is generally considered safe for your baby; ask your doctor about anything you are prescribed.

When it's about your baby

Seek urgent help if your baby is floppy, very sleepy and difficult to wake, not feeding, has very few wet nappies, has a fever, or is struggling to breathe. You never need permission to get your baby checked.

You don't have to do this alone

Fear thou not; for I am with thee: be not dismayed; for I am thy God: I will strengthen thee; yea, I will help thee; yea, I will uphold thee with the right hand of my righteousness. (Isaiah 41:10, KJV)

Notice how many times God says I will: strengthen, help, uphold. Often that help arrives through a midwife who sits down beside you or a friend who brings dinner. Asking for support is not a lack of faith. It may be exactly how God's promise reaches you this week.

A prayer for help

Lord, I don't have all the answers about feeding my baby. Lead me to the right people at the right time, and give me courage to ask. Strengthen my body, protect me from infection, and uphold me with your hand. Amen.