BREAST CARE

 PURPOSE:
 To clean the breast.
 To detect any abnormalities.
 To stimulate milk ejection .
 To prevent local infection.
 To prevent breast complications.
 Postnatal mothers.
 Before and after breastfeeding.
 Cracked nipple.
 Pt. who are not able to take self care.
 Nipple with unhygienic conditions.

INTRODUCTION
Breasts are very vulnerable and fragile part of women’s body. During pregnancy
because of various hormonal changes in the body, breasts too undergo a number of
changes. Therefore, it’s important to take special care of them during this period.
The breasts also show prominent signs of pregnancy. They evolve and prepare
themselves for the arrival of the newcomer.
DEFINITION
Breast care means care given to the breast by the mother during her prenatal period,
intranatal period and postnatal period.

WHY IS BREAST CARE IMPORTANT?

It is important to take care of your breasts if you plan to breastfeed or are breastfeeding.
With good breast care, the mother can improve her breastfeeding experience for herself and for
her baby. Taking care of breasts will also help to prevent problems that can happen while
breastfeeding.
CARE OF THE BREAST DURING PREGNANCY PERIOD
During pregnancy due to increased blood flow, the breasts become tender and
swollen. So, special care and attention should be given to the breasts so that
after childbirth, the mother is fully prepared to breastfeed her baby without any
problem.

 It is important to begin preparing the breast for breastfeeding during the prenatal period.
(1)  A well-fitting support bra should be worn at all times. This will provide good support
for the enlarging breasts. As the breasts enlarge, an increase in bra and cup size
 should be worn. Avoid underwear bras, as under wires can put pressure on milk glands
and interfere with milk production.
(2)  Wear a maternity sleep bra that ensures adequate breast support at night.

(3)  During the last weeks of pregnancy, the breasts start preparing themselves for
lactation Pads may be worn inside the bra cups to absorb possible colostrum leakage
from the nipples. The pads should be changed if they become wet from leakage.
Prolonged moisture against the nipples may lead to tenderness and cracking once the
newborn infant begins nursing. Select from reusable and disposable varieties available
at stores. Change them several times a day and allow the nipples to air dry each
change.

(4)  The breasts should be washed daily (without soap) to remove dried colostrum and to
prevent irritation to the nipples. Lanolin may be applied to the nipples to prevent
evaporation of perspiration, thereby softening the skin. Wet tea bags may be placed
on the nipples, as the tea will release tannic acid, which will toughen the skin. The
nipples should be air dried or blow dried after washing to help toughen them,
especially if the patient plans to breastfeed.
(5)  The major change during this period is the change in the breast size due to
increase in fat and milk glands. This means, breast grows in size and weight. Wear
a comfortable and correct size of bra. They must wear a good brand bra which
provides support and holds the breast in place without squeezing them.
(6)  The bra size should be changed according to the change in breast size during this
phase. Choosing the right bra, prevents the breasts from sagging.
(7)  Under wire bras should be avoided as they put pressure on the milk glands and thus
interferes with lactation.
(8)  As the size of the breast increases there are chances that this may lead to stretch
marks. So expecting mothers should apply and massage stretch mark creams on their
breast gently.
The nipples change in color and size as well. They sore, enlarge and stick out more. Too
much dryness, too much friction and too much wetness, makes the nipples sore. So, in
order to avoid the dryness, expecting mother should avoid:
* Using soaps on their breasts and instead should apply good moisturising creams on
them.
* Rubbing the breast and nipples with towel
* Wearing tight and incorrect size bras
Breasts need regular and special attention during pregnancy. One should not
overlook any tumours and must visit breast physician for their advice and treatment.
Because even the smallest tumour can start growing during this period and interfere
with the ducts and prove to be a hindrance during lactation.
 WHY CARE OF THE BREAST SHOULD BE TAKEN DURING
PREGNANCY?
          Proper education of mother and relatives is possible and mandatory during pregnancy. Flat
or inverted nipple can lead to difficulties in breastfeeding for the child. Hence, during pregnancy
women can become aware of it & take necessary steps.

CARE OF FLAT AND INVERTED NIPPLES: 

      Nipples can be flat, normal, long or inverted. Flat nipples cannot be gripped  easily. Inverted
nipples cannot be held by fingers. Both can cause feeding difficulties and get injured while
giving breastfeeding.
Steps of care:
Once breastfeeding is begun usually nipple starts protracting out.
Following tips can also help:
1. Try gentle pulling of nipples for flat nipples by fingers.
2. As shown in diagram cut a 10 ml syringe at the front end, remove the plunger from hind
end and insert it from the cut front end. Then press open hind end of the syringe lightly over the
areola covering the nipple and withdraw the plunger (which is now at the front cut end) so that
the nipple is pulled into the syringe. Maintain pull for 20 to 30 seconds and then release. Gently
remove the syringe. Nipple will remain protruded. Then put the child for breastfeeding.
3. Use “Nipple Shell” (hard plastic shell with holes worn over nipples) for flat and inverted
nipples. If not available in the market, make it at home from wood, plastic or cap of feeding
bottle. Remember, to make it with smooth margins So file all sharp margins, as there can be
injurious.

BREAST DISCHARGE DURING PREGNANCY:

From fourth to sixth month of pregnancy, thick, yellow fluid begins to form inside the
breast. This may or may not be, expressed out. There is no definite advantage or disadvantage of
expressing this milk. Take care, while expressing this milk, to avoid injury to the nipples.

CARE OF THE BREAST DURING BREASTFEEDING

Need of breast care for all lactating mothers is most necessary as this directly links health of
mother and her baby. So it becomes important to take care of your breasts if you are
breastfeeding. Good breast care improves health of your breast and in turn breast feeding for you
and your baby.
 Avoid pressure on the breasts: 
 Do not wear underwear bras, and avoid wearing bras that are too tight and clothes that are tight
over the breasts. Avoid wearing or carrying items that can squeeze or press on the breasts. These
include big purses, baby carriers and slings, and diaper bags.  After rinsing the breasts, you might
want to apply a few drops of breast milk or colostrum to the areolas. These substances will
soothe and protect your nipple. In addition, some women find it beneficial to rub a few drops of
corn oil or olive oil on their nipples.
 Sleeping Position:
Sleeping in a face down position may squeeze your breasts and block milk ducts.
 Breast support:
Wear a supportive bra. This can be a regular bra that the mother takes off when she breastfeed or
a nursing bra with breast flaps. Cotton bras are best as they will not trap moisture that can irritate
the nipples. Make sure the bra fits correctly and does not squeeze the breasts.

 Do not use underwire Bra:

Avoid wearing underwire bras. The milk ducts extend up towards the armpits. Underwire bras
can squeeze the breasts and pinch on milk ducts, and cause plugged ducts or mastitis (breast
infection).
 Cleaning the breasts: 
Always keep the breasts clean. Wash breasts with warm water once or twice every day. Strictly
do not use soap or other cleansing agents. These can wash up the natural lubrication and may
cause cracking of nipples and may irritate nipples. Always keep the hands clean while touching
your breasts to prevent infections. Always wash the hands thoroughly for 15 seconds before
breastfeeding, expressing, or pumping. Then dry them completely and always use a clean paper
towel after every washing.
 Keep the nipples dry: 
Do not wear plastic nipple shells or plastic-lined nursing pads. These can trap moisture and do
not allow air flow to the nipple. Placing cotton fabric breast pads inside your bra will let air
inside. Change breast pads often to prevent irritation. If nipples are damaged, nursing pads may
stick to the nipple. Soak the pads in warm water to help remove them.
 Nipple conditioning:
Let the nipples air dry after breastfeeding. Use breast milk or pure lanolin ointment or some pure
milk fat on the nipples if needed to keep them from getting chapped and dried out. Avoid creams
and lotions that can cause an allergic reaction with irritation of the skin.

 Breast Creams for Dry or Cracked Nipples:

Often, women who are breastfeeding will develop dry and/or cracked nipples. This
can make breastfeeding quite painful. In order to soothe and heal nipples, some
mothers use a breast cream, such as Pure Lan ® or Lansinoh®, after they nurse. If the
mother chose to use one of these creams, she shouldn't wash it off after application.
When buying a breast cream, look out for products that do not contain alcohol,
perfume and other substances that could contribute to drying and irritation.
 Using Nursing Pads to Prevent Leaks:
At some point or another, many breastfeeding moms will experience leakage. In fact,
many pregnant women will leak milk or colostrum during their second or third
trimesters. Leaking milk can not only stain your clothes but can also lead to
 embarrassing situations. In order to keep your clothes dry, you might consider wearing
nursing pads.Many breastfeeding moms opt to use washable or disposable nursing
pads. If selecting this type of nursing pad, you should look for one that is made of 100
percent cotton. This will allow air to circulate around the breasts and the nipples.
Avoid pads with plastic linings, which may not allow sufficient airflow and may
contribute to nipple infections.If the mother does not want to buy nursing pads, she
can create one by cutting a disposable diaper into the desired shape and removing the
plastic lining. Also, some women use cloth diapers or handkerchiefs as nursing pads.
She should not use a sanitary pad as a nursing pad, as it will prevent air from
circulating.If the mother uses a nursing pad, she should change it or dispose of it as
soon as it becomes damp. Wearing a moist pad can lead to irritation and infection.
WHAT PROBLEMS MAY OCCUR WHEN BREASTFEEDING?

        Decreased nipple blood supply: This

can cause the mother to have pain and blanching (becoming
pale) of her nipples while breastfeeding. Decrease the amount of caffeine the mother drink, such
as in coffee, tea, and soda, to help prevent nipple blanching. Do not smoke and avoid being in
cold areas. Certain medicines may make the blood vessels get narrow and decrease blood flow to
the nipples. Always ask the caregiver before using any medicine. Let him know when the mother
has nipple blanching.
        Engorgement: Although
it is normal for the breasts to fill with milk, they can become too full.
Breast engorgement is a condition where the breasts are painful and very swollen from too much
milk inside. Breastfeeding the baby often will help empty the milk and prevent engorgement. If
the baby cannot empty the breast milk, the mother can express milk from her breasts by hand or
with a breast pump. Ask the caregiver for more information about breast fullness verses breast
engorgement. Tell the caregiver if the mother want more information on expressing breast milk.
        Leaking breasts: The
breasts may leak when they are full of milk and not emptied often. The
mother may see milk dripping from her nipples. This is normal. To stop this, cross the arms over
the chest and press them lightly over the nipples. The mother can also wear nursing pads inside
her bra to soak up the milk. Wear several layers of clothing, and avoid wearing solid colored
shirts. Doing these things may make the leaking milk harder to see on her clothes.
        Nipple pain: The
mother can get sore nipples when she first start breastfeeding. This should get
better as her body gets used to breastfeeding. She can get sore, cracked, or bleeding nipples if her
baby is not latched-on in a good position. To prevent this, she needs to be careful when
positioning your baby to feed. Make sure her baby has a mouthful of her breast when he feeds.
To latch-on well, his lips and gums should be on her areola and not just on her nipple. Help the
baby to latch-on and come off the breast without sucking to prevent injuring the nipple. Ask the
caregiver for more information about nipple soreness.
        Plugged milk ducts: Milk
ducts are pathways where milk flows from milk producing areas in the
breast down to the nipple. Things that can block the milk ducts include milk that gets thicker,
scar tissue, or something pressing on them. The blockage can decrease or stop the flow of the
breast milk in one part of the breast. It can make the milk build up inside and cause the breast to
swell. Plugged ducts can lead to getting a breast abscess (area of infection in the breast) or
mastitis. Always empty the breasts completely and do not let long periods of time pass between
breast feedings. Breastfeeding often will help to prevent from getting plugged ducts again or
getting a breast infection. Ask the caregiver for more information about breastfeeding and
plugged ducts.