Breast-Feeding

When To Call a Doctor

During pregnancy

Prenatal visits are a good time to talk to your doctor about your breast-feeding plans. Ask about breast-feeding classes and other resources, such as a breast-feeding support group.

If you develop any unusual lumps or cysts in your breast, have them evaluated by your doctor. Although you can expect some breast changes (such as increased size and tenderness) during pregnancy, talk to your doctor if you have a concern.

While breast-feeding

It is important to talk to your doctor before taking any medication, whether it is prescription or non-prescription. Most problems that require medication can be treated with one that is safe to take while breast-feeding. The mild pain relievers acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) are safe to take for pain or fever while breast-feeding.

Your doctor or a lactation consultant can help treat problems that may affect your breast-feeding experience. Call your doctor if pain persists after trying home treatment measures. For more information, see the Home Treatment section of this topic.

Talk to your doctor if you are consistently losing or gaining more than 0.5 kg (1 lb) a week.

A doctor can also treat a breast infection (mastitis) that can make breast-feeding difficult and painful. If you have these symptoms, you may need antibiotic medication to treat a bacterial infection or nystatin to treat a yeast infection on the breast's surface. If the yeast infection is in the ducts (ductule), you will need a different medication. Call your doctor today if you have signs of mastitis, such as:

• Redness or warmth on the breast.
• A headache, fever, chills, or flu-like symptoms.
• Sore, red or very pink nipples, sometimes with stabbing or burning breast pain during or between feedings.

Also, breast-feeding problems may be exaggerated by postpartum depression. Many women experience some feelings of depression in the first few weeks after child birth. This is commonly known as the "baby blues," and it usually resolves on its own. However, some women's bodies respond to changing postpartum hormone levels with a lasting depression that requires treatment. Talk to your doctor if your baby is more than a few weeks old and you continue to have trouble sleeping (insomnia) or concentrating, or if you frequently feel sad, tearful, anxious, hopeless, or irritable.

Problems for the breast-feeding infant

Continue breast-feeding your sick baby. Breast milk is the best nutrition for your baby if he or she is vomiting or has diarrhea.

All babies, regardless of how they are fed, need close monitoring to ensure they are healthy and growing and developing normally. Call your doctor if your baby is not eating well for any reason or has any of the following symptoms:

• A rectal temperature higher than 38°C (100.4°F)
• Blue or very pale skin colour, which may indicate anemia
• Yellowing skin tone, which may indicate jaundice
• Fussiness or sleepiness that interferes with breast-feeding
• Weakness, listlessness, or lack of interest in feeding
• Thick, white patches in the mouth and cheeks, which indicate a yeast infection (thrush), or signs of a diaper rash

Also, call your doctor if you do not observe any of the above symptoms, but you strongly feel that something about your baby is not right. Your baby is probably fine, but it is always best to follow through on your instinct.

Signs of poor eating in a baby include:

• Not reaching his or her birth weight by 2 weeks of age or other signs of insufficient weight gain.
• Wetting fewer than 6 diapers a day.
• Passing little or no stool in the first 4 weeks, or passing stools that are dark green and contain mucus after the first few days. However, it is normal for your baby to have fewer stools starting around 4 to 8 weeks of age. As long as stools remain soft and he or she is feeding well, it should not be a concern.
• Having problems latching on to the breast.

Who to See

Health professionals who can help you prepare for breast-feeding during pregnancy include:

• Your family doctor or general practitioner.
• A nurse or registered midwife who is specially trained in caring for pregnant women.
• A lactation consultant.
• An obstetrician, or obstetrician and gynecologist (sometimes referred to as an "ob/gyn"), a doctor who specializes in the care of pregnant women and delivers babies.
• A pediatrician, a doctor who specializes in the care of children.

If you have special dietary needs, consider consulting a dietitian to help you plan healthy meals while you breast-feed.

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Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: June 28, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Joy Melnikow, MD, MPH - Family Medicine Andrew Swan, MD, CCFP, FCFP - Family Medicine
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