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mother feeding her baby in nature outdoors in the park

Engorgement and Mastitis

The breasts of women play a crucial role in life – it nourishes the infant shortly after birth and can make a difference in the growth, development and health of a baby. It is known that breastfeeding is the best means to nourish a newborn and today breastfeeding is once again becoming the preferred option among new mothers. However, there are two fairly common breast problems that can arise during lactation.

Firstly there is the situation where the breasts become overfilled with milk and painful. This is known as breast engorgement. The other problem that may be seen among breastfeeding women is an infection of a breast or even both breasts simultaneously. This is known as mastitis. Although both involve the breast during lactation, it is two very different conditions. However, engorgement may lead to mastitis.

Breast Overfilling

Breast milk production is a normal process that occurs shortly before giving birth and continues for as long as the infant is feeding. It can sometimes occur abnormally without pregnancy but milk production is usually very moderate in these cases. Some women produce more milk than others but the quantity of milk production is largely based on how frequently a baby feeds.

Milk production is fairly constant during lactation and regularly emptied by the feeding infant. Therefore the more a baby feeds, the more milk the breast produces. Milk production can occur indefinitely in this way. In breast engorgement the milk collects in the breast until it begins to exceed the maximum storage capacity of the breast. It leads to swollen and painful breasts.

Engorgement of the breasts is mainly due to a women stopping breastfeeding suddenly. Blockage of the milk ducts that carry milk out of the breast can worsen the condition but is usually not the sole cause. Contrary to popular belief, engorgement is unlikely to arise because the breasts are abnormally overactive in milk production.

Basically, if a lactating women expresses the milk regularly or allows the infant to feed more frequently, the breasts will not become overfilled. As the baby feeds less with supplementation of solid foods, the breast starts producing less milk and the chances of engorgement is unlikely. It is possible for engorgement to progress further and complicate into mastitis.

Breast Infection

Mastitis, in the true sense of the word, means inflammation of the breast. However, since the majority of cases are due to an infection, the term mastitis has become synonymous with a breast infection. Although mastitis can occur in any woman, it is more common during breastfeeding. Therefore the condition is more correctly known as lactation mastitis.

Breastfeeding is a time in a woman’s life when the breasts experience extensive trauma. However, breastfeeding is a natural process and the breasts are equipped to deal with it to a certain degree. The bacteria that cause mastitis exist naturally on the skin and within the baby’s mouth where it is not harmful. But when the bacteria enter the breast tissue, it can cause a serious infection.

Normally the breast can prevent bacteria from entering the breast tissue. However, when the nipples become chapped with breastfeeding, the bacteria may take the opportunity to infect the
breast. Mastitis can also occur when the milk ducts become blocked. This can lead to engorgement of the breasts as the milk is trapped but bacteria may also enter and infect the breast tissue.

Mother and new born.

Shoulder Pain with Breastfeeding

Breastfeeding is one of the most emotionally fulfilling experiences for any mother. It is a time of bonding between mother and baby, and is equally important for the baby’s growth, development and health. However, breastfeeding is not always without some degree of discomfort and symptoms that arise at various parts of the body. Shoulder pain is one such symptom during breastfeeding.


The most natural position to breastfeed is to hold the baby up against the breast where the infant’s mouth can reach the nipple. It does however, cause significant strain on the muscles of the arm and upper body. Although babies are light in weight, the constant carrying during feeding can strain the muscles of the shoulder and neck in particular. Shoulder pain may therefore occur. Sometimes problems with the breast such as engorgement and mastitis may also cause referred pain to the shoulder.

Despite the best efforts of the mother, shoulder pain is a common consequence of muscle strain during breastfeeding. Shoulder pain in these instances may also occur when the mother feeds the infant in the sleeping position. Although it is not recommended to breastfeed while lying down, midnight feeds can be taxing on the mother and inadvertently lead to feeding on the bed. However, lying on one side in a position that will allow the infant to feed can also strain the muscles of the shoulder and neck.


Shoulder pain is a symptom on its own. When it occurs in breastfeeding, mothers may experience difficulty in moving the arm at the shoulder joint. Raising the arm above the head or rotating it at the shoulder joint tends to exacerbate the pain as does holding the infant to the breast. Neck pain often occurs simultaneously and many mothers experience significant stiffness of both the shoulder and neck.

Usually there are no other symptoms unless the shoulder pain is related to breast problems. Symptoms such as shoulder pain during breastfeeding should not detract mothers from breastfeeding. Extensive research has shown that opting to breastfeed can make a difference in the baby’s immune defences, with allergies and proper growth and development.


Shoulder pain during breastfeeding is often seen as part of lactation and most mothers live with the pain and stiffness. As drugs may pass through the breast milk into the baby’s body, most mothers prefer to avoid painkillers and anti-inflammatory drugs that could ease the pain and stiffness. However, a few simple measures can help in managing shoulder pain during breastfeeding without opting for drugs.

Learning the proper technique to hold the baby during feeds while reducing the strain on the muscles of the upper body is important in preventing shoulder pain. Mothers should seek the advice of a medical doctor or paediatric nurse on the appropriate technique. Stretching exercises for the shoulder and neck muscles should be carried out several times a day to minimise the muscle strain.

Other simple measures that can be equally effective are a gentle massage and heat therapy. While breastfeeding mothers are advised to seek physical therapy for their shoulder pain, heat therapy can be conducted at home. A hot water bottle or heat pad applied to the shoulder and neck area can help to reduce muscle pain and is equally effective in preventing pain.