Hooray! You have a new baby, congratulations! Now that your body has completed the gargantuan task of growing a brand new human, it can start getting itself back to normal – well, most of it can. Possibly not your breasts for a while.
From the very moment your baby is delivered, the hormone levels in your body will change dramatically because the placenta, which was the source of all that oestrogen and progesterone has gone. But all of a sudden, you're producing large amounts of prolactin, which triggers the production of milk.
If you have decided to breastfeed, it can be a bit nerve wracking to realise that your milk doesn't arrive straight away, in fact it might take a few days to come in.
In the meantime, however, you can rest assured that your baby will be nourished by the nectar known as colostrum, a thick, yellowish-coloured substance, which is chock full of antibodies.
The letdown reflex
You might find, in the first few days as you feed your baby, you experience an almost painful tingling in your breasts. It's known as the 'letdown' reflex and it's caused by your baby's suckling triggering the release of oxytocin – this in turn causes your milk sacs and milk ducts to contract and propel milk out through the nipple.
Letdown will continue for as long as you breastfeed, but it tends to get less uncomfortable. One thing many mothers do find, however, is that although it's more bearable, it's not entirely controllable. For some, just thinking about their baby, or hearing them cry (or even hearing someone else's baby cry!) can cause a gushing flow of milk, so keep those breast pads in!
When your milk does come in, oh boy, your boobs might be in for a shock! Often overnight, your bosoms can go from feeling fairly normal to looking like overfilled water balloons. As pleasantly surprising as your reflection might be (tummy shrinking, boobs absolutely massive), this can be painful to say the least.
Tender, swollen, rock hard, stretched all over, heavy and sometimes very, very sore – it doesn't sound enjoyable. But thankfully, it usually settles down within just a few days, and probably the best thing you can do is to feed your baby frequently – it'll help your body get into the swing of producing the correct amount of milk on demand, as it were.
Not all tiny babies will manage to fully empty a breast, so engorgement can be temporarily eased by using a breast pump, or gently massaging the breast toward the nipple to expel excess milk. Remember though, however much milk leaves your body, it will be replaced. Getting that supply and demand thing going is key.
What if I'm not breastfeeding?
You might be unable to breastfeed, or you might decide that it's not for you and your baby – but your boobs won't know that, so they'll go through the same changes.
Engorgement can last longer and be more painful for women who do not nurse, and it can take several weeks for your breasts to stop producing milk.
In the meantime, you can take ibuprofen if your boobs are causing you a lot of discomfort, or try putting ice packs on them to reduce the swelling and hopefully inhibit the production of milk.
Wear a supportive bra, in bed as well as during the day, and use breast pads to soak up leakages while your body receives the message to stop producing milk.
Sore and cracked nipples
As we're constantly hearing that breastfeeding in 'the most natural thing in the world', it would be nice if it was also the easiest things in the world. Unfortunately, for many mums, it's not! In fact it can be downright difficult, not to mention painful.
If your baby does not latch on properly (if they're sucking only the nipple, rather than getting the entire areola in their mouth) this will quickly lead to sore and cracked nipples – and it can make breastfeeding excruciating.
The first thing to do is get some advice as soon as you can, from a midwife or a breastfeeding expert (ask where you can see one in your local area). Hopefully they will be able to help you and your baby quickly – it might just be that you need to alter your baby's position, or try a few tricks to get your baby to suckle in the right way.
If your nipples are just a little sore, there are nipple creams you can buy over the counter which can offer relief – you rub the ointment on after each feed, and there's no need to wash it off before the next one.
If your nipples are bleeding though, you should see someone, because you might need some anti-bacterial ointment to help them heal properly.
Some mums use something called a nipple shield, which is a thin piece of silicon that goes over the nipple to protect it during feeding. Nipple shields do not work for everyone however – some babies just don't like them and will refuse to feed.
If the worst comes to the worst and your nipples seem not to be healing, you might need to stop breastfeeding for a couple of days to give them a chance to recover.
If at any point you get a fever, inflammation around the nipple or elsewhere in the breast, or any oozing of pus, see your doctor as soon as you can as you might have an infection, such as mastitis.
Lumps and bumps
It's not uncommon for breastfeeding women to experience lumpy boobs and often this is caused by blocked milk ducts. You might find the lump feels a bit tender, or like you have a bruise, it might even be a bit red and quite painful.
Try feeding your baby in different positions, as you may find this helps them to fully drain the breast.
If that doesn't help, then put a warm flannel on your breast for 20 minutes or so, and then very gently massage the area, pushing it towards the nipple. Often, this can be enough to clear the blockage.
Whenever you decide to stop breastfeeding, your breasts might thank you if you do it gradually. If you stop suddenly, you're likely to experience a period of engorgement again. Instead, if you can, reduce the number of feeds, and the lengths of those feeds, over a period of time. As less milk is being taken from your body, so less will be produced.
Even if you do stop breastfeeding gradually, as you get towards cutting it out completely, your boobs can feel a bit heavy and full.
If they're very uncomfortable, express just enough milk to offer relief (otherwise the prolactin will kick in and whip up another pint!). Each time you express, take a little less, and this should give your body the signal to stop replacing what's been taken.
It could take several weeks for your boobs to stop producing any milk at all, and during this time, lots of women experience lumps and bumps (see above), but soon everything will be back to normal...
ANOTHER new bra?!
...almost! After all that hard work, you might well find that your breasts have changed in size and / or shape. Not all, but many, women report their boobs getting smaller after breastfeeding. No matter – that's what push-up bras are for. Enjoy shelving those nursing bras and go and get yourself something lacy!
Other booby issues...