Comfort and relaxation should go together when breastfeeding, and being relaxed helps the milk flow so getting comfortable really matters. Different positions may work for you at different times of day and stages in your baby's life, but to stay comfortable all through a feed you will usually need pillows or cushions for support. Your baby's mouth needs to be level with your nipple without you holding him up or bending down. Possible early problems Along with your milk you may (or may not) acquire various minor, short-lived but uncomfortable - sometimes really painful - problems. Describing them does not mean you have to have them and having them does not mean that there is anything the matter with you or your mothering. The size of your breasts, for example, has no relevance to their ability to produce an abundant supply of milk. Milk is produced in deeply buried glands, not in the surrounding fatty tissue. Engorgement After the birth and delivery of the placenta, production of the placental hormones, progesterone and oestrogen, is reduced in favour of prolactin, the hormone that controls your production of milk, and oxytocin, the hormone that controls the "let-down" reflex that delivers that milk to your baby. Often the milk "comes in" overnight so that your breasts suddenly become large and tightly swollen both with milk and an increased supply of blood. Sometimes the chemical messages the breasts receive are over-emphatic and they become engorged: rigidly hard, hot and painful, with even the areolae around the nipples distended. Breasts in this state are always uncomfortable and may be extremely painful. Fortunately the hormonal imbalance will settle down within a day or two. Your breasts will never again be so large, tight or uncomfortable, even when you are producing three times as much milk for a larger and hungrier baby. If your baby can latch on and nurse, he will relieve you of enough excess milk to reduce the painful tension in your breasts. If the areolae as well as the breasts are swollen and hard, he may not be able to latch on, though, and any efforts he makes will be frustrating for him and painful for you. You will first have to soften the breasts a little, by bathing them repeatedly with warm water, and then very gently expressing some milk by hand. Go carefully: swollen tissues are easily bruised. In between feeds, cold compresses applied to your breasts will constrict the blood vessels and help the swelling to subside. A packet of frozen peas makes the easiest usually available compress. If you divide the contents of one packet between two larger plastic bags, so that the peas are loosely packed, you can actually fit them to the shape of your breasts so that the whole surface is covered. If you can neither stand to be without the support of your maternity bra nor fit your pea-compresses inside it, try round cabbage leaves, selected for size and shape, pre-cooled in the fridge and changed as they warm. The let-down reflex and after-pains Babies are helped to get the milk from their mothers' breasts by the draught or let-down reflex. When the hormone oxytocin is released into the blood, the muscle fibres around the milk glands contract, forcing their milk down into the milk ducts and sometimes all the way out.
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