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Breast care and breast health in pregnancy

Breasts tenderness and changes can be one of the earliest signs of pregnancy. Your breasts undergo significant changes during pregnancy as your body prepares for making milk (lactation) and feeding a baby. It is important to be ‘breast aware’ during pregnancy and if you notice any unusual changes in your breasts to discuss with your midwife or GP.

Your breasts and nipples

Breasts are made up of milk-producing (glandular) tissue and ducts, which allows milk to move through towards the nipple. These are surrounded by other tissue such as fat which give the breasts their size and shape. The darker area of skin around the nipple is called the areola. On the areola there are small raised bumps called Montgomery glands, which produce fluid to moisturise the nipple and is similar to the fluid that surrounds the baby in the womb. A new born baby is attracted to this familiar smell as it’s a comforting smell of the womb. A baby placed on the mother’s chest or abdomen after birth will actively seek to move towards the breast guided by his/her sense of smell. 

Breasts changes during pregnancy

Breast changes during pregnancy are driven by hormones that prepare the breast for making milk and feeding a baby.

Common breast changes are:

  • Increase in size of breast, nipple and areola
  • Darkening in the colour of the nipples and areola
  • Tenderness or a change in sensation of the breasts and nipples
  • Enlarged Montgomery glands

The breasts start to produce milk from around the 16th week of pregnancy. It’s not unusual for pregnant women to notice small amounts of milk leakage (colostrum) from the nipples. Wearing a breast pad inside the bra can help absorb this leakage.  

In the last few weeks of pregnancy, breasts and nipples become larger as the glandular tissue increases in anticipation of lactation and birth of your baby. Your breasts may feel heavy and uncomfortable at times. Wearing a well-fitted and supportive bra may help relieve any discomfort. Wearing a supportive soft-cup type maternity bra overnight may help you sleep more comfortably.  

If your breasts are particularly painful, talk to your midwife for advice on soothing strategies. An example would be using cooling gel pads that you can keep ready in the fridge or taking pain medication if necessary.

Finding a comfortable and well-fitted bra during pregnancy

Make sure your bra isn't too tight or restrictive as your breast size increases during pregnancy. You can visit shops that have specially trained staff to measure and check your bra size. Special nursing bras can help you with breastfeeding, you can be fitted for this type in your final trimester of pregnancy.

How to know if your bra is well-fitted: 

  • Your breast should fill the cup of the bra, does not leave loose fabric, and holds the breast without any bulge at the top, bottom or sides. 
  • Feels comfortable without the strap at the back digging in. 
  • You shouldn't need to adjust the shoulder straps as the bra shifts with your movement.
  • The strap around the back and front lies close and comfortable to your body - this should be the same level at the front and back. 
  • An underwire bra should lie flat against your body and supports the your breast without digging in or gaping
  • Your bra should fit on the loosest set of hooks which allows you to tighten it as the bra stretches in time. 

Breast lumps and bleeding from nipple

Breast lumps can sometimes develop during pregnancy. The most common lumps are:

  • Cysts (fluid-filled sacs)
  • Galactoceles (milk-filled cysts)
  • Fibroadenomas (which develop in the lobules of the breast)

These are benign (not cancer) breast conditions. If you had a fibroadenoma before you were pregnant, you may find this gets bigger during pregnancy. 

Although breast cancer in women of child-bearing age and during pregnancy is uncommon, you should always contact your GP if you notice a new breast lump or experience changes to an existing breast lump. 

Is it normal to experience leakage of blood from your nipple during pregnancy?

Your breasts require an increase in blood supply as they change and increase in size during pregnancy. Some women may experience occasional leakage of blood from the nipple. Although this can be normal during pregnancy, it’s best to discuss any leakage of blood with your GP.

The significant increase in blood supply in the breast can sometimes lead to a brown staining of early colostrum - this is perfectly normal and can be safely fed to your baby.

Breast and hormonal conditions

Research shows that lactation/ breastfeeding reduces the risk of developing breast cancer. In particular, there is a reduced risk of developing triple negative breast cancers and for those women that carry high risk mutations e.g. BRCA1 gene

Women who experienced problems with breast development during puberty or had breast surgery due to breast cancer, breast reduction, surgery to the nipple or breast implants can face particular challenges and may benefit from specialist lactation care. Women with certain hormonal medical conditions such as thyroid imbalance, polycystic ovaries or high Body Mass Index (BMI) may find it impacts on lactation. 

Talk to your midwife if you are concerned about any breast conditions or hormonal issues that may affect your lactation or breastfeeding. Your midwife will discuss the available support from your local lactation specialist service so a clear plan can be made for you after your baby arrives. Informed preparation is the key to confident early mothering. 

Your baby's first gift - expressing colostrum before the birth

Many pregnant women start collecting colostrum before their baby arrives. Some babies may experience difficulties with feeding or maintaining their blood sugar levels during the first few days after birth and may require additional feeds. Mothers who have diabetes or who have other identified feeding challenges can particularly benefit from collecting colostrum. Colostrum contains important immune boosting  properties and is the perfect food for a new baby. 

Further information about expressing your milk before your baby arrives can be found on the Association of Breastfeeding Mothers website

Ask a midwife for guidance on antenatal hand expressing (from about 36 weeks) and consider joining and asking other mothers about it on our closed “Breastfeeding Friends” Facebook groups. 

What to expect with your breasts after the birth of your baby

Following the complete delivery of the placenta (after birth) the hormone progesterone decreases quickly and the hormone prolactin rises.

Prolactin triggers the process of lactation (making milk) within the glandular tissue of the breast. Colostrum is produced which coats the baby’s gut to help make it strong and provides important protection from infection. Prolactin is a powerful bonding and mothering hormone that helps a pregnant woman transition instinctively to being a new mother. Oxytocin is another important hormone that helps both mother and baby with early bonding, and the moving of milk through the breast. Oxytocin is highest when mother and baby are in skin to skin contact.

Milk production will usually increase by around 72 hours after the birth. You may experience a feeling of considerable fullness in the breasts and experience leakage of milk. This period of fullness should not last long. Feeding your baby frequently as well as hand expressing some milk at times will help keep your breasts comfortable. 

Find out more information about lactation and hand expressing milk, including useful videos to learn more.

During the first few days after giving birth, you will experience significant hormonal changes alongside changes to your breasts and body. The early recovery period after the birth can be exhausting, exhilarating and provokes changes in emotions and moods. This is temporary and you should soon regain your balance. You should always talk to a midwife if you feel your mood and emotions are not settling.   

If your decision is to not breastfeed then particular care may need to be taken to suppress your lactation safely so that you do not develop breast inflammation or infection. 

Your maternity care team should routinely discuss and provide you with information on how to care for your breasts in the early days after birth. You can also find this information in your 'hand held' maternity records. 

Preparing for the early days

A baby’s early feeding can be influenced by many factors such as the baby’s lie during pregnancy, labour, and the mode of birth. 

Breastfeeding is both an instinctive and a learned skill for the mother and baby, which usually takes some time and patience to establish. It is important to remember that breastfeeding is more than a simple transfer of milk to a baby – it is a whole new relationship which will take time to develop. This useful video on the Association of Breastfeeding Mothers website describes this time after birth. 

Many women find that they benefit from talking to other mothers. You can access friendly mother-mother support from our trained breastfeeding ‘peer’ supporters via our private Facebook groups

We have the following additional support available if required: 

  • Usual midwife or health visitor care
  • Health professional with additional breastfeeding training seen in community location e.g. an identified breastfeeding group
  • An appointment with an Infant Feeding Specialist in one of the hospitals or in a designated specialist clinics

You can also contact the National Breastfeeding Helpline for confidential support and information from highly qualified counsellors.

Further information on breast care and breast health