Don't hold back: express yourself

Breast-feeding can be agonising when supply outweighs demand. Emma Haughton seeks some relief

Anyone who has admired Paula Yates's determined and distinctly ample bosom in recent pictures may well have put it down to her much-feted boob job. Some of us have an entirely different term for it: engorgement.

Forced to abandon her sick two-month-old daughter in Australia while she flew over to contest the temporary custody of her three daughters by her former husband Bob Geldof, Paula risks more than just emotional discomfort. As any breast-feeding mother knows, we need our babies as much as they need us. Breast-feeding follows the basic laws of supply and demand, but it was never designed to cope with all the vicissitudes of modern life; if demand suddenly ceases, supply takes a while to catch on.

I spent one of the most uncomfortable evenings of my life at an office dinner-and-dance three months after the birth of my first child. Initially, all went well - it felt wonderful to swap constant feeds and dirty nappies for black lace and taffeta - but as the evening progressed, so did my bust. It swelled visibly, gradually reaching Pamela Anderson proportions and threatening to burst out entirely over the top of my ballgown. Eventually, a tactful colleague offered me a lift home. I spent an hour in his car with breasts as hard as cannonballs and aching so much I was in tears. My breasts wept with me, leaving milky stains all over the bodice of my new dress and embarrassing my colleague so deeply he could barely speak.

Don't get me wrong, I'm a great fan of breast-feeding; indeed, I'm still at it 18 months into my third. But it does have its drawbacks, and perhaps the greatest of those is the difficulties that ensue when mother and baby spend time apart.

"If a woman suddenly stops feeding, there is always a danger of engorgement and mastitis," warns Rosie Dodds, a breast-feeding counsellor with the National Childbirth Trust. Both conditions are as unpleasant as they sound. The hot, hard and tender breasts of engorgement, where milk literally begins to back up into the surrounding tissue, can easily lead into the painful lumps and flu-like symptoms associated with mastitis.

The only way to avoid these problems, says Dodds, is to express just enough of the excess milk to relieve the breasts without encouraging production of any more. Easier said than done, I've found. Breast pumps don't fit neatly into a handbag, and it took me several years of hopeless fumbling to acquire the knack of expressing by hand. And somehow I always felt I'd rather endure the discomfort than have to go off and milk myself in a public toilet.

If you do nothing and endure a few days of agony, the milk supply will eventually dwindle away to nothing. That's fine if you intend to give up, but mothers like Paula, who want to resume breast-feeding after a temporary leave of absence, will have to work a little harder, expressing a good amount at least four or five times a day to keep their supply going until the baby can take over.

Caroline, who became seriously ill while breast-feeding her five-month- old baby Zsofia, had to express milk constantly during her eight-day stay in hospital.

"I was told I couldn't breast-feed because of all the drugs in my system, but I was desperate not to give up. My breasts became painful, really tender and throbbing under the armpits, so I asked for an electric breast pump. I was throwing away two pints of milk a day, but at least at the end of it all I could carry on feeding my daughter."

Unfortunately, babies can get other ideas. A few days' feeding from a bottle can be enough to convince them that it's altogether a softer option. Chloe, who was three months old when her mother Catherine was rushed into hospital for problems with her ovary, took all too happily to the bottle.

"She had never had one before, so I was just very relieved that she could be properly fed while I was so ill," says Catherine. "But five days later when I put her back on the breast, she didn't really want it. She'd got used to the bottle, and insisted on having one during the day. It didn't break the bond between us, but it did affect it."

Other mothers encounter the opposite problem. Some exclusively breast- fed babies will simply go on hunger strike when faced with a rubber teat rather than a warm and malleable nipple. Not a happy situation for all concerned, but one that Dodds advises can be circumvented by giving babies the occasional bottle from an early age or substituting the bottle for a cup.

Fortunately, most women who breast-feed do not encounter such overwhelming difficulties. Breast is usually much more convenient than the bottle, as long as you undertake a bit of forward planning to gain a few free hours for a meal out or a quick dash to the hairdresser. With a decent hand pump, a spare corner in the freezer, and a little perseverance, you needn't always be left holding the baby.