Is blood in breast milk normal? Causes and concerns - Evidence Based Babies
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blood in breast milk when pumping

Is blood in breast milk normal? Causes and concerns

Realizing that there is blood in your freshly pumped milk can be very alarming and stressful for many mothers, especially for first-time mothers. What causes blood in breastmilk? What causes red milk or more likely, pink breastmilk? Is something wrong? Is it still safe for babies to consume breastmilk with blood in it? Does it affect the milk production or the milk supply in any way?

Blood in breastmilk can be due to many different reasons, sometimes due to minor reasons and sometimes it can be a sign of something more serious going on. Most of the time it’s only a very small amount of blood in the breastmilk and it’s usually nothing to worry about. It’s usually easily fixable with some adjustments and support.

What Causes Blood in Breast Milk

Seeing blood in your freshly expressed breastmilk may be very concerning to you, but it’s important to remember that it’s probably something minor and it’s almost in all cases still safe for your baby to consume the breastmilk.

Rusty pipe syndrome

Rusty pipe syndrome is a “breastfeeding condition” where the color of the breastmilk looks pink, brown, rust-colored or orange, similar to dirty water coming out of an old rusty pipe, hence the name. The rusty color is usually due to the mixing of colostrum with small amounts of blood.

The rusty-colored milk usually appears during the first few days of breastfeeding and spontaneously disappears after the first week and is of no concern.

Nipple damage

Breastfeeding with improper position or a skew or shallow latch can cause pretty severe damage to your nipples. There can be many reasons for a shallow latch including improper positioning, hypertonia, oral ties and many other conditions and complications.

The first sign of damage is usually a crack in your nipple or nipples and sore nipples. It’s important to get this sorted as soon as possible, as the open wounds increase the risk of a bacterial infection.

Biting is another reason for nipple trauma, but this is usually once babies are somewhat older. No, not all babies bite, and when they do, they can easily be helped or taught to stop doing it. The incorrect use of a breast pump, such as pumping with wrongly sized flanges, pumping on the wrong settings such as too high suction for too long or pumping for too long at a time can all cause the nipples to crack and bleed.

Benign Intraductal Papilloma

Benign intraductal papilloma is a term that’s used to describe small, benign tumors that are growing in the lining of the milk ducts. You may notice small bumps and some bleeding from your nipples. Benign intraductal papilloma is harmless but may increase your risk of breast cancer.

Infections

Most new-mothers will experience engorgement in the early days and weeks, and if it’s not dealt with properly, it can lead to plugged ducts and breast infections such as mastitis which is a common inflammation/infection that can also cause some blood in the breastmilk. Common symptoms of mastitis include engorgement, a possible clogged milk duct, a cracked nipple, breast pain, redness of the breast, feeling unwell with flu-like symptoms and fever.

More serious infections that cause pink breastmilk include Serratia Marcescens.

Common symptoms of breast infection or mastitis include body aches, nipple discharge, red and tender breasts and fever.

If at any time an infection of any sort is suspected, especially if you’re experiencing other symptoms and you’re feeling unwell, you should contact an International Board Certified Lactation Consultant (IBCLC) and/or your healthcare provider.

Breast cancer

In much more rare cases, blood in the breastmilk can be a sign of something more severe, such as breast cancer. Signs of breast cancer may include bloody discharge from your nipples and lumps in your breasts.

When is blood in breastmilk or red breastmilk a concern?

Noticing a red hue in your breastmilk is alarming and of course any worried mother is going to want to find the cause and a solution if necessary.

Sometimes pink or red food dyes and color pigments in drinks and supplements can cause your breastmilk to have a red tinge. This is absolutely nothing to worry about. This is very natural and normal and can’t harm your breastmilk or your baby in any way.

If the pink or red in your breastmilk appears to be more vivid, or closely resembles blood, it may be actual blood mixed into your breastmilk. This can have many causes as discussed above, from nipple trauma to infections. Fear not as your breastmilk is still completely safe for your baby to consume, even when there’s blood mixed into it. Your baby will probably not notice it in any way. If you were breastfeeding directly, you probably wouldn’t even have known about it in the first place.

If the red tinged breastmilk continues over multiple pumping sessions, or over several days or you’re experiencing any other symptoms, remember to reach out for support.

Serratia Marcescens

Serratia Marcescens is a type of bacteria known for producing a distinctive red pigment. It’s commonly found in the environment such as water and soil. It can also infiltrate the human body, leading to infections. If this bacterium infiltrates your body and causes an infection, it can be the cause for your pink breast milk. The pink color is due to the bacteria and not due to blood, although it may sometimes look like blood-tinged breastmilk.

This bacterium is usually harmless and when consumed in smaller quantities, it probably won’t affect your baby. When you’re breastfeeding directly, the quantity will be perfectly safe.

Feeding your baby expressed breastmilk should also be fine, unless they are fed excessively big quantities of breastmilk.

Consuming large quantities of this bacteria can cause serious disease, especially in premature infants.

When expressed breastmilk is left at room temperature, the bacteria may multiply to numbers capable of producing disease. So, it’s important to store your expressed breastmilk and/or your pump equipment in the fridge to prevent the bacteria from multiplying.

If Serratia Marcescens is suspected, contact your health care provider for prompt and proper assessment, diagnoses and treatment.

Is blood in the breastmilk safe to consume?

In almost all cases, blood in breastmilk is safe for infants to consume. But it’s important to determine the cause of the blood, or the red tinged breastmilk, so it can be treated promptly before further complications may occur.

It’s important to monitor your and your baby’s condition and/or symptoms. Especially if there’s signs of infection such as having a fever and feeling unwell.

Tips to ensure healthy nipples

  • Ensure that your baby’s latch is nice and deep. A bad latch can cause pretty severe pain and damage. Any amount of nipple pain is a sign of something going in with the latch. It would be wise to get the help of a lactation consultant to assist you in the correct position and latch techniques. Remember, you and your baby are both new to this and have to learn how to do it correctly. Sometimes, there may be complications that needs attention first, such as oral ties.
  • Ensure that you’re using correct pumping techniques. Make sure you have the correctly fitted flanges and that you’re using the correct pump settings to keep your nipples comfortable. Never pump for more than 30 minutes at a time as excessive pumping can cause nipple rawness and even damage. A lactation consultant can help you with everything pump related too.
  • Monitor your nipple and breast health and reach out for support if you experience any damage, pain or other symptoms. It’s best to treat the issue as soon as possible before it causes even further complications.

When and where to seek help

If you notice blood in your breastmilk, try to determine what may be the cause, do you have any nipple trauma? Do you have any known infection or any signs of an infection? Have you eaten or did you drink something with a red pigment? Have you been feeling unwell with flu-like symptoms?

More often than not, it’s probably something you ate. But if you do suspect any other causes, do not hesitate to contact an International Board Certified Lactation Consultant (IBCLC) for support.

Important notes on blood in the breastmilk

If you have damaged nipples and you’re noticing that you have blood-stained bras or shirts, use breast pads to protect you’re clothing, but be sure to practice great hygiene as your nipples have open wounds and any unwelcome bacteria can now easily enter your breasts and cause bacterial infections.

It can be alarming to witness the presence of blood in the milk that your baby should be drinking, but it’s perfectly safe. I always remind people that if they were breastfeeding directly, they wouldn’t even have known that there is blood in the breastmilk their baby is consuming.

Do not worry yourself too much, it’s usually minor and can easily be fixed. Don’t wean your baby or supplement them while your breastmilk has blood in it, it’s still perfectly safe for your baby to consume the breastmilk.

If your nipples are bleeding for whatever cause, you may notice that there may be a little bit of blood, or even small streaks of blood in your baby’s stool. Don’t be alarmed, this is just due to the blood they consumed.

If you’re ever in need of any help regarding breastfeeding, contact an International Board Certified Lactation Consultant (IBCLC) to assess and support you and your baby as needed.

If you’re ever in need of any medical advice, especially regarding your or baby’s health, do not hesitate to contact your baby’s doctor or your family healthcare provider for further assessment and treatment as needed.

Additional information and resources:

Flange sizing

Deep latch technique

Pink Breast Milk: Serratia marcescens Colonization

Nipple Discharge: An Early Warning Sign of Breast Cancer

Blood-Stained Colostrum: A Rare Phenomenon at an Early Lactation Stage

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