Just because breastfeeding is natural doesn’t mean it’s a skill that comes naturally to Mom or Baby. There’s still a learning curve involved and every baby (and mom) is different. Two local lactation consultants take time to troubleshoot five common breastfeeding issues.
Wendy McHale, BS, IBCLC and owner of Nurturing Lactation, LLC, says sore nipples are the number one issue that she gets phone calls about. The majority of the time she says it’s a latch issue and “friction on the nipple causing damage to the tissue.” This was true for Lori Duff. Lori remembers “sitting with the breast pump, crying and watching streams of blood join the milk in the bottle.”
Solution: “Pain is always bad,” says Ashley Brown-Combs RN, IBCLC, CLC and Owner of Blue Cocoon, LLC, adding that “cracked bleeding nipples are a sign of a latch issue.”
Mom Jennifer Moore says, “Lanolin saved my life to get through the pain and frustration of that first week of learning to latch.” When it comes to getting a proper latch, “It’s really a matter of getting the baby’s body in the right position,” says McHale. Combs agrees. She says, “Once we change positions, often times, the pain is gone!”
Ideally, babies should lead into the breast with their chins. “Our jaws only hinge down,” says McHale. If the baby is looking straight it’s difficult for him to open his mouth. If the head is tilted back a little then he can open his mouth much wider and get more breast tissue into the mouth – a deeper latch. If a mom is suffering from sore, cracked or bleeding nipples she should contact a lactation consultant to reassess the baby’s latch.
Not Making Enough Milk
It is a common perception, but it’s actually very rare. “Less than 1 percent of the population can not make enough milk,” says McHale. However, it’s one of the worries she gets the most calls about.
Solution: The key is getting correct information and understanding how the body works. The breast only knows to make milk when the placenta is born and the progesterone levels plummet. This tells the brain that a baby has been born and that milk volume should increase. However, in the first couple of weeks, new moms have to teach their bodies how much milk to make. “It’s a beautiful system,” says McHale. “The more milk you take out, the more milk you make.”
Because of that awesome system, Amy Brown was able to re-lactate after her milk production slowed to a halt due to birth complications. “When I delivered, my preeclampsia spiraled out of control,” says Amy, “I was on a magnesium sulfate IV and couldn’t even hold my baby or breastfeed, so my milk completely dried up.”
Brown credits the knowledge of her pediatrician’s lactation consultant on staff. “She was amazing,” she says. “She got me on a schedule of pumping and drinking fenugreek tea and staying hydrated.” With this regimen, Brown was able to stock her freezer with a five-month supply of breast milk as well as nurse her baby.
In the hospital, moms are advised to feed their babies every three hours for 15 minutes on each side as the golden standard, “but that’s the bare minimum and each baby is different,” says McHale. “Some babies are more efficient and will be finished in five minutes, while other babies will take up to 30 minutes.” Most breastfed newborns nurse 14 to 16 times per day, so every hour and a half.
Remember their stomachs are growing. Stomachs start off only able to hold a few drops to one ounce of liquid. This means babies will need to nurse more frequently.
Babies will often sleep through their own hunger cues and this can cause your milk supply to drop and their weight to drop so it is important to wake them to eat if they sleep past that three-hour mark as a newborn.
Resist the urge to put an infant on a schedule. “Let them self regulate, except when they’re sleeping,” says McHale. “Also avoid any rubber nipples for the first four to six weeks.” Mom should meet the babies suckling needs until breastfeeding is well established. Milk is produced in direct response to suckling.
Recognizing Signs of Hunger
If baby is crying due to hunger, earlier cues were missed. Once a baby is upset about being hungry, it’s difficult to get him to latch on because he’s wrapped up in what he’s feeling. Crying is the fourth signal of hunger.
Solution: Learn to recognize baby’s three earlier signs of hunger. First, is smacking of the lips. It’s a subtle sign, but moms can clue in to it. This sign is telling you the digestive tract is ready for food. The second sign is rooting. Baby’s mouth is open, looking for a nipple. His head will even bop like a baby bird in search of a nipple. The third thing you’ll see is the baby’s fist go into his mouth and he’ll really suck and gnaw on it.
When moms supplement with formula, many times they do so without a plan to rebuild their breast milk supply. They end up weaning the baby from the breast rather than weaning the baby from the supplementation.
Solution: Jana Counts recalls her milk coming in late and the baby not gaining weight fast enough. She sought the help of a lactation consultant who was able to confirm that her son was getting some breast milk. Counts continued to nurse her son while supplementing through a syringe and line while she built her milk supply.
“When we mention the word formula we automatically put doubt, concern and stress into the breast-feeding relationship,” Combs says. “Often times this suggestion is made without backing it up with breast-feeding support, ways to increase supply, and improve the latch.” If there’s a concern with the breast-feeding relationship that requires supplementation, a lactation consultant should be part of the conversation to help moms reach their breast-feeding goals.
It happens to many moms when milk first starts to “come in” or increase in volume following colostrum. Engorgement can make it difficult to latch on and also cause breast infection. When you give birth in a hospital or have a Cesarean section you will receive IV fluids. These fluids will cause your arms, legs and breast to swell while your body is trying to push the fluids out. This is not milk engorgement, but fluid from IVs. McHale calls this “day three engorgement.” Milk engorgement is usually in days five through eight.
Solution: Pumping can help if the baby has difficulty latching on. If he’s latching well then great, have him nurse as often as he wants. In between breastfeeding, use cool compresses. Make sure to keep a T-shirt or towel between the compress and skin. A cold compress will help reduce the inflammation. Anti-inflammatories are also good. The objective is to get the inflammation down. “Feeling full is not bad,” says McHale, “but pain is always bad. It means inflammation.”
Mastitis or Breast Infection
Brown had mastitis requiring an ER visit to get antibiotics via an IV. For her, engorgement was the big problem. “Once I got on the plan to build my milk supply I couldn’t stop,” she says.
Solution: “If mom is so full she is starting to feel pain she needs to get the milk out of her breast,” says McHale. Keep the milk flowing regularly. Engorgement leads to plugged ducts and plugged ducts lead to breast infection.
“Sometimes when the milk first comes in it’s the engorgement that causes the latch issues,” says McHale. Nipple damage can also lead to infection. Whenever there’s a damaged nipple there’s an entryway for bacteria and yeast. In the shower, moms should use soap and water on their nipples, especially if there’s damage. Keeping them clean reduces the risk of infection.
Once an infection has set in, see your doctor and call your lactation consultant. Breastfeed regularly to keep the milk flowing. The infection will not hurt the baby. “Rest like you have the flu,” says McHale. Everyone needs to help out and let Mom rest.
No matter what problem a mom experiences, she should seek advice from a trusted source. Both Combs and McHale emphasize that community support is vital to breast-feeding success. Join Facebook groups, go to meetings, and join a La Leche League group. Combs and McHale both host such groups and all of these things make a big difference.
“Often times we are not sure if what we are experiencing is normal so we Google,” says Combs. This gives worst-case scenario information and prompts stress and worry. “We’ve all been there,” she says, “it is important to find and build your village of support!”