8 Frustrating Breastfeeding Challenges—and SolutionsBeth M. Iovinelli, RN, BSN, IBCLC
Getting Baby to latch (the word used for attaching her mouth to your nipple) properly is the key to a good breastfeeding experience. In fact, many challenges can be avoided if you get the hang of this first. Why? A poor latch at the breast will cause discomfort and can make your nipples sore or even crack or bleed. And a poorly latched baby will not be able to remove milk efficiently—it’s a bummer for you AND Baby!
A poor latch is usually one that is too shallow. When your baby does not have enough of the breast in her mouth, she will be sucking on just the nipple, rather than keeping her mouth wide and far back onto the areola. This is what causes soreness.
Good latch pointers:
- Get as much help as you can when you are in the hospital from your nurse and/ or lactation consultant. Have them show you how to position yourself and the baby. Ask them to check on you several times to make sure you are latching well.
- Before each feeding, make sure you are comfortable: Empty your bladder, get some water for sipping, and take your time getting into position.
- To improve the latch, make sure Baby is awake and ready to nurse before feeding. Start by un-swaddling her and changing her diaper. Now she is ready to feed.
- Your baby’s mouth needs to be open wide for a proper latch. You can tickle her upper lip with your nipple to get her mouth to open. Once her mouth is open, bring her into your breast.
- A good latch should feel comfortable—like a strong tug or pull. If the latch feels like she is pinching or biting you, remove her from the breast by breaking the suction with your finger and re-latch.
- Check to see that your baby’s lips are flanged out and that her mouth is back on the areola—not just grasping the nipple.
- You want to make sure your baby is really drinking at the breast and not just nuzzling. Nuzzling is fine—just make sure that she is drinking first (listen for swallows) to insure that she is getting enough to eat. If she is just nuzzling or suckling when you think she is eating, she will probably come off the breast and not be satisfied.
Sore nipples are the result of a poor latch. Most women may have some baseline nipple tenderness after delivering their babies due to hormonal changes. Add on top of that eight to 10 nursing sessions a day, and that tenderness may turn seriously sore!
If your nipples are reddened, cracked, bruised, or even bleeding—get help! This is not a normal part of breastfeeding. The best cure for sore nipples is correcting the latch! But if you have reached the point of more than normal discomfort, try the following.
Sore nipple remedies:
- Work with a lactation consultant to fix the latch.
- After nursing, rub some colostrum or breast milk onto your nipples and allow to air dry.
- Change your breast pads between feeds so your nipples are not constantly wet.
- Make sure your bra is comfortable and not too tight, which can further irritate your nipples.
- Apply a lanolin-type nipple ointment sparingly to nipples after nursing.
- Start nursing on least sore side first.
- Try a hydro gel pad specifically made for sore nipples, which is worn over the nipple and areola and held in place by your bra. (Follow directions on package for use.)
- Vary your positions for feeding: cradle, football, side lying.
If these methods don’t help, your lactation consultant may recommend the following sore nipple treatments:
- Rest your nipples and pump for a day or so to allow healing if the cracking or soreness is severe
- Use a nipple shield—a thin, silicone artificial nipple that fits over your nipple. It may take the edge off the discomfort of latching and feeding with sore nipples. (This should be used with the guidance of a lactation consultant to insure that Baby is getting enough milk and not causing further damage to your nipples.)
Many women will get so discouraged while trying to overcome this challenge that they may feel like throwing in the towel and quitting. With the proper guidance and lots of patience and practice, you can heal and enjoy breastfeeding your baby. Hang in there—it’s worth it!
Engorgement is what happens to your breasts as your milk supply begins to increase. This is often referred to as your milk “coming in.” Approximately 48 to 72 hours after the baby is born, you will begin to feel your breasts becoming fuller. In addition to the milk that is there, there is additional fluid in your breast tissue and extra blood flow to the breasts left over from pregnancy. All this together can add up to a lot of fullness, and sometimes discomfort. (The answer to the commonly asked “Is there anything in there?” question is yes!)
Some moms may experience minimal engorgement, while others might experience moderate and sometimes even severe engorgement. I like to explain to moms that this is simply a management issue! There are a few very helpful tips to keep in mind to help ease the discomfort you might be experiencing with the arrival of your milk.
Engorgement symptoms include:
- A feeling of warmth or feeling flushed
- Increased thirst
- Noticeable fullness and heaviness of her breasts
- Weepy or tearful feelings—thanks to all the hormonal changes she is experiencing
- That she can hear Baby swallowing while nursing
- An increase in Baby’s wet and soiled diapers
As your breasts are filling, consider these engorgement treatments:
- Feed the baby frequently.
- Use a warm compress on your breasts before feeding to help soften them.
- When done nursing, use ice packs on your breasts to help reduce swelling.
- Use green cabbage leaves to reduce swelling. (Keep a head of green cabbage cold in the fridge. When you’re done nursing, take a leaf, rinse with cold water and place on breasts anywhere there is swelling. This can be done in conjunction with the ice. Leave in place for about 15-20 minutes. If your nipples are sore, avoid placing the cabbage leaves on the nipples. Note: Do not use if you are allergic to sulfa medications.)
- Pay attention to how Baby is latching—oftentimes it can be a bit of a challenge to achieve a deep latch with engorgement.
If you are having trouble managing your engorgement and cannot get Baby latched, seek assistance right away from a lactation consultant or your pediatrician’s office. You’ll feel more comfortable and confident in the long run.
Mastitis is an infection of the breast tissue. This infection can cause a good deal of discomfort to a nursing mom. The infection can be caused by a crack in your nipple, which allows bacteria to enter your breast and results in an infection. Inadequate emptying of the breast, which can lead to milk stasis, can also cause mastitis. When the breasts are not properly emptied, this fullness can place pressure on the surrounding tissue and cause pain and swelling.
One of the biggest myths surrounding mastitis is that you cannot nurse with the affected breast. This is not true! The milk is not infected and cannot hurt your baby. It is very important to keep the breast working and empty it as efficiently as possible. Efficient emptying can be accomplished by massaging the affected area while nursing or pumping.
Risk indicators for mastitis include:
- Cracked nipples
- Poorly fitted, too-tight bras
- Inadequate emptying of the breast
- History of prior bout of mastitis
- Plugged milk ducts
Symptoms of mastitis include:
- Fatigue and body aches
- Tender and often quite painful areas of the breast
- Redness, warmth, or especially hot spots over the affected area
- Pain during feedings
Your doctor and lactation consultant may recommend these mastitis remedies:
- Taking oral antibiotics for 10 to 14 days. You should notice a dramatic improvement in how you are feeling within 24 to 48 hours. Make sure you take all the medication prescribed to clear the infection.
- Resting and increasing fluids by mouth.
- Using pain medication (ibuprofen or acetaminophen as prescribed) to ease discomfort and lower fever.
- Applying warm compresses to the affected area prior to nursing or pumping.
- Massaging uncomfortable spots while nursing or pumping.
- Icing the affected area after nursing or pumping to help reduce swelling
- Varying feeding positions, which may help to drain the breast more efficiently.
- Making follow-up visits to assess your healing.
If you are following the recommendations are not noticing improvement, it is important to stay in touch with your doctor! If mastitis is not treated in a timely manner, you may develop an abscess of the breast, which would lead to hospitalization for IV antibiotics and drainage of the infection by a breast surgeon.
Plugged Milk Ducts
Your milk ducts deliver breast milk from milk-making cells in the breast through the breast tissue and nipple pores to your baby. When they become plugged, the results are hard, tender areas on the breast. The plug can occur deep in the breast or may be close to or right under the areola. If a mom has a milk blister, this will be on the nipple and will look like trapped milk, resembling like a pimple. Clogged nipples pores may prevent efficient emptying of the breast, which can lead to plugged ducts. If plugged milk ducts are not properly tended to, they can become quite uncomfortable and sometimes lead to mastitis.
Infrequent feedings and tight-fitting bras may cause plugged milk ducts. Treatment and care of the plug is very much the same as mastitis. The difference here is that there is no infection present. The goal is to resolve the plug quickly to avoid an infection.
Symptoms of plugged milk ducts:
- Firm, tender areas on the breast
- Slight warmth
- Milk blister (if the cause is due to a plugged nipple pore)
Use these tips to treat plugged milk ducts:
- Use warm compresses.
- Massage gently before and during feeds.
- Use ice packs on your breasts after nursing or pumping to the affected area.
- Feed frequently to promote emptying!
- Talk with a lactation consultant for tips on prevention and healing.
- Call your doctor if you start running a fever or feeling achy-you may be developing mastitis.
- Vary feeding positions to promote emptying.
As you are helping the plug to resolve, sometimes you may notice (while pumping or massaging) a clump or stringy consistency to the milk. The fat cells in the trapped milk can stick together.
Low Milk Supply
Many new moms worry from the start that they will not or do not have enough milk to feed their babies. Most times, the fears are unwarranted and once Mom learns how to assess her supply, she becomes much more confident of her ability to provide what her baby needs. A lot of moms will ask, “How do I know how much she is drinking?” Breastfeeding moms do not necessarily need to know to the ounce how much their babies are drinking, but there are many ways to determine how efficient your supply is.
- Are you feeding Baby at least eight times per 24-hour period?
- Is Baby latching effectively to maximize milk intake?
- Can you hear your baby swallowing as she is drinking?
- Are you keeping track of the wet and soiled diapers throughout the day? (By the time a baby is a week old, he should be wetting six to eight diapers and soiling at least four times in a 24-hour period.)
- Look at your baby: Does she look content and satisfied after a period of active eating?
- Does she generally sleep contentedly for two to three hours? (She may have a few fussy periods or cluster feeds in the evening or wee hours of the morning where she wants to feed more frequently—this is normal!)
- Do you notice a softening of your breasts after feeding? (Before feeds they will feel more full and firm.)
If you can answer yes to these questions, your baby should be getting what she needs. According to the World Health Organization (WHO) report on growth rates for breastfed babies, infants will gain on average between 4 and 7 ounces per week in the first four months or so of life. You should be visiting your pediatrician for weight checks periodically to assess her growth and chart her progress. Generally if all is going well, the scale will tell the tale!
If your baby is not gaining well and is more fussy than usual, not gaining as she should, or suddenly wanting to nurse much more frequently, your milk supply may need to be assessed. Sometimes when a baby is going through a growth spurt (about every three weeks), they will nurse more frequently. Be patient: If it is a growth spurt, after a few days of more frequently nursing she will settle back into her routine.
Possible causes of low milk supply:
- Supplementation of formula
- Over-use of pacifier
- Maternal illness or return to work (fatigue and illness can put a temporary dent in your supply)
- History of hormonal issues (i.e.: infertility)
- Poor latch
- Premature baby
- Sleepy baby (insufficient stimulation can lead to low supply)
- Breast reduction or augmentation (more common with reductions)
- Limiting time at breast
Talk to your pediatrician about your concerns and work with a lactation consultant to get to the root of the problem. Depending on the cause, there are different techniques unique to each situation that may help.
Without knowing the exact cause of a specific low-supply situation, the following are good low milk supply treatment strategies to implement:
- Rest, eat well, and increase fluids by mouth.
- Spend time working with a professional to determine the cause.
- Avoid bottles and supplementation (unless medically necessary).
- Make sure your baby is wetting and soiling the right amount of diapers for her age.
- Breastfeed frequently—the more milk that is removed, the more your body will make.
- Make sure Baby is latched properly.
- If Baby falls asleep after nursing from the first breast, change her diaper, wake her up, and encourage her to nurse on the second breast.
- If recommended by a lactation consultant, try pumping a few times a day to increase stimulation.
- If recommended by a lactation consultant and your doctor, the use of herbal supplements called galactogogues—milk supply boosters!—may help.
- In some cases your doctor may write a prescription for medications that may boost supply.
Although concern about not having enough milk is the number-one reason that mothers wean their babies early, having too much milk (commonly referred to as oversupply) can also be a problem.
Symptoms of oversupply for moms are:
- Strong or even painful sensation when milk ejects
- Constant breast fullness or engorgement
- Frequent spraying of milk from one or both breasts
- Excessive leaking
- More than one let-down per nursing session
- Repeated mastitis and plugged ducts
- Sore nipples
Oversupply is equally difficult for Baby. Infants whose moms have too much milk will often exhibit symptoms such as fussing, pulling off the breast, colicky crying, gassiness, spitting up, and hiccupping.
Effects of oversupply on Baby:
- These infants may want to nurse frequently and they may gain weight more rapidly than the average baby (who usually gains 4 to 8 ounces each week during the first three or four months), or they may gain weight more slowly than the average baby.
- Their stools may be explosive, green and watery, and their bottoms may be red and sore.
- The mother’s letdown reflex may be so forceful that the baby chokes, gags and sputters as he struggles when her milk lets down.
- Baby may be misdiagnosed by health care providers with colic, lactose intolerance, or GER (gastro esophageal reflux). The diagnosis may result in unnecessary interruption of breastfeeding and unnecessary prescribing of medications.
Causes of oversupply: When a woman has a more than abundant supply of milk and Baby is consuming large quantities of it, an imbalance can occur in which the lactose he is taking in from the breast is not able to be broken down by his own body’s lactase (the enzyme that breaks down and helps in the digestion of sugar). The sugar that accumulates in his gut can cause upset and bloating—leading to the fussy behavior and explosive stools.
Dr. Christina Smillie, MD, of Breastfeeding Resources, one of the leaders in hyperlactation research, explains this phenomenon as follows: “Hyperlactation itself is not something inherent in the mother anatomy or physiology or caused by the infants feeding style, but is rather a vicious cycle of behaviors initiated and reinforced by cultural expectations (i.e.; rigid schedules and the idea of having to feed from both breasts) and rules for feeding, which overrule basic instincts toward homeostasis.
Learning to trust her body, to listen to her infant and to let comfort needs guide behavior, can help restore comfort to the feeding situation, and in this way, help them stop the vicious cycle of symptoms of abundant milk supply.”
Use these tips to reduce your overall milk supply:
- Try one-sided feedings. Let Baby finish up on one breast without offering the other. Remember—you have plenty of milk. Some moms may even nurse two feedings in a row on one breast. By leaving milk in the “unused” breast, your body gets the signal to slow down production.
- “Pump to comfort” the other breast. You’ll feel a lot of fullness on the “unused” side. The tendency is to want to pump to empty the breast. Only pump to relieve pressure. If you are uncomfortable—feeling engorged—you can pump for a few minutes. By removing some milk, it will relieve the pressure but not empty the breast fully.
- Be on the lookout though for plugged ducts or even mastitis.
- Use ice packs to help reduce swelling.
Thrush is another name for a yeast infection. When breastfeeding, if either you or your Baby develops a yeast infection, you will both be affected and should both be treated. It is sometimes difficult to determine who has started the infection.
What causes thrush? A baby may have been exposed to yeast in the course of being delivered. A mom who has been prone to vaginal yeast infections may be more prone to thrush. If you received any antibiotics during labor (if the yeast infection occurs early in the postpartum period) or if you are taking antibiotics for another reason, this may be a factor. Antibiotics work to kill of harmful bacteria and in the process can kill off “good bacteria” that helps to keep yeast in check in your body. Yeast thrives on moisture and sugar—both of which are in abundance when you are breastfeeding!
Mom’s symptoms of thrush include:
- Itching, burning or “pins and needles” feeling of the nipples and sometimes into the breast
- Reddening, shiny or appearance of your nipples
- Painful latch
- Pain during and after feeds
Baby’s thrush symptoms include:
- Fussiness with feeds (if her mouth is sore, drinking may be uncomfortable)
- Bright red, raised patchy diaper rash that is difficult to clear up
- White spots in her mouth (not all babies will have this symptom)
General thrush guidelines for mom:
- Start with a visit to a lactation consultant and/ or be diagnosed by your doctor.
- Begin treatment of both you and Baby right away.
- Insist that all family members who are caring for the baby practice scrupulous hand washing techniques.
- Wash all bottles, nipples, or pacifiers that the baby is using in hot water after each use.
- Sterilize breast pump parts if you are using one.
- Change breast pads frequently to cut down on moisture.
- Wash bras and clothing in hot water.
- Try taking in lactobacillus acidophilus (either in yogurt or as a dietary supplement) to boost/support your intestinal flora.
- Talk to your pediatrician about acidophilus supplements for your baby.
- Allow your nipples to air dry when possible after showers and feedings.
- Reduce your dietary sugar intake. (Remember: yeast loves sugar!)
- Rest! Anything you can do to help boost your body’s overall health will help!
Thrush treatments include:
- Nystatin cream (an anti-fungal agent) to be applied to your nipples after feeding and areola for about 10 days.
- Nystatin drops to be swabbed inside your baby’s cheeks and mouth after feeding for about 10 days.
- Anti-fungal diaper cream to help clear up diaper rash.
- If the cream is not working, your doctor may recommend trying a course of oral medication called Diflucan for 14 days (sometimes longer).
- Gentian violet—a dye that when comes into contact with yeast, kills it —may be recommended. This is a messy proposition but can work effectively if nothing else is working. It involves using a cotton swab to paint the inside of the baby’s cheeks and mouth. Check with your health care provider for tips on safe and effective use.
- A vinegar rinse—one tablespoon of white vinegar in one cup of water. Rinse nipples and allow to air dry. You can also use this on the baby’s diaper rash.
Take all medication and complete all recommended course of treatment—just because you are feeling the symptoms improve; yeast can be stubborn and can flare up again—be diligent!
Once you begin to treat the yeast, you should notice symptoms improving over a few days. If you are not noticing an improvement, make sure to follow up with your health care provider.