Common breastfeeding concerns and how to address them

Common breastfeeding concerns and how to address them 2018-01-11T00:17:59-05:00

How to establish good latch?

Getting your baby to “latch” on properly takes some practice and can be a source of frustration for you and your baby. One approach to learning to breastfeed is a more relaxed, baby-led latch. This laid-back, more natural breastfeeding style allows your baby to lead and follow his or her instincts to suck.

The following steps can help your newborn latch onto the breast to start sucking when he or she is ready. Letting your baby begin the process of searching for the breast may take some of the pressure off of you and keeps the baby calm and relaxed. Keep in mind that there is no one way to start breastfeeding. As long as the baby is latched on well, how you get there is up to you.

  • Create a calm environment first: Lie back on pillows or another comfortable area. Make sure you are relaxed and calm.
  • Hold your baby skin-to-skin: Hold your baby, wearing only a diaper, against your bare chest. Hold the baby upright between your breasts and just enjoy your baby for a while with no thoughts of breastfeeding.
  • Let your baby lead: If your baby is not hungry, he will stay curled up against your chest. If your baby is hungry, he will bob his head against you, try to make eye contact, and squirm around.
  • Support your baby, but don’t force the latch: Support his head and shoulders as he searches for your breast. Avoid the temptation to help him latch on.
  • Allow your breast to hand naturally: When your baby’s chin hits your breast, the firm pressure makes her open her mouth wide and reach up and over the nipple. As she presses her chin into the breast and opens her mouth, she should get a deep latch. Keep in mind that your baby can breathe at the breast. The nostrils flare to allow air in.

Flat/inverted/very large nipples

Some women have nipples that turn inward instead of pointing outward, or that are flat and do not protrude. Nipples also can sometimes flatten for a short time because of engorgement or swelling from breastfeeding. Inverted or flat nipples can sometimes make it harder to breastfeed. But remember, for breastfeeding to work, your baby must latch on to both the nipple and the breast, so even inverted nipples can work just fine. Often, flat and inverted nipples will protrude more over time as the baby sucks more.

Very large nipples can make it hard for the baby to get enough of the areola into his or her mouth to compress the milk ducts and get enough milk.

What you can do: 

  • Talk to your doctor or a lactation consultant if you are concerned about your nipples.
  • You can use your fingers to try and pull your nipples out. You also can use a special device that pulls out inverted or temporarily flattened nipples.
  • The latch for babies of mothers with very large nipples will improve with time as the baby grows. It might take several weeks to get the baby to latch well. But if you have a good milk supply, your baby will get enough milk even with a poor latch.

Sore/Cracked nipples and breast pain

Many moms say that their nipples feel tender when they first start breastfeeding. Breastfeeding should be comfortable once you and your baby have found a good latch and some positions that work.

What you can do

  • A good latch is key. If your baby sucks only on the nipple, gently break your baby’s suction to your breast by placing a clean finger in the corner of your baby’s mouth and try again. (Your nipple should not look flat or compressed when it comes out of your baby’s mouth. It should look round and long, or the same shape as it was before the feeding.)
  • If you find yourself wanting to delay feedings because of pain, get help from a lactation consultant. Delaying feedings can cause more pain and harm your milk supply.
  • Try changing positions each time you breastfeed.
  • After breastfeeding, express a few drops of milk and gently rub it on your nipples with clean hands. Human milk has natural healing properties and oils that soothe. Also, try letting your nipples air-dry after feeding or wear a soft cotton shirt.
  • Get help from your doctor or lactation consultant before using creams, hydrogel pads (a moist covering for the nipple to help ease soreness), or a nipple shield (a plastic device that covers the nipple while breastfeeding). Some women should not use these products. Your doctor will help you make the choice that is best for you and your baby.
  • Don’t wear bras or clothes that are too tight and put pressure on your nipples.
  • Change nursing pads (washable or disposable pads you can place in your bra to absorb leaks) often to avoid trapping in moisture.
  • Avoid harsh soaps or ointments that contain astringents (like a toner) on your nipples. Washing with clean water is all that is needed to keep your nipples and breasts clean.
  • If you have very sore nipples, you can ask your doctor about using non-aspirin pain relievers.

How to increase milk supply

Most mothers can make plenty of milk for their babies. But many mothers worry about having enough milk. Checking your baby’s weight and growth is the best way to make sure he gets enough milk. Let your baby’s doctor know if you are concerned.

When your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. (It’s also normal for some women to never experience “full” breasts.) At the same time, your baby may nurse for only a short time, such as five minutes at each feeding. These are not signs of a lower milk supply. The mother’s body adjusts to meet the needs of her baby, and the baby gets very good at getting milk from the breast. It’s also normal for your baby to continue to nurse for 10 or 15 minutes on each breast at each feeding or to prefer one breast over the other. Each baby is different.

Growth spurts can cause your baby to want to nurse longer and more often. These growth spurts can happen when your baby is around 2 to 3 weeks, 6 weeks, and 3 months of age. Growth spurts can also happen at any time. Don’t be worried that your milk supply is too low to satisfy your baby. Follow your baby’s lead. Nursing more often will help build up your milk supply. Once your supply increases, you will likely be back to your usual routine.

What you can do

  • Make sure your baby is latched on and positioned well.
  • Breastfeed often and let your baby decide when to end the feeding. If your baby does not empty the breast, try pumping afterward. The more often you empty your breasts, the more milk your breasts will make.
  • Offer both breasts at each feeding. Have your baby stay at the first breast as long as he or she is still sucking and swallowing. Offer the second breast when the baby slows down or stops.
  • Try to avoid giving your baby formula or cereal in addition to your breastmilk. Otherwise, your baby may lose interest in your breastmilk, and your milk supply will then decrease. If you need to supplement your baby’s feedings, try using a spoon, syringe, cup, or dropper filled with breastmilk.
  • Limit or stop your baby’s use of a pacifier while, at the same time, trying the above tips.
  • Check with your doctor for health issues, such as hormonal issues or primary breast insufficiency, if the above steps don’t help.

What if you have too much milk?

Some mothers worry about an oversupply of milk. An over-full breast can make breastfeeding stressful and uncomfortable for you and your baby.

What you can do

  • Breastfeed on one side for each feeding. Continue to offer that same breast for at least two hours until the next full feeding, gradually increasing the length of time per feeding.
  • If the other breast feels too full before you are ready to breastfeed on it, hand express for a few moments to relieve some of the pressure. You also can use a cold compress or washcloth to reduce discomfort and swelling.
  • Feed your baby before he or she becomes overly hungry to prevent aggressive sucking. Burp your baby often if he or she is gassy.

Can I breastfeed my premature baby?

Premature birth is when a baby is born before 37 weeks. Prematurity often will mean that the baby is born at a low birth weight, defined as less than 5½ pounds. When a baby is born early or is small at birth, the mother and baby will face added challenges with breastfeeding and may need to adjust, especially if the baby has to stay in the hospital for extra care. But keep in mind that breastmilk has been shown to help premature babies grow and stay healthy.

  • Some babies can breastfeed right away: This may be true if your baby was born at a low birth weight but after 37 weeks. These babies will need more skin-to-skin contact to help keep warm. These smaller babies may also need feedings more often, and they may get sleepier during those feedings.
  • Even if your baby is born prematurely and you are not able to breastfeed at first, your baby can still benefit from your milk. You can: 
    • Express colostrum by hand or pump in the hospital as soon as you are able.
    • Talk to the hospital staff about renting an electric pump. Call your insurance company or local WIC office to find out whether you can get refunded for this type of pump. Under the Affordable Care Act, most insurance plans must cover breast pumps, but your plan will tell you if you are able to rent an electric pump or a manual pump.
    • Pump milk as often as you would normally breastfeed — about eight times in a 24-hour period.
    • Give your baby skin-to-skin contact once your baby is ready to breastfeed directly. This can be very calming and a great start to your first feeding. Be sure to work with a lactation consultant on proper latch and positioning. It may take some time for you and your baby to get into a good routine.

Is it possible to breastfeed twins/multiplets?

The benefits of breastfeeding for mothers of multiples and their babies are the same as for all mothers and babies — possibly greater, since many multiples are born early. The idea of breastfeeding more than one baby may seem overwhelming at first! But many moms of multiples find breastfeeding easier than other feeding methods because there is nothing to prepare. Many mothers successfully breastfeed more than one baby even after going back to work.

It may also be beneficial to join a support group for parents of multiples through your doctor, hospital, local breastfeeding center, or La Leche League International.

Finding a lactation consultant who has experience with multiples. Ask the lactation consultant where you can rent a breast pump if the babies are born early.

Can I breastfeed my baby after breast surgery?

How much milk you can make depends on how your surgery was done, where your incisions are, and the reasons for your surgery. Women who had incisions in the fold under the breast are less likely to have problems making milk than women who had incisions around or across the areola, which can cut into milk ducts and nerves. Women who have had breast implants usually breastfeed successfully.

If you have had surgery on your breasts for any reason, talk with a lactation consultant. If you are planning to have breast surgery, talk with your surgeon about ways he or she can preserve as much of the breast tissue and milk ducts as possible

I adopted a baby. Can I breastfeed?

Many mothers who adopt want to breastfeed their babies and can do it successfully with some help. You may need to supplement your breastmilk with donated breastmilk from a milk bank or with infant formula. But some adoptive mothers can breastfeed exclusively, especially if they have been pregnant. Lactation is a hormonal response to a physical action. The stimulation of the baby nursing causes the body to see a need for and make milk. The more your baby nurses, the more milk your body will make.

If you plan to adopt and want to breastfeed, talk with both your doctor and a lactation consultant. They can help you decide the best way to try to establish a milk supply for your new baby. You might be able to prepare by pumping every three hours around the clock for two to three weeks before your baby arrives, or you can wait until the baby arrives and start to breastfeed then. You can also try a supplemental nursing system or a lactation aid to ensure your baby gets enough nutrition and that your breasts are stimulated to make milk at the same time