Prepared by Elizabeth Stricker, BSN, RNC-OB
Breastfeeding can be a beautiful time, full of bonding and bliss, or one of the most frustrating experiences of your life. New mothers, or even mothers who have been through it all with multiple children, can find themselves challenged by many complications, especially in the early days. Add sleep deprivation, the physical challenges of healing after having a baby, and the many hormone changes new mothers face, and the prospect of working through these difficulties can seem impossible.
Fortunately, there are many resources that can help you through this difficult time.
Here are some common challenges that mothers face and what you can do about them.
Studies show that most breastfeeding mothers experience some nipple soreness, especially when just starting. Some types of pain should go away as your nipples become accustomed to your baby’s latch. Some pain you need to pay attention to.
- Is the pain severe, mild or something in between?
- How long does it last? Does it go away after about 30 seconds, or does it continue through the feeding?[ii]
- Do you have any visible injury to your nipple?
- When your baby finishes feeding, does your nipple have any compressed or white spots? Is it round or football-shaped?
- Do you have pain during times your baby is not feeding?
- Has it been longer than a couple of weeks since you started breastfeeding?[iii]
If any of the following is true: your nipple soreness is severely painful, lasts longer than 30 seconds, is accompanied by a visible injury, or if it happens when your baby is not feeding, you should seek help. Depending on where you live, you may have different options.
An in-person visit with a lactation consultant is one of the best things you can do. There are often lactation consultants associated with your hospital or pediatrician’s office. You can also contact your OBGYN office for guidance or to connect you to resources. Another option is to contact your local La Leche League and seek help from a group leader.
If your nipple is compressed or has pinched, white spots after your baby unlatches, you should have a lactation consultant evaluate your latch.
Problems with Latch
It seems like breastfeeding should come naturally and be something babies know how to do by instinct. The opposite is the truth. While sucking is a reflex, getting a good latch is something babies need to learn.
A good latch should be:[iv]
- Deep—the baby should not just be sucking on your nipple. At least a one-inch radius of the areola should be inside the baby’s mouth while nursing.
- With lips turned out instead of in—you should be able to see the pink of the inside of their lips.
- With the baby’s tongue between your breast and their lower lip.
- Baby is swallowing- this is something you can hear if you listen.
- You can see your baby’s ears moving up and down—this is because their jaw is working.
- You don’t see cheeks sucking in or milk leaking out of your baby’s mouth corners.
- It feels comfortable.
How to get a good latch?
Knowing what a good latch looks like is one thing. Getting there with your baby is another!
Here are a few tips:
- Make sure your baby is positioned in a comfortable, secure way. This means their hips, spine, and shoulders should be in a line. They should be tucked into you. If they have a shoulder or hip spilling out or their spine is twisted, they will not be able to latch well.
- Line the baby up nipple-to-nose. This will seem counterintuitive—don’t you want the nipple to go in their mouth? The reason for this is so that they open their mouths wide to get on the breast. This is one of the most important elements of a good latch.
- Bring the baby to the breast, not the breast to the baby. This can give you a sore back, and your baby will pick up on your tension and have difficulty relaxing to nurse.
- Tickle the baby’s mouth and nose with the nipple and wait until they have a wide-open mouth, then bring the baby in and onto the nipple. Lead with their chin, not their top lip.
- A quick limerick to remember all of this is:
Tummy to mummy, nose to nips, tuck in the hips to open the lips![vii]
Milk supply is one of the biggest stress points for many new mothers. Is my baby getting enough? Can I make enough for them? The pride of being able to feed your baby from your body can be interrupted by extreme anxiety if you don’t know you have enough.
- When your baby is first born, your body makes colostrum. This first milk is high in calories but low in volume. You make two tablespoons per hour on average.
- This milk has many purposes for your baby, all of them important!
- It delivers protection against disease through antibodies and oligosaccharides, which seal the intestines against viruses and bacteria.[x]
- It is made of the perfect amounts of fats and sugars for the new baby’s needs after birth.
- The smaller volume encourages the baby to nurse more often, which helps milk come in and establishes a good milk supply—as exhausting for mom as this can be!
- There are substances in colostrum that help the baby pass meconium.[xi]
- It takes an average of 3-5 days for mature milk to “come in.” This can be a little longer or a little less depending on a few things:
- If your baby is feeding around the clock constantly in the first few days, it could happen faster.
- It could take longer if you had blood loss or a stressful delivery.
- It could take longer if your baby is separated from you or if you must rely on a pump to get your milk to come in.
- When milk first comes in, your body delivers as much as it can come up with. You may get engorgement—that is when your breasts make so much milk that they become overfull and tight. It is essential to avoid pumping during this time. You can hand express to relieve pain. Removing more milk than your baby needs will tell your body to make more and prolong the engorgement phase.
- After a few days, engorgement should improve.
- After 6-12 weeks, you may notice that your supply does not seem as plentiful. You may stop leaking milk between feedings. This is because the breasts regulate to match precisely what the baby needs, and it takes some time with milk being removed consistently for this to happen.[xii]
- The breasts operate on a supply and demand system. An empty breast makes milk quickly. A full breast slows down. Because of this, the best way to increase your supply is to empty your breasts often.
How to make more milk[xiii]
The most effective way to increase milk supply is to empty the breasts frequently. This means nursing often or using a pump between nursing sessions.
Here are some other things to consider:
- Stay hydrated. Drink water or other non-caffeinated fluid. Electrolytes can also be helpful to support hydration but watch that you are not taking in large amounts of vitamins beyond the recommended amounts with any drink powders.
- Watch your nutrition. Continue taking prenatal vitamins, and ensure you get enough calories to support breastfeeding.
- Some foods have been shown to support your body in making milk. Some of these are oatmeal, raw nuts, garlic, fennel, coriander and dill.[xiv]
- Be cautious if adding any herbal supplements to increase supply. Fenugreek, in particular, has been shown to have the opposite effect on some women. Other substances can change the composition of your milk.
- Some medications can increase milk supply. However, these can have side effects, including depression.
- Depending on your baby’s feeding schedule, adding a pumping session between 1 a.m. and 5 a.m. can be helpful to increase milk supply. This is because prolactin levels are the highest at this time of day.
Milk supply is enough for the baby if:[xv]
- They eat 8-12 times per day
- They make 6-8 wet or poopy diapers per day
- They seem satisfied after feeding
- They are not lethargic (floppy muscles and hard to wake up) or inconsolable.
- They are gaining weight. Babies will lose weight after birth, but most should return to their birth weight by 10 days of age.
- If in doubt, ask your baby’s pediatrician
Clogged Ducts and Mastitis[xvi]
If milk is not removed from the breast fully, this can cause a milk duct to become clogged. A clogged duct feels like a small, painful lump. They are sometimes the shape of a large pea.
To remove the clog and get your milk flowing again, try these things:
- Nurse and/ or pump frequently. This will get the milk flowing and help the clog to come out. If possible, choose nursing over pumping. Babies are better at removing milk from the breasts than pumps.
- Vary your feeding positions. Point the baby’s chin in the direction of the clog. This will focus their sucking power at that spot.
- Apply heat—a warm bath, shower, or warm compress can help get milk moving.
- Use vibration to break up the clog and help the milk move. There are lactation massagers available that can help with this. Some also have a heat function. Even the handle of an electric toothbrush can work in a pinch! Massaging the area with your fingers can also help.
- Avoid wearing a bra that does not fit well or with an underwire. This can help prevent clogged ducts in the first place.
Symptoms of mastitis can include:
- Body aches
- General flu-like symptoms
- Yellow fluid coming from the nipple
It is a good idea to call your doctor. Mastitis sometimes goes away on its own but often requires antibiotics. Most antibiotics are safe to take during breastfeeding.[xix] Your doctor is the expert on which ones are appropriate. Mastitis can be dangerous if the infection spreads in your body.
Get medical help right away if you see:
- Signs of infection in both breasts
- Red streaks on your skin near the affected area.
- Blood or pus in your breast milk.
While taking antibiotics, keep nursing frequently and do everything recommended to relieve clogged ducts. Getting the milk flowing in the affected area is the best thing you can do to recover.
- One of the best resources is your obstetrician or certified nurse midwife. Their office can connect you with available resources, such as lactation consultants, and provide evaluation and medical help for problems like mastitis. Lay midwives cannot prescribe medication.[xx]
- Many hospitals and pediatrician’s offices employ lactation consultants who can help with many breastfeeding difficulties.
- La Leche League is an international organization that sponsors local support groups. La Leche League group leaders are trained in breastfeeding support and local groups meet regularly.
Breastfeeding gives a multitude of benefits to you and your baby. It is cost-effective and decreases your risk of breast cancer, ovarian cancer, type 2 diabetes and high blood pressure—for those who do not already have these conditions. It protects your baby against asthma, obesity, type 1 diabetes, sudden infant death syndrome, ear infections and viruses.[xxi] While it is not always an easy road, you and your baby can enjoy these benefits and more with a bit of persistence.
[i] Common Breastfeeding Challenges, U.S. National Library of Medicine, Office on Women’s Health
[ii] Busting the top ten myths about breastfeeding, AWHONN, Healthy Mom and Baby
[iii] Sore Nipples or Breasts. Here’s help, Kelly Mom
[iv] Latching and Positioning Resources, Kelly Mom
[v] Latching and Positioning Resources, Kelly Mom
[vi] Breastfeeding Challenges, Committee Opinion 820, ACOG
[vii] Center for Breastfeeding, Certified Lactation Counselor Training Course
[viii] Breastfeeding Challenges, ACOG
[ix] Common Breastfeeding Challenges, NLM
[x] Breastfeeding benefits both baby and mom, U.S. National Library of Medicine, Centers for Disease Control https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/
[xi] How breast milk protects newborns, Kelly Mom
[xii] Busting the top ten myths about breastfeeding, AWHONN, Healthy Mom and Baby
[xiii] Common Breastfeeding Challenges, NLM
[xiv] Common Herbs and Foods Used as Galactogogues, Infant, Child and Adolescent Nutrition.
[xv] Breastfeeding Challenges, ACOG
[xvi] Common Breastfeeding Challenges, NLM
[xvii] Breastfeeding Challenges, ACOG
[xviii] Common Breastfeeding Challenges, NLM
[xx] State law chart: Certified Professional Midwife Scope of Practice, AMA, Advocacy Resource Center
[xxi] Breastfeeding benefits both baby and mom, NLM, CDC