Troubleshooting Breastfeeding

Learning how to breastfeed can be challenging. Maternity nurse and postnatal advisor Katie Thomas tackles some of the common difficulties newly nursing mums experience.

When it comes to feeding your brand new baby, breastfeeding is the most natural option. The benefits of breastfeeding extend far beyond complete nutrition for your baby. They also include providing disease-fighting antibodies that will protect baby from a long list of illnesses and allergies, lowered risk of cot death, lowered risk of postpartum depression, stress, some cancers, and helping to deepen bonding with your baby in those early days. That being said breastfeeding for most mothers will come with its challenges. It is a learning curve for you and your baby, that will take patience and practice. It is beneficial to be aware of the possible issues that you may face as a breastfeeding mother, and the helpful solutions and support available. 

How do I know when my milk has come in?

After birth, your baby will be getting colostrum while they are feeding. This is a thick yellow concentrated type of milk that your breasts have been producing leading up to birth. It is high in antibodies to kickstart baby’s immune system. Transitional breastmilk generally will ‘come in’ around day two to four following birth. This milk contains high levels of fat, vitamins and lactose, and will be present for up to two weeks, often causing engorgement (large, firm, uncomfortable breasts). Regular feeding and correct latching is important during this stage. Towards the end of the second week, your mature milk will come in, which contains more water than the previous transitional milk. This mature milk will continue to be produced for as long as you breastfeed, cleverly adapting to your baby’s needs.

Why are my breasts so sore? Will they always feel this way?

It is normal for your breasts to feel large, heavy, and a little sore in the first few days of feeding your baby due to extra blood flow and milk production. If your breasts begin to feel excessively hard, tight, throbby, swollen, hot or painful, it is highly likely you are engorged. Engorgement can make breastfeeding a little difficult, especially during the early stages of trying to get the hang of it. A hard areola can make it tricky for your baby to latch, so to help soften your breast ask a midwife or lactation consultant to show you how to hand-express some milk before attempting to latch. Having a warm shower or using a warm compress can help with the swelling before a feed, and cabbage leaves in your bra temporarily or a cold compress after feeding can be helpful. Feeding frequently during the first few weeks of breastfeeding is paramount, to help ease the pain of engorgement and kickstart your milk supply. Often mothers will also experience a let-down pain, which happens shortly after you begin feeding as the milk starts flowing steadily. It is known to feel like pins and needles or a dull ache. If the sensation goes beyond the mild tingling or doesn’t subside, talk to your midwife or GP to rule out infection.

How do I know if my baby is latched correctly?

Learning how to correctly latch baby onto your breast is imperative for a positive breastfeeding experience. It is one of the most common issues mothers face, but luckily one with plenty of solutions. There are multiple reasons why baby may be difficult to latch or is latching incorrectly. Finding the feeding positions that work for you is important; these may be cradle hold, crossover hold, football hold, lying back or lying on your side. There are no rights or wrongs, it’s purely a process of working out what works and doesn’t for you and your baby. Gulping, choking and fussiness on the breast are normal as your baby gets used to feeding, and your milk supply adapts. The let-down of milk can be too quick for some babies, causing gulping or choking. Hand expressing a little before feeding can help, as well as stroking and talking to your baby to keep them calm. Lie down or lean back to help slow down the flow if necessary. It is normal to feel some sensitivity or tenderness when you’ve first latched baby on, but not outright pain. If you are feeling pain and it doesn’t ease within a minute, the latch isn’t right and you need to try again. To break baby’s suction insert your clean pinky finger into the corner of their mouth and push your breast down and away slowly to break the suction. Try again ensuring baby’s nose is in line with your nipple, tease baby until they have a big wide open mouth and bring them to you with as much areola in their mouth as possible. If you are struggling, take a few deep breaths, change position if necessary, take your tops off and allow skin to skin time or pump a little to soften your breast. 

Why do my nipples look weird?

Nipples come in all shapes and sizes, as do breasts! The size of your breasts does not mean you will have any more or less milk. The shape of your nipples can sometimes mean slightly more difficulty latching, but there are things that can help. Your midwife at the hospital or birthcare will help with feeding positions relative to your nipple and breast shape, and often you will get to see a lactation consultant which is extremely helpful to do before you head home. Inverted nipples can make latching slightly trickier but with support and advice you’ll get the hang of it; often nipple shields or a little expressing prior to feeding to encourage the letdown, will be introduced.

My baby is tongue-tied, does this mean he can’t breastfeed?

A tongue tie is when the tissue underneath baby’s tongue is too short or extends too far towards the front of tongue. This can also happen with baby’s top lip, called a lip-tie. It can cause latching issues, sore nipples and a hungry baby with low weight gain. Depending on the severity of the tie, your baby may be able to feed without any intervention. Talk to your GP, midwife or lactation consultant if you suspect this is an issue for your baby.

Ouch! My nipples are cracked and bleeding!

Cracked nipples are another common painful issue for breastfeeding mothers. It takes time for your nipples to toughen up from the strong suck of a baby and in the meantime, together with incorrect latching, they can become cracked and sore. The best treatment for cracked nipples is your breastmilk, so after a feed leaving some milk to air dry on your nipples will be extremely helpful. Airing your nipples as much as possible will benefit, rather than in a tight maternity bra. Try to find loose fitting bras and clothes. Don’t wash with anything except water, as soaps and most products result in drying your skin out. It can also be helpful to use a natural nipple cream.

I’ve got a sore, red lump on one boob. What is it?

If you find you have a red tender small lump on you breast, it is most likely a blocked milk duct. This means that the duct of milk hasn’t drained properly during feeding, causing a blockage; or you’re making milk faster than it’s being taken out. It is important to take special care to unblock the duct, to prevent the onset of a possible infection (mastitis). Feeding from the breast frequently is important. Changing from your usual feeding position can help to ensure full drainage is taking place, as well as gently massaging the spot while feeding. A heat compress before and between feeds is also useful. 

I think I’ve got a breast infection… What do I do?

There are two common infections that can occur when breastfeeding: a yeast infection called thrush, and a bacterial infection called mastitis. Oral thrush is caused by an overgrowth of a yeast strain called candida in baby’s mouth. There may be a white rash inside the mouth, as well as itchiness and soreness. It spreads quickly onto your breasts if breastfeeding, and can cause shooting pains during and after a feed as well as a rash and itchiness. Both you and baby need to be treated to ensure you don’t keep passing it back and forth. Mastitis is a bacterial infection that occurs in your breast. It can be brought on by cracked nipples, blocked ducts or engorgement. You may experience flu-like symptoms as well as engorgement and blocked duct symptoms. It is important that you see your GP as soon as possible as you will need antibiotics to treat the mastitis infection. Hot or cold compresses will help relieve the pain, as well as emptying of your breasts. It is completely safe and actually recommended to continue feeding your baby if you develop mastitis, as it will help the healing process. 

How do I know if I have enough milk?

Having a low milk supply is a common and consuming worry for new mothers. It is actually very uncommon that a mother cannot produce enough milk for her growing baby, and it is often the steps taken to try and help that end up being detrimental. The best way to boost your milk supply is frequent feeds especially in the early weeks, expressing as needed, skin to skin cuddles, fluids and rest. There are plenty of speculated ‘milk boosting’ foods and teas on the market too, and there’s no harm in trying them, especially if you enjoy them! If you notice a change in your breasts and/or milk such as not feeling as full or no leaking etc, there is no need to assume your milk supply is lacking. Your breastmilk very cleverly adjusts to your baby’s feeding needs, and the the supply and demand process takes a while to adapt. The number one indicators for an adequate milk supply are wet and dirty nappies, a content baby and healthy weight gain.

My baby keeps falling asleep at the breast!

Your sleepy newborn will be extremely comforted by the warmth of your body and the breastmilk while feeding; this means they fall asleep on the breast very frequently, especially during the early weeks! This is completely normal and ok, enjoy it while it lasts. To ensure they feed when they need to, some helpful tricks are tickling their little feet, stroking under the chin, blowing softly on their face, undressing them or stopping for a burp or a nappy change.

Breastfeeding is nature’s beautiful way of nourishing your baby completely while allowing you bonding and lots of cuddle time. The good thing about newborns is they have tiny tummies and therefore need frequent feeding, this allows plenty of practice time for you both! Try to relax and enjoy your breastfeeding journey as much as possible, knowing that the challenges and issues you may face are all completely normal. There is always help available if you are not managing. Contact Katie for support and guidance.