Breastfeeding Help: Advice from the experts for new parents

For many lactating parents, breastfeeding goes swimmingly. The baby latches on, and off they go — nursing parent experiences little or no pain and baby arrives at their first doctor’s visit fat and happy. But for an equal number of parents and babies, breastfeeding challenges are a reality.

What follows is a primer on the most common challenges and potential solutions I’ve gleaned as a doula/lactation consultant of 25 years, and from some of Seattle’s most revered IBCLC-certified lactation consultants, doctors (MD and ND), local La Leche League groups, and — most importantly — at least a thousand of my own lactating clients.

Note: When in doubt, or when pain or baby’s weight loss continues, always consult your pediatrician and an IBCLC-certified lactation consultant. I recommend a home-visiting consultant who will meet your baby on their schedule and in the setting where most of your nursing will take place (rather than on-demand in a medical office). For great information and a list of supports, check the PEPS breastfeeding resources page.

 

Nipple pain

What is it? Nipple pain is common in the first week of nursing. In fact, I haven’t met a lactating parent yet who hasn’t experienced at least some initial discomfort as they begin the breast/chestfeeding journey. After all, if this is your first rodeo, you’ve never had a baby attached to your breast eight to 10 times a day. First thing: Breathe. A long out breath will help you ease the discomfort. Next, ask yourself: “Is what I’m feeling just discomfort? Or am I feeling a pinching, biting pain?” If biting pain is your answer, fixing the latch is the first step. If that and placing frozen cabbage leaves on your breasts doesn’t help, move on to…

What to do

1. Break your baby’s latch and start over. Gently insert your finger in baby’s month and press down on the tongue to break the latch. This time wait until your baby’s mouth is wide open in a big ‘O’ (almost as big as a yawn) and guide their head to the breast. The goal is a nipple at the top back of the baby’s palate — to achieve that you should see little or no areola, so the baby is literally on the breast, not just on the nipple. Visualize a baby bird: its head is tilted up. Your baby’s head should take the same tilt so that when latched, their nose is lightly touching the breast (rather than smashed into it).
2. Nurse first from the breast without nipple pain. The baby will be more sated and less aggressive on the affected breast.
3. Too torturous to nurse? Hand express or pump that side to prevent engorgement and keep up supply.
4. Need more tips? Kellymoms.com is my go-to resource for nursing.

Cracked/bleeding nipples

What is it? There are a couple possible culprits here: shallow latch or an extreme tongue tie to name two. If you see bleeding or cracking, know first that blood in your milk will not harm the baby.

What to do

1. Take a closer look at your latch and see if you can get a better, wider latch where most, if not all of the areola is in the baby’s mouth. This leads to breast compression rather than nipple compression and by extension, lip-sticked shaped, cracked and or bleeding nipples.
2. Make an appointment with a lactation consultant for an ASAP visit and in the meantime, get a silicone breast shield to use it until that visit. Hint: Order your shield overnight on Amazon in the three sizes offered. You want a shield in which your nipple is covered but not crammed tight into the shield before you even put the baby to the breast.
3. Too torturous to nurse? Hand express or pump that side to keep your supply up and prevent mastitis.
4. After nursing, soak nipples in saline solution (salted water) for five minutes.
5. Put a small dab of antibiotic cream on the affected area. Wipe the cream away before nursing.

Engorgement

What is it? As your milk comes in three to five days after baby arrives, you are likely to experience considerable swelling as it fills your ducts. Breasts may become hard and uncomfortable, and a baby who was well-latched right out the gate may suddenly struggle. The trick is releasing enough milk, but not enough to keep you overfull.

What to do:

1. Feed the baby every 1.5 hours during the day and no less than every three hours between 10 p.m. and 6 a.m.
2. Place warm compresses on your breast to soften tissue and help with releasing some milk before baby latches.
3. Hand release or use a breast pump to express a bit of your milk before attempting a latch. Do not overdo it. I repeat, don’t empty the breast. People often ask me if they should pump after the baby is done nursing “to get the rest of the milk out.” Resist this urge. Pumping too much can lead to a vicious cycle of engorgement by causing your breast to overproduce. Take out only enough milk to tolerate the discomfort.
4. Apply ice to breasts between feedings to reduce inflammation.
5. Need more ideas? Check out my favorite guide to engorgement management sheet from UK Le Leche League.

Tongue Tie

What is it? Let’s just use the American Academy of Pediatrics (AAP) definition. Tongue tie is a mouth anomaly where the tongue is tethered to the floor of the mouth by the frenulum (that thin piece of vertical tissue you sometimes see when people open wide). It can restrict the tongue’s range of motion. According to AAP, between 1% and 11% of newborns may have a tongue tie. Some babies successfully nurse even with a tongue tie. But if a tie is impacting your baby’s ability to latch without causing you pain or fill up, you may need professional help.

What to do

1. A lactation consultant is your first defense. They will assess your baby’s latch, diagnose any significant tie and offer you exercises that help stretch your baby’s tongue over the gum line to help them get a better latch and transfer milk to the back of their throat.
2. In some cases, a lactation consultant or well-educated pediatrician may refer your baby for a simple tongue-tie release (snipping the frenulum, called a frenectomy) to improve baby’s tongue mobility and improve latch and milk transfer. Note: There is quite a debate around a dramatic increase in frenectomies in the U.S. It is a good idea to seek a second opinion. Curious about one longtime Seattle IBCLC-certified lactation consultant’s take on tongue tie? Check out our article, “Fit to be Tied: A new parent guide to tongue ties.”

Low milk production

What it is? You’ve been nursing around the clock but your baby is cranky and always hungry. They are not gaining weight on schedule or at all. There’s a good chance your milk supply is low. A number of things can cause this, but rest assured none of them have to do with breast size. Even tiny breasts can be big producers, and substantial breasts can struggle to make enough. The way to make more milk is to stimulate the breast more often — and add things to your diet that evidence shows help increase supply.

What to do

1. Work with a lactation consultant or La Leche League leader to develop a feeding or pumping schedule to increase your supply. Hint: It’s not quite the opposite schedule or approach to oversupply, but close. The trick is to carefully, strategically add feedings/pumpings to increase your supply to meet baby’s ever-changing needs.
2. Consider taking herbs that show evidence of helping increase supply. According to UW Medicine, these “galactagogue’ herbs include fenugreek seeds, moringa (mulanggay), galena or Goat’s Rue, and shatavari.
3. The following foods are considered lactogenic (milk production enhancing). Add some — better yet, all — to your diet: beets, Brewer’s yeast, carrots, chickpeas, ark, leafy greens, grains, green papaya, fennel, raw macadamia nuts, walnuts and cashews, Sesame seeds, and yams.
4. There are some medications that help increase milk supply. Talk to your lactation consultant or doctor about the pros and cons of these.

Milk overproduction

What is it? Lucky you! You make lots of wonderful milk for your baby. Unlucky you, you make so much you are constantly engorged. Milk oversupply is largely the luck of the draw. Some parents’ breasts just love the job of making milk.

What to do

1. Work with a lactation consultant or Le Leche League leader in your area to develop a feeding, pumping schedule to reduce your output.
2. Celebrate that great supply (while you are working on the reduction nursing/pumping schedule) by stocking up your freezer with milk. Think of the date nights down the road. Think of the breaks you’ll be able to take when someone else can give your baby breastmilk in a bottle. Speaking of which, be sure to introduce your baby to a bottle around week three to six.
3. Consider donating your milk! Your doula or midwife are likely connected to a network of families that would love to have it. And hospitals are always in need of breastmilk to improve outcomes in neonatal ICUs when parents there are unable to produce enough. Find out more through the Northwest Mothers Milk Bank.

Baby bobbing, or popping on/off breast

What is it? If your tiny person seems to be “bobbing” at the breast, pulling off and on and getting very agitated while doing so, gasping, gulping, or spitting up a lot, you may have what we call “forceful let-down”. It is just as it sounds: your milk flows down and out quickly, before your baby can navigate the right latch and suck to handle it. Don’t worry, they’ll grow into your efficient system. In the meantime …

What to do

1. Try a position where the milk isn’t spraying like a spigot into their mouth: football hold, side-lying, laid back, or cradle hold.
2. Hand express until the flow slows down before latching
3. Burp between and after nursing.
4. Nursing more frequently may also help.

Clogged ducts

What are they? Milk overproduction, among other culprits, can lead to clogged ducts. Think of ducts as tiny bladders of milk whose spouts are opened so milk can pour down to the nipple and out the breast. But what happens if the bladder swells so much it causes the spout to swell and barely open? It leads to a back-up in the system.

What to do

1. Blocked ducts may feel like firm pebbles in the breast. They are generally painful to the touch. Try warm wet compresses for two to five minutes before latching. Warmth eases pain, and gets blood circulating to help fight inflammation.
2. Following warmth, very gentle massage may help bring the milk down and out. The operative word here is GENTLE.
3. Hammering on your breast will only cause more inflammation in the tissue. So gently, gently massage the duct using a fluttery circular stroke for a few minutes after using warmth. Pause for a few minutes. Massage. Pause. Feed.

Mastitis

What is it? It’s an infection of a breast duct(s) or connective tissue and it is not something to ignore. If you have dramatic pain in your breast, see red splotches on the breast, and have even a low-grade fever (99), there’s a good chance you have an infection. Make an appointment with your doctor and a lactation consultant immediately. The answer is to get the milk out and fight the infection.

What to do

1. Frequent feeding, or in some cases using a breast pump to remove milk from the infected area is key. But remember, the goal is to soften and empty the infected portions of the breast, not the entire breast . Rotating heat and ice can help with that work and provide comfort.
2. Infections need to be fought. Your doctor may prescribe antibiotics. I haven’t met the mother yet who wants to give her baby antibiotics through breast milk. Do it anyway, infections can turn into abscesses, which are dangerous for the breast-feeding parent. Talk to your provider about ways to mitigate problems like antibiotic-related yeast infections that might lead to oral thrush in baby.

Abscess

What is it? An abscess is a step-up-from-mastitis bad infection in the breast which causes a puss-filled access to form, damaging tissue and threatening the lactating parent’s health. They are a serious development, the care of which must be overseen by a medical provider.

What to do

1. While the abscess is being treated, work with a lactation consultant to continue nursing or pumping on the side with the infection to keep your supply up. Note that babies can be fully fed on one breast.
2. Most abscesses must be drained. Follow your provider’s instructions carefully, paying close attention to keeping the area clean.
3. Take the antibiotics.

Milk bleb

What is it? What the bleb? It’s perfectly fitting that Breastfeeding USA calls blebs teeny tiny meanies. Because blebs (also known as milk blisters) are blocked nipple pores. They often look like little white dots.

What to do

1. Just like with other blockages and infections, nurse from the non-blebbed side first.
2. Several times daily, soak the breast in warm saline or epsom salts before nursing and then gently try to remove the bleb with a moist soft washcloth.
3. If there’s “plug” in the middle of the blister, wash your hands and gently tug it out.
4. If that doesn’t work, your baby will likely, eventually nurse it off.
5. Rub some breast milk over the area or apply OTC antibiotic cream (cleaning it off before nursing).
6. Ask your health care provider to get the milk flowing by opening the blister with a sterile needle

Yeast/Thrush

What is it? Sometimes babies get thrush, a yeast (Candida) infection. Lots of things can cause this. For example, I’ve seen thrush come when a baby’s immune system is immature, a parent develops a yeast infection after taking antibiotics and passes it to the baby, or when the baby is born prematurely. Thrush can be uncomfortable for parents and babies, but it’s generally not serious. Check out Seattle Children’s Hospital’s fact sheet about thrush.

What to do

1. Before I run to anti-yeast medication prescribed by a pediatrician, I suggest using a cotton swab to wipe Gentian violet, an anti-fungal, inside the baby’s mouth. Warning: It will turn your baby’s mouth violet purple, and, in turn, paint your breast purple. But, as with all, topical treatments, check in with your pediatrician first in case they have allergy concerns.
2. If that doesn’t work, anti-yeast medication prescribed by a pediatrician is next. Diflucan is the popular choice.
3. Thrust can cause a baby’s mouth to hurt. You may want to shorten feeding sessions to 20 minutes to reduce mouth irritation.
4. Limit pacifier use for the same reason.
5. Remember that diaper rash can also be caused by yeast, so keep Lotriman AF or other anti-yeast cream on hand and if you see the telltale signs. Apply it twice a day.

Nursing strike

What is it? Things are going just great with chestfeeding. Then one day baby (or toddler) refuses to take your breast. Sure they may be ready to wean, but under six months it’s far more likely the baby is on a breast strike. And it’s usually temporary. Lots of things can cause a strike: your baby has recently been injured, you’re pregnant again and the flavor of your milk has changed, you changed your deodorant, the baby is teething and in pain, you’re stressed, your remote is out of battery and you can’t continue your binge of “The Gilmore Girls” … strikes happen.

What to do

1. Don’t stress! When you feel stressed, the baby feels your stress and that could prolong their refusal.
2. Lay topless in bed with your baby and just play to give them easy access in case their interest returns.
3. Stimulate your milk letdown before trying to put the baby to breast. This gives them immediate reward.
4. Try nursing when your baby is very drowsy, and vary positions.
5. This one sounds crazy, but it worked for me and many of my clients (not to mention it’s recommended by Le Leche League International). Nurse while you are carrying your baby around, using a sling or a cross cradle hold.

In all my years of work, and seeing many cases of all of these issues — my greatest advice is to hold on to the fact that most of these can be worked through, treated or waited out. With persistence, you can enjoy your nursing experience, as long as it continues to give you and your child joy.

Cheryl Murfin is a certified doula, lactation educator and childbirth educator and owner of Nesting Instincts Seattle / Los Angeles. She recently retired from perinatal support.