It’s a natural process so it should be easy, right? But just like learning how to ride a bike, you need to learn how to breastfeed (and so does baby, by the way). We consulted with Jane Morton, MD, on how to handle the 10 most common breastfeeding problems. She should know — she’s been teaching doctors, nurses, and lactation consultants how to teach the rest of us for more than 30 years. And she’s on staff at Lucile Packard Children’s Hospital at Stanford in Palo Alto, California.
Problem #1: Latching pain
It’s normal for your nipples to feel sore when you first start to breastfeed, especially if you’re a first-timer. But if baby has latched and the pain lasts longer than a minute into your feeding session, check the positioning.
Solution: Try to achieve an asymmetrical latch where baby’s mouth covers more of the areola below the nipple rather than above. To reposition him, place your index finger inside baby’s mouth to take him off your breast. Tickle his chin or wait until he yawns so his mouth is wide open and seize your opportunity. (Sandwich the breast as described in the video clip below to shape it to the baby’s mouth.) When he is correctly positioned, his chin and nose touch your breast, his lips splay out and you can’t see your nipple or part of the lower areola.
If baby’s position is correct and latching on still hurts, your nipples may be dry. Make sure to wear loose clothing and avoid washing with soap. Lanolin-based creams are good for applying between feedings.
Problem #2: Cracked nipples
Cracked nipples can be the result of many different things: thrush (see #6), dry skin, pumping improperly, or most likely, latching problems. During the first week of breastfeeding, you may have bloody discharge when your baby is just learning to latch or you are just beginning to pump. A little blood, while kind of gross, won’t harm baby.
Solution: Check baby’s positioning — the bottom part of your areola underneath your nipple should be in baby’s mouth. Also, try breastfeeding more frequently, and at shorter intervals. The less hungry baby is, the softer his sucking will be.
As tempting as it is to treat your cracked nipples with anything you can find in your medicine cabinet, soaps, alcohol, lotions, and perfumes are no good — clean water is all you need to wash with. Try letting some milk stay on your nipples to air dry after feeding (the milk actually helps heal them). You can also try taking a mild painkiller like acetaminophen or ibuprofen 30 minutes before nursing. If all this fails, try an over-the-counter lanolin cream, specially made for nursing mothers and use plastic hard breast shells inside your bra.
Problem #3: Clogged/plugged ducts
Ducts clog because your milk isn’t draining completely. You may notice a hard lump on your breast or soreness to the touch and even some redness. If you start feeling feverish and achy, that’s a sign of infection and you should see your doctor. Most importantly try not to have long stretches in between feedings — milk needs to be expressed often. A nursing bra that is too tight can also cause clogged ducts. Stress (something all new mommies have an over abundance of) can also affect your milk flow.
Solution: Do your best to get adequate rest (you should recruit your partner to pick up some slack when possible). Also, try applying warm compresses to your breasts and massage them to stimulate milk movement.
Clogged ducts are not harmful to your baby because breastmilk has natural antibiotics. That said, there’s no reason why you have to suffer. Breastfeeding should be enjoyable for mom and baby.
Problem #4: Engorgement/high milk supply
Engorgement makes it difficult for baby to latch on to the breast because it’s hard and un-conforming to his mouth.
Solution: Try hand-expressing a little before feeding to get the milk flowing and soften the breast, making it easier for baby to latch and access milk. Of course, the more you nurse, the less likely your breasts are to get engorged.
Problem #5: Mastitis
Mastitis is a bacterial infection in your breasts marked by flu-like symptoms such as fever and pain in your breasts. It’s common within the first few weeks after birth (though it can also happen during weaning) and is caused by cracked skin, clogged milk ducts, or engorgement.
Solution: The only sufficient way to treat the infection is with antibiotics, hot compresses, and most importantly, frequent emptying. Use hands-on pumping, making sure the red firm areas of the breast and the periphery are softened. It’s safe and actually recommended that you continue breastfeeding when you have mastitis.
Problem #6: Thrush
Thrush is a yeast infection in your baby’s mouth, which can also spread to your breasts. It causes incessant itchiness, soreness, and sometimes a rash.
Solution: Your doctor will need to give you antifungal medication to put on your nipple and in baby’s mouth — if you’re not both treated at the same time, you can give each other the fungi and prolong healing.
Problem #7: Low milk supply
Breastfeeding is a supply-and-demand process. If your doctor is concerned about baby’s weight gain, and he is being plotted on the World Health Organization curves designed for breastfeeding babies, this may be the problem.
Solution: Frequent nursing and hands-on pumping during the day can help increase milk supply. Surprisingly, forcing fluids and eating more calories or different foods hasn’t been shown to increase milk production.
Problem #8: Baby sleeping at breast
Baby is sleepy in the first couple of months after birth (hey, he’s been through a lot) so falling asleep while nursing is common. All that bonding makes baby relaxed!
Solution: Milk flow is fastest after your first let-down, so if you want to increase efficiency, start off at the fuller breast, then switch to the other breast sooner, rather than later. When you notice baby’s sucking slowing down and his eyes closing, remove him from your breast and try to stimulate him by burping, tickling his feet, or gently talking to him while rubbing his back, and then switch breasts. As baby gets older he’ll be able to stay awake longer, so don’t fret.
Problem #9: Inverted/flat nipples
You can tell if you have flat or inverted nipples by doing a simple squeeze test: Gently grab your areola with your thumb and index finger — if your nipple retracts rather than protrudes, you’ve got a problem, Houston. Not really. But breastfeeding will be more challenging.
Solution: Use a pump to get the milk flowing before placing baby at your nipple and use breast shells between feeds. Once you feel like your milk supply is adequate, try using nipple shields if baby still has problems latching.
Problem #10: Painful/overactive let down
Your breast is like a machine — when you let down, all the milk-producing engines constrict to move the milk forward and out of your nipple. Sometimes the working of these inner parts can hurt, especially when in overdrive. Some mothers feel a prickly pins-and-needles sensation and others just get an achy feeling.
Solution: If this feeling of pins and needles goes beyond a mere tingling and feels more like a hundred little daggers poking your breasts, you need to check for a breast infection (yeast or bacteria). Sometimes this pain develops when you have an excessive amount of milk. Try feeding baby longer on one particular breast and switching to the other only if you need to. If the result is an infection (fever, aches, and chills may be present), you’ll need to get antibiotics from your doctor. No matter how unpleasant it is for you, it’s still safe for baby to nurse.