Top 5 breastfeeding concerns and how to address them

For women who wish to breastfeed and are able, breastfeeding can be one of the most wonderful experiences a mom can have. But as natural as breastfeeding is, it does not always come easily to a new mom or baby. Getting help is important to make sure your baby is getting enough to eat.

Here are the top five most common problems mothers face when providing breast milk for their babies and some suggestions to help.

Engorgement

The first few days postpartum can be uncomfortable as well as joyous. Engorgement — painful swelling of the breasts — happens to most women when their milk “comes in” three to five days after birth. It usually lasts for a day or two and then subsides. Here are some ways to get relief:

• Use heat and massage before pumping or nursing, followed by ice or cool cabbage leaves afterward.
• Let the shower spray onto your breasts while you massage them or do warm breast baths in a large basin to relax the breasts and allow milk to flow.
• Try reverse pressure softening to move fluid away from the nipple area. Press all five fingertips around the base of the nipple and apply gentle steady pressure for about a minute.
• Ibuprofen can help with pain relief as well as inflammation.

It is normal for milk output to be low during the first few days, even though breasts feel so full. Milk production should increase in a couple of days. If you at any time feel flu-like symptoms, call your physician. Continuing to nurse or pump milk is fine.

Low milk supply

Often, a mother’s main concern is whether her baby is getting enough milk. Here are some indications your baby is eating enough:

• You are breastfeeding on demand 8-10 times/day or pumping 7-8 times/day (or a combination of pumping and breastfeeding).
• Baby is making 6-8 wet diapers per day, having yellow, curdy stools and gaining weight.
• Moms who pump breast milk can expect 1 oz total at each pump session by the end of the first week post-partum, and 2-3 oz per session after 2-3 weeks.

If you do not pump or nurse at night, or if you offer bottles and don’t pump at that time to keep up your supply, you may make less milk. Women who have had breast reductions or women with polycystic ovary syndrome may also have a lower milk supply. As a rule, the more you pump or breastfeed, the more milk you will make.

Sore/cracked nipples

Breastfeeding should not be painful. Pain with breastfeeding may mean baby is not latching properly. The baby’s mouth should be covering the areola (the brown skin around your nipple), not just latched on the nipple. Your baby needs to pull on the ducts behind the nipple to release milk, and needs a wide open mouth to get a deep latch. Always bring the baby to the breast, do not put your nipple in the baby’s mouth.

Other causes of sore nipples may be:

• A yeast infection on the nipple. This can be quite painful and needs to be treated by a physician.
• Baby’s tongue tie. This is a condition that needs to be diagnosed and corrected by a pediatrician.
• Flat nipples. This can make it hard to center the breast in baby’s mouth. A nipple shield can help, which requires meeting with a lactation consultant to ensure proper size and fit.
• Too much pressure on a breast pump. Only turn the pump pressure up as high as is comfortable and productive.

Painful breasts

Lactating breasts may be uncomfortable initially, but if pain persists or comes back after the engorgement phase, there may be a problem.

• Red, painful breasts may indicate mastitis — an infection of the breast that will require antibiotics to treat. This does not affect milk quality, so keep nursing or pumping to ensure your supply stays up.
• A clogged milk duct can be relieved with warm compresses and massage while pumping or breastfeeding on that breast. Use massage to help the clog move down the breast towards the nipple.
• Avoid underwire bras as they can lead to clogs. Keep your breasts as empty as you can by using hand massage while you pump and by nursing early and often.

Finding reliable information on breastfeeding

Navigating the internet for accurate and helpful information on breastfeeding and pumping breastmilk can be overwhelming. Between blogs, corporate promotions and social media it can be hard to find quality sources for the information you need. We recommend these reliable websites for accurate and research-based information.

Be wary of blogs or social media posts that may be based on personal opinion or folklore. When in doubt, check with an internationally board certified lactation consultant (IBCLC) or your pediatrician for up-to-date, evidence-based information.

Enjoy your breastfeeding experience and congratulations on providing the best nutrition for your infant and growing child! If you have concerns about how your baby is feeding or are worried about your milk supply, talk to your pediatrician.

Linda McNamara, RN, BS, IBCLC, CLC Lactation Consultant Children's Wisconsin

Children’s Wisconsin has more than 20 primary care offices conveniently located throughout the Milwaukee area and southeast Wisconsin. Find a pediatrician near you.