Breastfeeding Challenges

My friend told me to be prepared for sore nipples, engorgement and plugged milk ducts. I’m determined to breastfeed, but what are some challenges I might experience?

It’s great you are determined to breastfeed, and it’s normal to want to know what issues may come up. Below is a list of possible breastfeeding issues and ways to deal with them. Each breastfeeding journey is different. Some go smoothly with few bumps along the way, while others present hurdles to overcome. Just remember, “Difficult things aren’t easy, but they’re worth it.” -Mia Love

Contents:

Difficulty Latching
Sore Nipples
Low Milk Supply
Engorgement
Plugged Ducts/Mastitis
Milk Blebs
Distracted Nursing
Nursing Strikes
Related Issues

Difficulty Latching

Babies are born with the instinct to breastfeed, but sometimes it takes practice to achieve a good, deep latch. Learn about proper latching and positioning techniques during your pregnancy! 

Causes/Solutions:

1.  Baby is drowsy after birth due to medication(s) mom received during labor/delivery.

• • Make a birth and breastfeeding plan and share it with hospital staff.
  • Hold baby skin-to-skin immediately after birth for 1-2 hours.
  • Learn about babies’ 9 instinctive stages after birth and allow them to breastfeed early, before falling asleep.

2.  Mom has flat/inverted nipples. Although women can breastfeed no matter what their nipple looks like, this may make latching more difficult. Babies “breast” feed, not “nipple” feed. Their suck can form and draw the nipple into their mouth. 

Other ways to draw out the nipple:

• • Roll the nipple between your fingers.
  • Hand express or briefly pump before latching.
  • Wear breast shells about 30 minutes before a feeding.
  • Nipple shields can be used after other things are tried first. They are a tool that should only be used as a short-term solution.

3.  Baby has a lip/tongue tie. Ties can restrict the movement of the tongue/lip, causing latching issues. Have a trained professional (dentist or CLC) look in baby’s mouth. If needed, a same-day procedure can correct a tie and make breastfeeding much easier.

4.  Bottles are introduced too soon. Different muscles and mouth movements are used to remove milk from the breast versus a bottle. Offering a bottle too soon can complicate latch.

• • Wait 2-4 weeks, if possible, to offer a bottle.
  • While baby is still learning to latch (or doesn't stay latched long enough to get a good feeding), hand express and offer colostrum/breast milk using an alternative feeding method.  The breasts need to be emptied 8–12 times in 24 hours to establish and maintain a good milk supply. 
  • If you decide to offer a bottle, use the paced bottle-feeding method.

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Sore Nipples

It’s normal for nipples to feel sore, sensitive or tender as they adjust to breastfeeding in the early days, but pain lasting longer than 10-20 seconds is not normal.

Causes/Solutions:

1.  Improper latch. If you’re unsure baby is latched correctly, here’s some things to look for:

• • Baby is positioned facing you and is not having to turn their head to nurse.
  • Baby's chin comes into the breast first, so the nipple is aimed at the roof of their mouth (to achieve this, line baby's nose across from your nipple).
  • Baby's mouth is opened wide (more than just the nipple is in the mouth). Some areola may be seen above the lips, but not below.
  • Lips are flanged outward like a fish, not tucked in.
  • No clicking or slurping sounds can be heard.
  • There is a rocker-like motion at the jaw making the ear move.
  • Pain does NOT last the whole feeding (some discomfort may occur in the beginning, but should go away shortly into the feeding).
  • The nipple is not misshapen after feeding.

2.  Thrush - a yeast infection that can occur on mom’s nipples and in baby’s mouth. Diagnosis and treatment need to be confirmed by your doctor. Mom and baby should receive treatment at the same time, so thrush is not passed back-and-forth. Click here for more information about thrush.

3.  Vasospasm - a muscle spasm in the tip of the nipple, forcing blood out of the nipple. This leads to white, blue or purple nipples. When the spasm ends, the nipple turns bright red as blood flows back in. Click here for more information about vasospasm. 

• • Keep nipples warm.
  • Apply pressure to the nipple or use a warm washcloth when baby comes off the breast.
  • Massage the nipples immediately after feeding.
  • Avoid/decrease nicotine and caffeine use.

4.  Using an incorrect breast pump flange or too high of a suction setting when pumping.

• • Get measured for the correct flange size. The size needed can change throughout your breastfeeding experience.
  • Use a suction setting that is high enough to remove breast milk, but not so high it hurts. Click here for more information about pumping pain.

To Soothe Sore Nipples:

• • Rub a few drops of breast milk on the nipple and air dry.
  • After feedings, apply cool packs covered in a cloth.
  • Go without a bra or wear one that’s comfy but doesn’t rub.
  • Apply nipple cream designed for breastfeeding mothers. (Do not use lanolin products if you have a wool allergy.)

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Low Milk Supply

It’s common for moms to be concerned with milk supply and wonder if their baby is getting enough breast milk. If the signs baby is getting enough are present, it’s likely your milk supply is just right. Growth spurts and cluster feeding are a normal, healthy part of a baby's development, and baby wanting to breastfeed more often does not typically mean low milk supply. Click here for more information about making breast milk.

Causes/Solutions:

1.  Not feeding/pumping on demand or waking a sleepy baby to feed.

• • Aim for 8-12 feedings in 24 hours.
  • Avoid formula supplementation.
  • Avoid pacifiers until breastfeeding is established, and don’t allow them to replace/delay feedings.

2.  Improper latch - a deep latch is necessary for adequate milk transfer. If baby isn’t removing milk effectively, milk supply will decrease.

3.  Certain types of birth control or other medications.

• • Inform your doctor of your breastfeeding status before medications are prescribed.
  • Check with your doctor or a pharmacist before taking over-the-counter medications. There are many options that are safe to use while breastfeeding that will not affect milk supply.

Click here for more ways to increase milk supply.

4.  Excess stress.

• • Practice relaxation techniques like deep breathing.
  • Hold baby skin-to-skin.
  • Take a warm bath.
  • Get some fresh air.
  • If stress becomes unmanageable, seek help. Click here for more information about postpartum depression/anxiety.

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Engorgement

Engorgement makes the breasts feel very full, tight, heavy, hard and uncomfortable.

Causes/Solutions:

1.  Colostrum transitions to mature milk about 2-4 days after delivery. Baby’s frequent nursing has signaled your body to bring in a plentiful milk supply. Sometimes your body goes into overdrive and makes more than baby needs. There is also extra blood flow to the breast tissue causing swelling.

• • Gently hand express to soften the nipple before latching.
  • Breastfeed 8-12 times a day.
  • Change nursing positions.
  • Use ice between feedings to decrease swelling.
  • Ask your doctor about taking an over-the-counter anti-inflammatory medication like ibuprofen.

2.  Missed feedings.

• • Avoid pacifiers (until breastfeeding is established), formula supplementation or anything that takes time away from breastfeeding.
  • Wake baby to nurse in the early days, even at night.

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Plugged Ducts/Mastitis

There’s not necessarily a plug/clog/block in the milk ducts; instead, breast tissue is inflamed or swollen, which restricts the flow of breast milk. You may feel a hard spot/lump in the breast.

Causes/Solutions:

1.  Tight fitting bras/tops.
2.  Nursing in just one position.
3.  Skipping/delaying feedings or pumping sessions.
4.  Baby’s feeding schedule changes (like starting solid foods or during weaning).
5.  Baby isn’t effectively draining the breast (perhaps from a poor latch).

• • Rest.
  • Nurse/pump on-demand as usual, but don’t overfeed.
  • Use ice to decrease swelling.
  • Gently massage with fingertips.
  • Dangle nurse/pump.
  • Ask your doctor about taking an over-the-counter anti-inflammatory medication like ibuprofen.

Watch for signs of infection (mastitis), and contact your doctor if they appear. Mastitis usually occurs from unresolved inflammation. Symptoms include breast pain, swelling, warmth, redness, and/or hard spots accompanied by a fever, chills, body aches, and fatigue. If these symptoms last more than 24 hours, contact your doctor as you may need medication. Keep removing milk as usual, get lots of rest, stay well hydrated, and use cool packs to reduce inflammation. It is still safe to feed your baby even if you are diagnosed with mastitis and are receiving treatment!

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Milk Blebs

The initial cause of a milk bleb (blister) may be related to a latch issue. It can be very painful during breastfeeding or pumping, and you will notice a white spot on your nipple.

Causes/Solutions:

1.  A plugged duct that is scabbed over. The milk can’t get out and is clogged behind the scab/bleb.

• • Soak a cotton ball in olive or coconut oil and put it against your nipple overnight.
  • First thing in the morning, pump or hand express (in a warm shower helps). Typically the softened scab will come off, and you can express some of the thicker “clogged” milk out. It may look stringy or like toothpaste. It isn’t harmful to baby if they swallow it while breastfeeding.
  • Continue to breastfeed, pump or hand express to keep it open and milk flowing.
  • Contact your healthcare provider if the bleb continues to reappear.

It is not recommended to pick at the bleb or try to open it up yourself. 

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Distracted Nursing

Around 4 months, babies become more curious and aware of their surroundings. Moms may wonder if their baby is paying attention long enough to get a full feeding.

Solutions:

• • Nurse baby in a quiet, dimly lit room, away from other distractions.
  • Cover baby with a light blanket or nursing cover during the feeding.
  • Breastfeed while wearing baby in a sling.
  • Bounce or rock in a chair while feeding.
  • Change breastfeeding positions (lying down or baby sitting facing you).
  • Interact by talking, singing and making eye contact with baby.
  • Give baby a toy to play with or wear a chunky necklace.
  • Nurse when baby is just waking or sleepy.
  • Take advantage of nap time and night time feedings, when baby is less distracted.

If baby isn’t latching for full feedings, protect your milk supply by hand expressing or pumping.

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Nursing Strikes

Nursing strikes can be concerning to moms and we don’t always know the cause. They are temporary and do not mean baby is self-weaning.

Causes/Solutions:

1.  Illness - stuffy nose, sore throat, ear infection, etc.

• • Contact your doctor for ways to help.

2.  Teething - baby’s gums may be tender or a strong reaction to a bite startled them.

• • Ease teething pain prior to nursing.

3.  Stress - recent life changes, like starting daycare or moving to a new home.

• • Make your breast a pleasant place to be.
  • Stop if you or baby becomes frustrated - calm baby and try again later.

4.  Distraction - too much stimulation in their environment.

• • Nurse in a dark, quiet room.
  • Rock in a chair or walk around while feeding.
  • Take advantage of sleepy or drowsy periods.

5.  Nipple Confusion - baby starts to prefer bottles

• • Use paced bottle-feeding to make a bottle-feeding session more similar to breastfeeding

Skin-to-skin contact can encourage a baby to latch and calm them in all of the situations mentioned. During nursing strikes, protect your milk supply by hand expressing or pumping when a feeding is missed.

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Related Issues

Other issues that aren’t necessarily a breastfeeding problem, but can impact breastfeeding, are prematurity and jaundice. For information on breastfeeding the premature baby, click here. For information on breastfeeding through jaundice, click here.

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The breast is like a muscle you haven’t used yet. "Remember taking up a new sport? Remember how much the new set of muscles you used surprised you by aching so much? Well, that’s what it’s like to use your breasts, for the very first time, for the purpose they have been awaiting all your life.”
-Julia Glass

SOURCE: https://wicbreastfeeding.fns.usda.gov/common-breastfeeding-challenges