So you’ve made the decision to breastfeed, but now you have this tiny baby in your arms and it doesn’t seem to be as easy as you thought it was going to be. You may be experiencing some pain, sore or cracked nipples and you are worried that your baby might not be getting enough. While the journey may not be without a few bumps along the way, your commitment to do your best to feed your baby is one of the best gifts you can give them. While there is no replacement for an in-person assessment and latch correction for these challenges, below you will find some common obstacles new moms are likely to experience in the first weeks of breastfeeding. But also remember that both you AND baby are learning something new- it will take practice! Even if you are doing everything correctly, contacting a lactation consultant is going to be the best route to ensure your baby is latching correctly for your body.
- Inverted Nipples. As mentioned in my previous post, your provider should have done a breast exam at one of your prenatal appointments. At that time they may have mentioned that you have inverted nipples (or just one nipple). Don’t panic! Most women with inverted nipples are very capable and able to successfully feed their babies. One common misconception is that you need to toughen up your nipples while pregnant. This simply isn’t true. Mothers with inverted nipples, however, may benefit from some intervention starting after week 37 or later of pregnancy. The most effective method is hand expression of a few drops of breast milk per day. While this isn’t harmful, it also isn’t necessary and mothers with inverted nipples can also wait until baby is born without issues. If you have already discussed having inverted nipples with your care provider, I would suggest that you have a few supplies on hand just in case. Go ahead and purchase a pair of nipple shields (or ask if where you plan to birth will provide them- many hospitals and birth centers will have them on hand), and either a hand pump or electric pump (remember to inquire with your insurance company as a pump is usually provided free of charge with prescription). You make not need to use the shields, but having them on hand to try immediately postpartum will be beneficial, as there will be providers to assist you learning how to use them. You can also look into a Latch Assist Nipple Everter to try the last few weeks of pregnancy to begin to stretch the ligaments holding the nipple inverted but this will also happen naturally for most mothers as baby begins feeding.
The goal of any device is to draw the nipple out before feeding baby to allow for an easier time getting baby to latch. This can be accomplished a number of ways and it may be good to experiment with which will work for you. Sometimes just using the shield while nursing will be the easiest, other options would be to use a device such as the Latch Assist Everter, a few minutes of hand expression, a hand or electric pumping to draw out the nipple just prior to baby latching. Especially in the beginning, when using the pump, the goal is not to pump milk, but just to stimulate the nipple to evert for latching purposes. For some women pumping too early and often will stimulate supply leading to issues with engorgement later on. If you choose to use an electric pump, you want to make sure that the flange size is well fitting and that it’s used sparingly. Another advantage of making sure that you know how to contact a lactation consultant prior to baby’s arrival, is to have someone who can help you make sure that your pump is properly fitting. More information about how to find a local lactation consultant can be found in my previous post.
The length of use of nipple shields or pre-pumping varies. Some mamas will be able to use the shield (or everter or pump) for just a short time to encourage the connective tissue to stretch allowing the nipple to be drawn out on it’s own without assistance from a device. I have seen women use a nipple shield for just a few weeks up to a few months before weaning off devices. In addition to the structure of the nipple adapting as time progresses, babies also learn to become more efficient suckers and will make device usage not needed.
- Engorgement initially can be pretty common as your breasts are in a constant conversation with your baby about how much milk is exactly perfect to produce based on baby’s needs. Engorgement is the sensation of fullness and can often be uncomfortable or even described as painful for some mothers. Engorgement is not a plugged duct or infection (mastitis) as these will require different recommendations. If at any time you feel flu-like or a part of your breast is warm to the touch and exquisitely painful (usually just one breast), I encourage you to reach out to a lactation consultant or your doctor for steps to take to prevent progression or treat an infection. There are things that can be done before needing antibiotics, but in some cases you may need to take that route.
One of the best tactics to help with engorgement is continue to feed baby on demand. Forget timing and clocks and just feed your baby paying attention to feeding cues. Similarly to inverted nipples, an engorged breast can be challenging for a baby to latch to, so you can also try nipple shields, hand expression before feeding or pre-pumping to assist with latching. Another method to try if you don’t have nipple shields and baby is having a hard time latching, is called reverse pressure softening. Here is a description of how to do this, but your lactation consultant can also teach you in person: https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/
Hand expression to comfort between feedings is a good way to take some pressure off the breast from engorgement without leading to increased supply issues in the future. Secondarily, pumping with an electric or hand pump to comfort can be used but it can be more difficult to keep supply regulated, and you should take caution over-pumping, especially early on while your supply is still being established.
In addition to the above, a warm shower and breast self-massage (starting at the chest wall and going towards the nipple) can help with pain and you can also easily hand express in the shower to relieve pressure. Ice packs can be used for pain as well and some women find great success with applying cabbage leaf compresses but some don’t find it helpful. It is not harmful to you or your baby and worth a try though. Instructions can be found here: https://kellymom.com/bf/concerns/mother/engorgement/#cabbage
Another option is to change feeding positions. For women with engorgement, strong let down or even just large breasts, you can try “laid back feeding”. This is where mom is slightly reclining and the baby is laid across the belly (mom and baby are belly-to-belly) and you position baby to correctly latch in this position. If you are having a hard time figuring this one out, a lactation consultant can definitely help you get it down!
- Low Supply.This is often one of the most common worries of a new mother. The first step is to determine if you do, in fact, have low supply. This will require paying attention to the number of wet and dirty diapers your baby is having. Your doctor or a lactation consultant can also help you with this, by weighing your baby before and after a feed, a “weighted feeding.” It is very common for a new mama to feel like she has a low supply when, in fact, baby is transferring milk just fine and gaining weight appropriately. The main thing with low supply is to figure out is if you actually aren’t producing enough or if the baby is not taking enough due to other reasons (incorrect latch, anatomical challenges or having a sleepier baby). If there are latching problems, you will best benefit from in person help to adjust baby for a more efficient latch and to make sure your baby is nursing as often as needed.
In the first few weeks the most important way to increase milk supply is to make sure you are getting as much skin-to-skin time with your baby as you can and holding baby often. Make sure you are feeding on demand based on feeding cues and try not to wait until baby is crying to breastfeed.
If you would like to more generally support your supply and make sure you keep it at an acceptable level, there are quite a few things that can be done. One main factor is hydration, it’s often surprising how much fluid you need to take in while breastfeeding. If you can, electrolyte drinks such as coconut water, electrolyte enhanced water, or Nuun Electrolyte tablets can be helpful. Along with hydration, a good diet supports milk supply and often new moms feel overwhelmed with having a new baby to care for, plus are sleep deprived and can forget to eat. Ensure that you are getting enough protein, and a diet with varied fruits and vegetables. Beyond that you want to make sure you are not dropping below 1500 calories a day as this will definitely decrease your supply. I recommend focusing on the content of your diet as opposed to focusing solely on calories. Many breastfeeding moms will increase their diets anywhere from 100 to 500 additional calories per day to accommodate breastfeeding but focusing on whole, nutritious, healings foods will ensure that both you and the milk you are producing for your baby are healthy.
Some foods have been used traditionally to support breastfeeding for mothers, these include oatmeal, fennel, barley, adzuki beans, chicken soup with bone broth, or seaweed broth based soups. Unfortunately, the research is sparse on the effectiveness of a food-based approach, but many new moms find that adding these foods really helps. I fully support increasing healthy whole foods such as these.
Herbs have also been used traditionally for supporting milk supply. Some common ones are fenugreek, fennel, shatavari and alfalfa. Individual, personalized dosing and specific herb selection or combination is best given by a naturopathic doctor, but you can also look for these herbs in commercially made teas. I like Traditional Medicinal’s Mother’s Milk or Mother’s Milk with Shatavari and Cardamom. Herbal supplements aren’t going to completely fix low supply and are just that- supplements. I encourage you to work with care providers (your doctor, midwife, lactation consultant or naturopathic doctor) to come up with an individualized plan that is addressing the root cause of low supply issues.
Beyond these most common challenges there are still some obstacles you may need to overcome on your journey. One of the more common is when baby has a tongue and/or lip tie. These are best assessed in person with a lactation consultant or your pediatrician. Many babies can overcome this challenge without intervention as time passes as their mouth tissues stretch, but for some correcting this issue early can be the key to a more successful breastfeeding journey. I really encourage new mamas to know their resources and reach out sooner than they think they need to. Encouragement, support and education are key to figuring out the breastfeeding puzzle!