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Serving the Greater Los Angeles area
Serving the Greater Los Angeles area

ADDRESSING BREASTFEEDING DIFFICULTIES

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breastfeeding

This list was compiled by new Supported Birth moms who experienced special challenges or had advice to give, and their concerns were addressed by Certified Lactation Consultant Jane Mycroft, former Supported Birth Doula.

THE MOST IMPORTANT MESSAGE IS TO CONSULT WITH A LACTATION CONSULTANT BEFORE BIRTH AS WELL AS AFTERWARDS IMMEDIATELY UPON ANY PROBLEMS. 

REMEMBER, NOT ALL WOMEN EXPERIENCE THESE ISSUES. Those who don’t, however, still report the normal breastfeeding challenges of: cramping, baby blues, exhaustion, feeling “broken” and feeling guilty for feeling broken, crying, baby falling asleep at half feeding, mom starving all the time, some nipple soreness. 

1. EXHAUSTION. 

Using so much energy making and giving milk, you may feel like you are breastfeeding all day long. Surprised by the length of the feeding sessions – normal to nurse for 45 minutes to an hour at a time. Be gentle with yourself. Crying, overwhelmed. First weeks messy, stressful, hard. It does get better/easier. Expect cluster feeding and marathon sessions. 

Please keep in mind that tiredness accumulates through 9 months of pregnancy, hours of labor, delivering a baby, then trying to learn something new. It isn’t just breastfeeding that is exhausting. Your level of health/fitness prior to pregnancy, your labor, any interventions, method of delivery, and support system, can all impact how exhausted you feel in the weeks after delivery. Hormones are fluctuating and coping levels change accordingly. Whatever your feeding choice, newborns are exhausting PERIOD!

2. HYDRATE, HYDRATE, HYDRATE.

First weeks – the best way for partners to help is to bring water, snacks.

Breastmilk is 88% water so it is essential to replenish your own liquid stores very frequently. Coconut water, water, soups, watermelon and other fluid-packed foods!

3. HORMONAL SHIFT DURING LET-DOWN

This results in temporary feelings of sadness, tiredness & moodiness. 

Lots of skin-to-skin time with your newborn can counteract these dips in hormones and help to increase oxytocin. 


4. CRACKED & BLEEDING NIPPLES, NIPPLE PAIN  

Cracked and bleeding nipples are the end result of a series of mishaps with plenty of warning signs along the way. Seeking help early is essential. A warm compress, lansinoh, or cool hydrogel pads can aid healing, however, correcting the reason for the damaged nipples is essential to avoid repeating. Catching nipple pain early, can reduce the discomfort, avoid broken skin, and resolve faster. Breastfeeding should feel like a strong pulling/tugging sensation that can be uncomfortable initially but a sharp, pinching pain is a sign that something needs adjusting. 

5. PURCHASE NURSING BRAS BEFOREHAND  

Do take a good nursing bra or 2 with you to the delivery. If you need assistance to evert flat nipples, shells should be offered to you and they work at a fairly fast rate, but you’ll need a bra.  Cool hydrogel pads are a lovely method of healing tender nipples, but you’ll need a bra. Most hospitals will offer Lansinoh; however, feel free to bring a good nipple balm/cream/butter.   

6. CLOGGED, PLUGGED DUCTS

This is usually resolved with heat, breast massage, sunflower lecithin supplements, and at least 6 feeding/pumping sessions.

Again, these are late signs of problems that have been building up over time and for the most part are easily avoided with early professional support. Not letting breastmilk sit in the breast once the capacity of the breast reaches its limit is key. 

7. MASTITIS – Symptoms: fever, chills, tenderness, pain. Breast swollen and red with a hard lump inside, nipple hard and erect and very painful, cracked. Mastitis can come on suddenly.  Need antibiotics asap (+ Tylenol/ibuprofen). Engorgement without pumping resulted in mastitis. Nursing through the pain, warm shower, massage, hand express so baby can latch because the breast is so hard. Don’t give up!                  

Mastitis can become a big problem if not realized and treated as early as possible. 

As before, there are quite a few warning signs along the way; a clogged duct that wasn’t found, waiting too long to empty a full breast, not draining the full breast completely, incorrect flange size when pumping, baby becoming distracted and therefore leaves milk sitting in the breast.  Warm compress, breast massage, effective pumping as well as breastfeeding to ensure complete emptying of the breast. Antibiotics are essential so a probiotic would be good too.  

8. HAVE A PUMP READY!

Clean, washed, sterilized. Pumps can often be accessed through insurance. Bring your pump to the hospital and have the IBLCC show you how to use it. 

Breastpumps are a tool to help overcome multiple challenges before they become bigger problems.  The Affordable Care Act ensures that all women who have insurance are eligible for a breast pump. Note: some insurance companies will not ship it until after you give birth making sizing, sanitizing, and getting familiar with it very difficult.

9. TONGUE TIE. 

Insist on having the pediatrician/LC/midwife check for tongue-tie before you leave the hospital. Pain during feeding can indicate tongue tie. 

The newborn needs to take in an adequate amount of colostrum in the first few days. A short or tight frenulum, tongue-tie, can restrict movement of the tongue and should be evaluated during the hospital stay. Some centers do not offer a revision and a private consultation may be needed.  At some medical centers, the revision will be offered prior to discharge if it appears to be causing a problem or possibly at the follow-up visit in the outpatient setting. It is very important that shields are not used in the first few days until breastmilk production has increased as newborns are unable to transfer colostrum from the breast through a shield.

10. THRUSH. 

The Baby’s tongue is white. Must boil all bottles, pacifiers after use. Thrush can go back & forth between baby & mom. 

Most times if caught early, Thrush can be overcome with a warm vinegar water nipple soak, air drying or changing out breast pads extra frequently, and cutting back on sugar and wheat, however, once Thrush takes hold, the OB will prescribe Diflucan, plus the aforementioned treatments.  Women who have c-section deliveries and/or receive antibiotics can be vulnerable to Candida albicans, Thrush.  APNO is very good for broken skin/damaged nipples but works mostly superficially as thrush is an internal problem.  

11. FLAT NIPPLES

Flat nipples, which have not been identified and addressed during prenatal visits.

Not many OBs will offer to give a breast exam which is why a prenatal breastfeeding class with a Lactation Consultant is important.  Shells are very effective if you have a good nursing bra with you.  A shield should not be given to you during the first few days. Learn Positioning and different ways to hold other than the way they show you at the hospital.

12. FORCEFUL, OVERACTIVE LETDOWN

(Gassy baby, gulping, choking, foamy poops).

Feed in different positions, breastfeeding chair, use gravity to help. (45-degree angle pillow, laying baby across my chest, or baby with hips lower than head). Support & guidance. Using a breast pump prior to latching.

13. NEED SUPPORT/CONNECTION.  FEELINGS OF ISOLATION.

It is important for women to know they aren’t alone and for some, it’s a long, tedious journey! Demoralized, anguished, and nerve-wracking to have worry & frustration about BF problems, not to mention painful. “Be kind to yourself.”  

Many cultures around the world value offering help and are honored to receive it, instead of feeling weaker for needing the support. Find grassroots groups in your area; there are many! 

14. MASSAGING BREAST

Massaging breasts before breastfeeding was really helpful to see colostrum and then milk comes out.                                                                                                    

Colostrum is the first nutrition; it is a fairly thick and sticky substance.  It often doesn’t leak out of the breasts and isn’t easy for the uninitiated to hand express.  Some women are reassured when they see the colostrum, so hand expression is a good technique to learn.  Breast massage is also good as lumps can develop if milk is getting stuck in a particular part of the breast structure and need some help to drain, especially in a denser breast.   

15. BABY SCREAMING

Baby screaming if not given breast fast enough.

Babies are ‘people’ and have their own personalities. Being observant of the early feeding cues is important to catch them in a ‘good mood,’ avoid having your little impatient person losing their cool if you miss those early signs of need. Some babies are more patient than others, just like people. Feed as soon as cued.

16. ISSUE WITH MILK COMING IN OR “NOT ENOUGH” 

Worked with a lactation consultant. Would breastfeed, pump, and then supplement (using a syringe) either pumped breast milk or formula or both. We did this every 2 hours for about a week, was rough. Low supply of milk, possibly due to C-S or underactive thyroid. 

This is the number one fear of mothers.  It is a very common statement in the first week as the baby wants to be at the breast constantly which gives the impression that the newborn “isn’t getting enough.” Feeding 8-12 times in 24 hours can mean every 1-2 hours is NORMAL. Understand that the newborn is ‘homesick’ and wants to feel familiarity, reassured, warm, secure, and loved. Plus more breast stimulation in the first week sets up breastmilk production. With good prenatal education, a decent support group, and a healthy dose of determination, most uncertainties can be held at bay.

Challenging labors and deliveries can delay milk production but not completely suppress milk supply.  There are some mysterious reasons why milk production is delayed but finding professional help early is key.  Rule #1 is always feed the baby and careful, moderate and conservative use of formula is a must until milk production kicks in. Breastmilk is the first choice, sometimes donor milk from a reliable source can be a second choice and then formula is another choice.  The first week can feel like an eternity however when looking back, it will feel like a lifetime ago as you find yourself now breastfeeding, while on the phone, stirring dinner and answering emails…all at the same time….and you are so glad you persisted.  

Some breasts do not have enough glandular tissue, are wide-spaced, or did not develop in puberty due to a hormonal imbalance and no amount of effort will change the fact. Even with the best intentions, the most loyal support group, and a fantastic lactation consultant, milk production can be insufficient and formula should be used in these cases.  

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