Breastfeeding is promoted as an easy and natural experience that every woman and baby can achieve. It’s boasted as the best for both mother and baby. If you have an infant who struggles to breastfeed, you’re often instantly suggested formula. The amount of knowledge pediatricians and general practitioners have about breastfeeding is so limited that they frequently jump to removing this variable from the equation in order to “solve” problems. In this post I’ll discuss some common breastfeeding challenges and potential solutions. In our lengthy and rough breastfeeding journey, we’ve actually dealt with ALL of these issues.
Latch
When baby is first born, mothers are encouraged to latch them on the breast right away. Sedition or c-sections can impact the first hours after birth and either or both mother and baby could have a hard time with the first latch. Significant others, family members, nurses, or lactation consultants can offer some assistance if you’re groggy after delivery.
Sometimes mom and babe are separated which would inhibit the first latch. This was the case with our delivery story. Jett was whisked away to the NICU. I found myself hand expressing colostrum in the recovery room to help my body recognize the need to produce milk. Once I had a room, I was brought a breast pump and began pumping every three hours. The colostrum was brought to the NICU in syringes if Jett needed it.
If it’s a short separation, no nutritional supplementation or feeding may be needed. Jett was on a glucose line and was able to latch at a day old. He didn’t need to be fed with an alternative method. If you find yourself with a longer separation or inability to latch baby, it’s recommended to use finger feeding with a supplemental nursing system, a small cup, or even a syringe if necessary. Bottles should be limited.
Lip and Tongue Tie
In order for baby to nurse effectively, a fully flanged upper lip and full range of motion in the tongue is necessary. Tongue ties “tie” part or all of the tongue to the floor of the mouth. This inhibits baby’s ability to make the wave like motion necessary to extract milk from the breast. Some babies compensate by biting, chomping, munching motions which may remove some milk but typically result in decreased milk supply over time. A lip tie reduces the ability to flange the top lip creating a shallow latch which can cause pain for mama and a challenge for baby to “hold on” while nursing.
Symptoms in Mama
- Nipple pain
- Nipple blanching, pinching, bruising
- Mastitis
- Plugged ducts
- Low milk supply
- Oversupply
- Full breasts after a full nursing session
Symtoms in Baby
- Slow or poor weight gain
- Poor latch (maintaining a latch, dribbling milk, frequently sliding off the breast)
- Chomping or biting the nipple
- Clicking, gulping, choking sounds during nursing
- Ineffective at transferring milk, fatigue, jaw quivering
- Falling asleep before a full feed is over
- Fussing at the breast
- Colic, gas, or reflux
Many practitioners are not skilled in spotting tongue and lip ties. It’s recommended to seek out a preferred provider, usually a pediatric dentist, for an evaluation. Some lactation consultants specialize in tongue and lip ties and can help guide you to someone who is able to evaluate and complete the revision if necessary. If you or baby have any of these symptoms, I encourage you to seek out an evaluation.
Lip ties are more easily spotted, and tongue ties usually coincide. Here‘s a video of Dr. Kotlow evaluating a newborn for a tongue tie. He’s one of the leading experts in TT and LT revisions in the US.
Lip and tongue ties don’t just effect nursing. They also can cause problems with teeth spacing and cause cavities, eating disorders and issues, speech problems, etc. Having a revision before any of these other issues arise is advantageous for your baby, even if you’re not planning on nursing.
Muscle/Skeletal Tightness or Misalignment
Babies with particularly rough deliveries, long labors, or weird womb positioning are more susceptible to neck and jaw tightness or spinal misalignments. These issues can cause nursing positional discomfort or inability to nurse easily or comfortably. They also can cause reflux, digestive issues, and colic.
Seeking relief from a craniosacral therapist, miofacial release practitioner, or a chiropractor may help, particularly after a tongue and lip tie revision.
Plugged Ducts and Mastitis
The first sign of a plugged duct is a painful lump in your breast. The best thing for relieving the clog is heat and nursing. Sometimes dangling your breast over baby’s mouth while nursing helps draw it out. Massaging and hand expressing in a hot shower can help too. Plugged ducts are often caused by inefficient breast emptying.
Mastitis is a breast infection caused by a lingering plugged duct. Symptoms would be a red, hot, spot on your breast, pain, fever, and chills. Getting the clog out is crucial. We’ve been fortunate that consuming large amounts of raw garlic, apple cider vinegar, and taking belladonna homeopathic pellets squashed my horrible mastitis. Some mamas need antibiotics, talk with your healthcare practitioner.
Allergies or Intolerances
Again, since most practitioners aren’t well versed in breastfeeding, many will tell you it’s impossible for baby to react to what you eat. As a mother of a child who has chronic FPIES reactions through my milk and an active member in many breastfeeding, allergy, and TED groups, this is not the case. Some doctors believe only dairy and soy can cause reactions.. I’m not exactly sure why they feel it’s possible for SOME food proteins to get into the mother’s milk and not others. Anyway, it’s totally possible.
Symptoms of Intolerances/Allergies
- Gas
- Colic
- Spitting up
- Vomiting
- Mucous stools
- Acid burned bottom
- Eczema
- Rashes
- Green stools
- Blood in stool
- Too frequent (diarrhea) or too infrequent (constipation) stooling
Top culprits for intolerances or allergies are dairy, soy, gluten, grains (rice and oats especially if FPIES is suspected), seafood, nuts, and corn. Use a food log to help you narrow down the suspected problematic foods. Then, simply remove the suspected food (and all of it’s derivatives) for several days (dairy, soy, and grains take weeks to leave your milk and baby’s body) and observe baby’s symptoms. This is a great way to see what’s causing problems.
When eliminating several foods doesn’t help, some mothers choose to do a Total Elimination Diet. The base of this is different for every child and mother but the basics are a protein, a vegetable, and a fat. Some choose to add a fruit from the beginning as well. Once a baseline TED has been found, as in all symptoms are resolved, adding one food at a time is crucial to ensure the new foods are safe.
Low Supply
Symptoms of low supply range from fussing at the breast, low or slow weight gain, frequent nursing or increased time nursing, decreased time nursing, empty feeling in your breasts, and inability to pump or hand express milk. All of these symptoms don’t necessarily mean your supply is low. The best way to check is a weighed feeding at a lactation consultant’s or pediatrician’s office.
Causes
There are many causes of low supply. Tongue and lip ties are common causes. Allergies and intolerances can also cause a supply dip if baby is reducing his nursing due to discomfort. Other causes like dehydration and insufficient caloric intake can be solved with simple tricks.
Ensuring your drinking enough water is tough when you’re exhausted and so busy with a newborn. I found that if I drank a full bottle of water between every nursing session, I was hydrated enough. An unexpected benefit to this was super clear skin!!
Another challenge with a newborn is eating enough. Frozen meals and leftovers are your best friend! Grabbing something quickly is a necessity when you’re caring for your new babe. Fruits like apples, oranges, bananas, and grapes are all easy to snag and eat with one hand. My supply would dip if I skipped ONE meal or snack. I even had to eat in the middle of the night.
Galactagogues
Galactagogues are foods and herbs that help increase milk supply. It’s best to work with a lactation consultant to find the right herbs for you.
- Fenugreek is a common one (It is closely related to soy and does upset some moms and babies)
- Shatavari
- Milk thistle
- Goat’s rue
- Fennel
- Oats
- Moringa
Some people have success with carrot juice, dark leafy greens (kale, collards, spinach), and almonds.
Pumping
Breastfeeding works (usually) on a supply and demand basis. If you’re not producing enough milk, adding a pumping session or power pumping session to your regimen can help. By using your breast pump, you’re telling your body to make more milk. Don’t be discouraged if you’re not pumping anything at the beginning. The point is to pump after you’re already empty to signal your body that, “hey I need more milk.”
Not all breast pumps are created equal. I’ve used FIVE different types in our journey and have found that the Spectra S1 (S2 is the same just without the rechargeable battery that I love so dearly) empties me the quickest, is the most gentile on my nipples, super quiet, affordable, and portable! If your insurance doesn’t cover it, in my opinion, it’s way worth it.
Medications
Only you and your provider can decide if this is right for you and your baby. Having your prolactin level checked would be the first step as the medications work by raising your prolactin level.
Medical Reasons for Low Supply
Things like insulin resistance, IGT (insufficient glandular tissue), PCOS, and thyroid issues can cause trouble with supply. If you suspect any of these, it’s best to talk with your health care provider.
In the end, only you and your baby (and your health care providers) can decide if breastfeeding is right for you. There are countless benefits, and for us (even with every one of these challenges) the benefits outweighed the struggles. Jett is almost three and we are still breastfeeding.
Jett diving to nurse after his “nap”
