Breastfeeding and chestfeeding can be quite challenging at first. You do NOT have to do this alone! A kind, warm face with lots of knowledge and a solid plan for how to navigate the next days and weeks can feel like a lifesaver in a storm. “Thank you, this was SO helpful” is my favorite thing to hear at the end of my visits.
Not only does human milk providing nutrition for your baby, but it also share immunities and antibodies which can prevent disease and infection. It also allows for lots of bonding time snuggly skin-on-skin contact. If you’re having trouble, reach out to a supportive and experienced International Board Certified Lactation Consultant (IBCLC) to help meet get you on the right track. If you need a Lactation Ally, I’m Allyson Murphy, IBCLC, and I’m here to help families in Northern New Jersey. You can book your consult right now.
Nipples and latching trouble
Getting a good latch
If you’re a first timer, latching can be tricky! Your baby needs to open wide (sometimes hard with a newborn) and take a large mouthful of chest/breast tissue far back in their mouth for a comfortable and effective latch. If you’ve never done this before, try to have patience while you both learn.
Latching shouldn’t hurt. Though sometimes there can and initial “ohmygosh” wince when baby latches in the early days. This is because you’re likely not used to the sensation of your nipple being stretched back to the junction of the baby’s hard and soft palate. This should pass quickly. If you’re experiencing pain throughout a feeding, this is a sign that something is NOT right. OFten the latch is to shallow which causes “chomping” on the nipple. Please seek help to improve your latch.
Sleepy babies can be difficult to wake. A diaper change with a cold wipe often does the trick. And I sometimes change the diaper again e
Sometimes a baby is awake but unwilling to latch. Skin-to-skin may help kick in their natural instincts to feed. Plus it’s warm and cuddly for you both, and helps encourage milk supply.
During home visits, I perform an oral exam on baby’s mouth. With a gloved finger, I check the baby’s lips, palate, cheeks, and feel the movement and range of motion of the tongue. Sometimes babies have a tight frenulum (the small bit of connective tissue that connects the tongue and floor of the mouth) which can affect how effectively they can suck and remove milk. If a baby has this tight tissue—also known as tongue tie—their latch may be ineffective or painful.
If I suspect your baby may have a tie, I refer to excellent providers who can release the frenum for wider range of motion. I always see clients after a release for follow up care and another weighted feeding.
“Breastfeeding shouldn’t hurt,” is a common refrain. It’s true that with a proper latch you should be able to feed pain-free. However it’s not uncommon for the early days to lead to sore nipples, especially while your body adjusts to the initial latch.
Pain is a sign from our bodies that something isn’t working properly and needs attention. Just as we’d never tell someone with their hand on a hot stove to keep it there and hope the burn stops, we need to address a painful latch early to correct issues. Reaching out to an experienced lactation consultant like Allyson can get you on track for comfortable feedings.
Enduring pain throughout a nursing session can lead to nipple damage, and cracked or bleeding nipples. The pain can be compounded by continuing to injure the nipples at subsequent feedings. Improving the latch will help make feeding more comfortable. Shooting pains can be related to an infection such as thrush or mastitis. Plugged or clogged milk ducts may present as hard, painful lumps in the breast or chest. These need to be resolved quickly to avoid infection known as mastitis. Frequent feeding and/or pumping with gentle massage can help clear the clog and maintain milk supply.
Sometimes babies are unable to latch deeply because of a tongue tie or upper lip tie. Working closely with an experienced lactation consultant can help you identify the symptoms and learn more about the proper oral motor function required for successful breastfeeding.
Inverted or flat nipples
Nipples come in all shapes and sizes. And their appearance may change after delivery and even from feeding to feeding, depending on fullness. If baby is having trouble latching on to a flat nipple, pumping or hand expressing first may soften and evert the nippled for a deeper latch. A nipple shield — a thin silicone cover that sits on top of the nipple during feeding — can sometimes be a temporary tool to help babies learn to latch. It’s important to work with an IBCLC to understand why the shield is being used and come up with a plan to phase it out as feeding improves. Some pumping after feedings is also recommended to ensure nipples are being stimulated.
Milk blisters or blebs
If you notice a small, white or yellow dot at the end of your nipple, this may be a “bleb” or a milk blister. It’s actually an overgrowth of skin over one of the milk duct openings at the end of the nipple. Sometimes they can be painful. And sometimes they cause clogs in the breast if they’re preventing proper drainage.
A warm epsom salt soak can help soften the skin up. Sometimes they resolve on their own, but other times they need to be treated by a doctor. A lactation consultant can help you identify if your baby’s latch may be contributing to recurring clogs.
Milk supply and breast/chest issues
Engorgement and mastitis
When milk first “comes in” this means the body is transitioning from colostrum — the thick early milk present in small volumes — to mature milk. Mature milk is thinner, whiter, and volume should increase steadily in the first few weeks. During the first day or two of this transition it is normal for breast to feel heavy, full, tender, and slightly warm to the touch.
Engorgement is an uncomfortable over-fullness of the breasts. Swelling can also put pressure on the milk ducts which actually makes it harder to express milk. Engorgement can also make it harder for baby to latch deeply or at all. Try hand expressing or pumping out just a little bit of milk to soften the nipple before latching again.
Continued engorgement can lead to mastitis, an infection in the breast. Mastitis often presents with a fever and flu-like symptoms of body aches and chills. If you’re experiencing this, call your midwife, OB-Gyn, or PCP right away. Antibiotics are often prescribed. Frequent pumping or feeding is also required to drain the breasts and help protect milk supply.
Oversupply and strong letdown
If your body consistently makes more milk that your baby needs in a day, this is know as oversupply. You can gradually and carefully reduce the amount of milk you make to help down-regulate supply. But work closely with an IBCLC to help maintain the proper milk supply for your baby and avoid clogs. Milk supply regulates on it’s own staring at about 6 weeks postpartum, it’s often recommended to wait until after this time to try adjusting your supply.
Strong, forceful, or overactive letdown can cause hard gulping or choking during feedings. Sometimes it also makes babies gassy and fussy or leads to excessive spitting up. A reclined position for the parent can sometimes help because baby is able to work with gravity to control the milk flow. Sometimes this issue resolves when milk supply gets regulated.
Low milk supply
It can be frustrating when you’re trying a lot of things to increase milk supply and they don’t seem to be working. Consulting with an experienced IBCLC can help you understand more about the physiology of milk production, learn the most effective ways to pump, and set up a care plan that works for you. Often families supplement with donor milk or formula while working to increase milk supply. A weighted feeding and an infant oral exam can often help get a clearer picture of the situation.
A supplemental nursing system (SNS) can help to give supplements at the breast/chest while baby is latched on. This stimulates the nipple at the same time.
Another important point is to understand what a “normal” milk supply looks like. Once babies reach 1 month old, they’re drinking 2.5-5 oz at a feeding. So if you pump in place of a feeding at that age and express 3-4 ounces, that’s a very typical range. The internet and social media often set unrealistic expectations of what a parent should be producing and storing. If you have questions about supply, working with an experienced IBCLC can provide peace of mind.
What’s normal for your baby?
Weight gain issues
One of the biggest questions I hear is “HOW do I know baby is getting enough milk?!” It’s normal for babies to lose some weight in the first few days after birth, but they should soon begin gaining 0.5-1 oz per day. If baby is not gaining enough, a plan needs to be put in place to ensure they’re getting enough. Pumping is almost always part of the play to help protect or increase milk supply. Again, working with a good lactation consultant can help you find a plan that’s manageable for your family.
During home-visit consultation, I performa we weighted feeding to determine exactly how much milk your baby gets during the feeding. Using my very sensitive digital scale, we weight the baby, feed, and then weigh again. It can be reassuring to see they’re abel to take milk from the breast or chest.
When going for weight checks at your pediatrician, babies should also be weighed on the same scale each time. Weighing naked or in a clean, dry diaper each time can avoid misreadings and discrepancies.
Let’s talk about sleep
Newborns have small stomachs and digest breast milk quickly. This means they need to eat frequently, around the clock. Waking frequently is normal and appropriate. In the first several weeks, they should eat at least 8 times in a 24 hour period, and for many babies it’s more like 10-12+ times a day. This can be exhausting for new families, but be reassured it’s normal!
Once baby is back to their birth weight by two weeks postpartum, they may begin to sleep slightly longer stretches at night. However they continue to need 8+ feedings a day, so tracking feedings and diaper output is important. Continuing to feed on-demand when your baby cues is important. Working with an experienced lactation consultant can help you understand normal infant development and find a good routine for your family.
Pumping and return to work
If only we had laws that provided new parents extended leave with full pay like other countries. In reality, may of us have to return to work sooner than we’d like. The impending return can cause worry and anxiety soon after baby arrives. Working with me to set up a plan can help you enjoy your time with baby and head back to work with confidence and a solid plan for pumping and bottle feeding.
Many families begin a routine of pumping once a day immediately after a morning nursing session to pump out the “extra” milk to store in their freezer. Even if you’re only making 1 oz extra a day, that adds up quickly at the end of the month.
Thinking through how, when, and where you’ll pump at work is important too. Knowing your rights in New Jersey can help you advocate for yourself if your workplace is not accommodating.
Setting up a great plan for return to work can make heading back less stressful for you, your partner, and your baby.
Need help solving an issue with you and your baby?
I’d love to help. Schedule a visit now!