Overcoming common challenges with breastfeeding

Although breastfeeding is called natural, it doesn’t always come naturally or easily to some mothers and their babies.

Breastfeeding takes practice but don’t let that put you off; with the right support and advice in the early weeks, or knowing where to seek support when met with challenges, you can meet your goals and breastfeed successfully.

Some of the more common challenges faced include:

Sore nipples

When you first latch your baby onto the breast, you may experience some slight discomfort in the nipple, but this should ease after the initial sucks.

If this is an intense pain and does not ease after those initial sucks, it’s likely to be due to a shallow latch. At this point, break the suction using a clean finger in the corner of baby’s mouth, remove them from the breast and then try again. The pain should not last for more than a week or so, as your nipples get used to breastfeeding.

Some mothers experience painful nipples in the first couple of days or weeks. This can be due to your baby not getting enough of the breast in their mouth, or poor attachment (link to Article). Check the shape of your nipple after feeding; it should not be pinched at the end or misshapen.  If this happens, seek support from your midwife, health visitor or peer supporter.

Tip:

• Air your nipples after feeding to dry
• Use comfortable non-stick breast pads and
• Dab ointment on to nipples post feed

Milk supply

Breastfeeding is all about supply and demand; the more your baby feeds, the more milk your body will produce. It’s normal for babies to feed up to 12 times a day initially. This should become less frequent as your milk comes in and supply settles.

Your baby may cluster feed; this is where they feed constantly or several times in a row at a certain time of the day or night. This is perfectly normal, it may happen initially to increase your supply as your baby goes through a growth spurt.

Tip:

• Don’t introduce a dummy or bottle feeding before you have established breastfeeding

Weight gain

Lots of mothers and fathers worry about their baby’s weight gain. It’s normal for babies, both breast and formula fed, to lose weight in the first few days after birth; they then start to regain weight, or are normally back to birth weight by 14 days.

Tips:

Look for wet and dirty nappies-

• In the first 48hrs, 2-3 wet nappies, building up to 6-8 per day
• In the early days, baby poo looks like tar; after about day 5-6 it should be soft and yellow
• Breast fed baby’s poo is runny yellow, sometimes looking seedy and does not smell
• They should pass 2 poos per day. If you are worried about your baby, speak to your midwife or health visitor

Engorgement

Engorgement is when your breasts get too full of milk. They may feel hard, tight and painful.

This can happen when there is increased blood flow to the breasts and milk supply. It often occurs in the early days of breastfeeding and, even if you are not breast feeding. It can also occur whenever your milk supply adjusts to meet your baby’s needs.

Tips to ease engorged breasts:

• Breastfeed your baby frequently; 1-2 times hourly during the day and 2-3 times hourly overnight. Always start timing from the start of the feed
• Try hand expressing
• Take a warm shower or apply wet, warm towels to the breast before feeding or expressing, as applying warmth to the breasts will help the milk to flow
• Cold cloths applied to the breasts between feeds can help reduce swelling. It’s best to apply straight after a feed for about 15 minutes
• Wear supportive clothing – avoid bras that are wired, too tight or don’t fit well
• Take over-the-counter Ibuprofen or Paracetamol as a pain killer – both are safe to take whilst breastfeeding

Recognising and treating engorgement quickly can help you avoid it leading to complications such as blocked ducts and mastitis.

These occur when the breast is not drained fully, leading to inflammation of the breast tissue. You may feel a lump, pain, heat or redness in the breast, and may experience a temperature or flu like symptoms.

If you experience this, follow the same advice as above, plus:

• Don’t stop breastfeeding. Start the feeds on the affected breast and offer both breasts
• Gently massage the lumpy /painful area of the breast
• If it’s too sore for you or your baby won’t feed, try to express instead
• Ensure you rest and drink enough fluid to keep well hydrated
• Get help with positioning and attachment to ensure that it’s as good as it can be

If your symptoms are very severe, get worse or don’t start to improve after 12-24 hours, even when you’ve tried the steps above, contact your GP.

Medication and breastfeeding

Some mums may need to take medication at some point while they’re still breastfeeding, whether it’s painkillers, antibiotics or a medication for a long term condition.

Harmful reactions from medicines passing through breast milk are thought to be rare. But there is still some concern about prescribing and selling medication to breastfeeding mums. If you’re breastfeeding, make sure you tell your GP or pharmacist.

The Breastfeeding Network Drugs in Breastmilk Information Service is run by a specialist pharmacist who has produced a number of factsheets about the use of many drugs during breastfeeding. You can also contact the service through the website for information about a particular prescription drug.

The NHS website provides information about breastfeeding and medicines.

UK Drugs in Lactation Advisory Service (UKDILAS) is run by highly trained, experienced pharmacists for both healthcare professionals and members of the public, and will be able to advise on your individual circumstances, including if you need to take multiple medications.

Useful links

• Breastfeeding Network-Mastitis and breastfeeding
• Breastfeeding Network– Thrush and breastfeeding
• Advice leaflet: How to help a reluctant feeder
• Advice leaflet: Suffering from sore nipples?
• Advice leaflet: Suffering from painful breasts?
• NHS Start for Life- Breastfeeding