The Early Days of Breastfeeding: Common Problems and How to Troubleshoot
The first few days after birth can be the most trying for many mothers as they navigate breastfeeding. Our Expert & Family Medicine Physician, Dr. Rebecca Berens, gives her tips for beginning to breastfeed when you welcome baby!
The most important time to establish your milk supply is in the first few weeks of your baby’s life. Breast milk production is based on supply and demand, so the more the infant demands milk by feeding at the breast, the more milk you will produce.
Though starting to breastfeed can be tricky business (here's an article on preparing to breastfeed), here's what you need to know before you begin:
Skin to Skin Contact
It is recommended that as long as mom and baby are both medically stable, the infant be placed directly on mom’s chest at birth. Skin to skin contact is important for regulating baby’s temperature and promoting bonding between mom and baby. This bonding increases maternal Oxytocin production, which is important for milk production. Skin to skin contact is also important for helping baby latch, as baby has several natural reflexes that allow to to find the nipple and latch. Most babies will spontaneously latch at the breast in the first hour or so of life when placed on mom’s chest.
Deep, Asymmetric Latch
The key to “demand” for milk is making sure that baby has a good latch. An ineffective latch will not allow the baby to transfer much milk from the breast. Therefore, even though the baby is latched frequently, if milk is not being removed or transferred well, the breast will not be stimulated to produce more. An ideal latch is deep with the majority of the areola within the baby’s mouth, and slightly asymmetric. Later in the this article, I'll give recommendations on how to encourage a good latch.
There are several resources available online to help with latching - I recommend KellyMom.com. If latching or feeding is painful, or if there is any trauma to the nipple, it is important to involve a lactation professional early to help assess the situation and correct this to prevent nipple damage and low supply. If mom and baby need to be separated or if the baby is not able to remove adequate milk by direct feeding alone, it is recommended that the mother express breast milk to empty the breast at least 8-12 times per day. This will allow her to build and maintain supply while these issues are being addressed.
When To Introduce Bottle and/or Pacifier
If infant supplementation is needed due to separation of mom and baby for medical reasons, or while addressing problems with low supply or inadequate transfer of milk, it is recommended to avoid bottle use and supplement using alternative methods at the breast or with a cup or spoon until a good latch is well established (usually around 3-4wks old). If bottles will be needed later for feeding, such as if the mother will be separated from the baby while working, it is recommended to introduce the bottle by around 6 weeks old. Later introduction can sometimes result in infants that will refuse to use a bottle, which can be very stressful for the mother.
Steps to a Good Latch
When trying to get your baby to latch properly, there are several steps you can take to make sure baby is latching well. Remember, how it feels and works is much more important than how it looks.
1. Aim nipple to baby's nose
2. Support neck and shoulders, don't only hold behind the head
3. Hold breast like a sandwich
4. When baby lifts chin and mouth opens wide, guide them towards the breast
Common Breastfeeding Problems & Troubleshooting
Nobody's breastfeeding experience is perfect and you are bound to run into problems at some point. Have no fear! These problems, for the most part, are totally normal. If you do experience issues, be sure to also contact your doctor and/or lactation consultant for help.
Low Milk Supply
Low milk supply can be a result of medical or anatomical problems, but is more commonly due to inadequate demand resulting in inadequate supply. Medical conditions that can impact milk production include diabetes, thyroid problems and other endocrine diseases, severe anemia, and retained placental tissue. A history of certain breast surgeries can also impact supply. Some women have anatomic differences in their breasts such as tubular breasts or insufficient glandular tissue that also result in inadequate milk production.
Inadequate demand is commonly due to infrequent breast emptying (in the newborn period breasts should be emptied minimum 8 times in 24 hours, preferred 10-12 times in 24 hours). This can happen when milk supplementation is provided, as infants therefore take in less milk at the breast or feed at the breast less frequently. If supplementation is provided, mothers should pump to replace these feedings to maintain supply.
Inadequate demand can also be caused by an inefficient latch which results in incomplete emptying of the breast. This can happen if the infant is born before 39 weeks, even if not premature, or if there is an anatomic problem such as a tongue tie. It is important that a lactation professional assess these situations early to address any problems and help create a plan to develop and maintain adequate milk supply.
Signs of Low Milk Supply
Below are signs of low milk supply. This can be difficult to determine on your own early on, so it is important to keep appointments with your pediatrician so these assessments can be made. Most babies need to be seen within a few days of discharge from the hospital to monitor weight and assess for jaundice.
1. Low urine output
2. Inadequate bowel movements
3. Poor weight gain
4. Jaundice
Nipple/Breast Pain
There are various causes of nipple and breast pain during breastfeeding. The important thing to know is that pain with breastfeeding is NOT normal and you should not suffer through it - you should seek help immediately if you are having pain! Pain can be caused by a poor latch which can result in nipple trauma. Engorgement and clogged milk ducts can also cause pain, and clogged ducts can progress to a serious infection such as mastitis. Clogged ducts can be prevented by ensuring that milk is removed from the breasts regularly and breasts are emptied with each feed. Infections of the nipple such as yeast infections or bacterial superinfection of wounds to the nipple can also cause pain.
When to Seek Help
These are all warning signs of problems that require intervention from a professional.
1. Nipple or breast pain
2. Nipples flattened or dented after breastfeeding
3. Cracks, bleeding, or drainage on nipples
4. Fever, redness, breast hot to touch, flu-like symptoms (call Doctor immediately!)
If you are experiencing pain or notice deformities or trauma to your nipples after feeds, please seek help from a lactation professional immediately. Cracks, bleeding, or drainage on the nipples also need to be assessed by a lactation professional and/or your doctor for treatment. If you experience fever, flu-like symptoms, redness, warmth and/or pain in one or both breasts, this needs to be quickly assessed for mastitis. Mastitis can become serious very quickly without treatment - do not delay and reach out to your doctor as soon as you notice these symptoms.
Reliable Resources You Can Always Refer To:
• Your doctor (OB or PCP) or midwife, baby’s pediatrician
• Local lactation professionals: https://uslca.org/resources/find-an-ibclc
• La Leche League: https://lllusa.org/
• WIC: https://wicbreastfeeding.fns.usda.gov/get-support-wic
Have more questions? Dr. Berens is available 24/7 on SocialMama to help you when you need it most. Links to download the app below.
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About the Contributor:
Dr. Rebecca Berens is a board-certified Family Medicine Physician with expertise in Women's Health and Breastfeeding Medicine. Her holistic approach serves patients from newborns to elderly, focusing on the physical and mental well-being of each family member. She is the practitioner at Vida Family Medicine in Houston, TX, and is an Expert on the SocialMama app!