Cathy Garbin, child health nurse, midwife and lactation consultant:
For seven years, Cathy was a Research Associate with the renowned Hartmann Human Lactation Research Group, while supporting breastfeeding mothers in their homes and in hospitals. The mum of two still works with families, and also conducts study days for healthcare professionals and speaks at international conferences.
Breastfeeding isn’t always easy and if you’re experiencing difficulties you’re not alone. In fact a US study of more than 500 mums found that 92% reported breastfeeding challenges by day three1. Thankfully, many early breastfeeding difficulties are simple to deal with – here are my solutions to the most common problems mums experience in the first week.
I have sore nipples what should I do?
Problem 1: Breastfeeding hurts!
Pain while breastfeeding is usually down to sore, tender nipples, especially once your milk ‘comes in’ around two to four days after giving birth.2 Your baby will be feeding every couple of hours, which means the problem can worsen quickly, with some mums finding their nipples crack, bleed or become blistered. Ouch!
- Check your baby’s latch. Your baby not latching correctly is the most likely cause of breastfeeding pain. Your newborn should have a large portion of the lower part of the areola (the dark skin around your nipple) in her mouth when she feeds, with your nipple against the roof of her mouth, cupped gently underneath by her tongue.
- See a lactation consultant or breastfeeding specialist to make sure your baby’s mouth and body are positioned correctly and that there are no other latching problems. They can also check inside your baby’s mouth to see if there is a physical problem.
- Try different breastfeeding positions. A laid-back, cross-cradle, underarm (‘rugby ball’) or lying-down hold may take the pressure off the most painful areas of your breast.
- Wipe damaged nipples gently with several pieces of water-moistened cotton wool after feeding to remove any debris that could lead to infection.
- Air-dry nipples or dab with a very clean, soft muslin or flannel, as infection can flourish in damp conditions. Use either disposable or washable nursing pads to absorb any milk leakage, remembering to change them regularly.
- Soothe your nipples. Relieve soreness and any dry skin with ultra-pure lanolin cream or gently apply a few drops of your own breast milk – you won’t have to remove either before the next feed. You could also try hydrogel pads straight from the fridge. These nipple dressings cool and provide instant breastfeeding pain relief, while creating ideal conditions for healing.
- Protect your nipples. Breast shells prevent your clothes from rubbing against sore areas.
- Be patient. Soreness normally settles down after a few days as your body gets used to breastfeeding and your baby’s sucking becomes more efficient.
- Consult a healthcare professional, lactation consultant or breastfeeding specialist if the pain while breastfeeding doesn’t subside after a few days. Ongoing nipple soreness can be a sign of an infection that may require medication.
Problem 2: My baby is not latching properly
Some newborns just don’t seem to manage to get a great latch – perhaps because you both need a little more time to get breastfeeding coordinated, or because they were born prematurely, are uncomfortable after a difficult birth, or their mum has flat or inverted nipples.
- Get support from a lactation consultant or breastfeeding specialist who can diagnose the cause of the problem and develop a plan to help you overcome it.
- Draw out inverted or flat nipples. Nipple formers fit comfortably inside your bra, and apply a gentle pressure that can help draw out your nipples to support breastfeeding.
- Adopt different holds to make things easier for your newborn. She needs to feel supported, comfortable, and able to breathe in order to feed effectively. Make sure you’re not holding her head or pushing it. A laid-back, baby-led feeding style encourages your baby to use her innate reflexes, making it easier for her to reach your breast and latch on.4
- Make tiny adjustments while feeding. Rather than take your baby on and off the breast, creating frustration for you both, try ensuring she’s well positioned and comfortable. Keep her body and bottom close to you, support her across her shoulder girth, and hold her firmly so she feels secure. Let her head rest on your wrist so it can tilt back slightly and allow more space for her nose to breathe. Her chin should be close to your breast. If minor adjustments don’t seem to be improving your baby’s comfort, seek support from a lactation consultant or breastfeeding specialist.
- Feed through nipple shields. If your baby will not latch on, a lactation consultant or breastfeeding specialist may recommend using nipple shields to give your baby a larger, firmer target to attach to. In general, nipple shields should be considered a short-term solution.
The top 8 tips if your baby has lost too much weight
Problem 3: I do not have enough breast milk
Initially you’ll make a small amount of breast milk because the hormonal changes that trigger your milk production happen slowly, and won’t be finished until around day two to four.2 This may cause you to worry your baby isn’t getting enough, but as her stomach is only tiny at first and she feeds frequently, it’s not a problem. During the first few days you only need to be concerned if your baby is losing more weight than expected and producing too few wet and dirty nappies, or is showing signs of dehydration. For a full explanation of how often your newborn should be weeing and pooing, read breastfeeding a newborn: what to expect in the first week.
- Seek support from a lactation consultant, breastfeeding specialist or healthcare professional, who’ll be able to assess if you have a milk supply problem. The earlier you get help, the better.
- Feed on demand, not to a schedule. In the first week after birth your newborn will want to feed at least every two to three hours (maybe more!) throughout the day and night. This frequency helps to build your milk production.
- Look after yourself. It’s not always easy with a newborn, but try to rest when you can, eat well, and get as much help as possible with chores and any older children so you can focus on breastfeeding.
- Try expressing. If your baby is feeding often and still not putting on weight, a lactation consultant or breastfeeding specialist may recommend pumping to build your milk supply. If your milk hasn’t come in yet, the Medela Symphony hospital-grade double electric breast pump has an ‘Initiate’ program that mimics the way a newborn feeds in the first few days.
Problem 4: My breasts are really full and hard
When your milk comes in, your breasts will become fuller and firmer. If your baby is feeding well and frequently, this should pass without problems. However, some women’s breasts become rock hard, and they may also be tender, uncomfortable, even painful – a condition called breast engorgement. Engorged breasts may also feel fairly hot due to all the activity inside – it’s like a traffic jam in there! Although it’s only temporary, often lasting 24 to 48 hours, engorgement can also make it difficult for your baby to latch, as your nipples may become flattened.5
- Feed your baby frequently. Aim to feed at least eight to 12 times every 24 hours. This is the primary treatment for this condition – for more tips and advice read our article on breast engorgement.6,7
- See a healthcare professional, lactation consultant or breastfeeding specialist if the symptoms last more than 48 hours, you have a fever, or your baby is unable to breastfeed because of the engorgement.
Problem 5: My breasts are leaking
Leaky breasts are very common in the early days of breastfeeding, once your milk has come in. You may leak from one breast when you’re feeding your baby from the other, when lying on your front while sleeping, or when something stimulates your let-down reflex unexpectedly – like another baby crying in the supermarket. Leaking usually settles down after six weeks or so.
- Protect your clothes by wearing disposable or washable nursing pads inside your bra day and night.
- Don’t waste a drop! Milk collection shells fit inside your bra to collect any leaked milk. They’re helpful when the leakage is too much for nursing pads, or if one nipple tends to drip while you’re feeding from the other. If you want to save the collected milk, you can, but only use milk you’ve collected during a breastfeed. Store in a sterile container and, if you’re not feeding it to your baby straight away, place in the fridge immediately and use within 24 hours. Don’t wear collection shells for more than two to three hours at a time.
Problem 6: I think I’m producing too much milk
Sometimes when your milk comes in, it really comes in! You may have a temporary oversupply for the first few weeks but it should settle down soon.7 Until then your breasts may feel painful and hard most of the time, even straight after a feed, and you might be leaking a lot of milk. Your baby may cough and splutter with the force of your let down, vomit as soon as she is moved after feeds, and have an uncomfortable tummy or explosive, frothy, greenish poos. All this suggests you may have too much milk, but this issue may resolve itself as soon as your breasts adjust to their new job.
- Express a little milk by hand at the start of each feed to reduce the force of your let down.
- Try the laid-back breastfeeding position so your baby can better control the flow of milk. Or use the cradle position: holding her across her shoulders, ensuring your baby’s head is tilting back slightly and resting on your wrist. Her body will be resting on yours, sloping down diagonally.
- Be gentle and patient. Allow your baby to rest and digest her milk, both during and after a feed. Moving her around too much or too quickly could make her feel sick. As she grows, she’ll get better at coping with the flow, which is likely to slow in any case.
- Use a towel or muslin cloth to soak up the surge if your baby gets overwhelmed when your milk starts to flow, and put a milk collection shell on your other breast to catch any leaks.
- Seek advice from a lactation consultant or breastfeeding specialist if you’re still having difficulties after several weeks. They will assess you, and may advise on one-sided feeding or block feeding if you need to reduce your milk supply.