Common Breastfeeding Problems 

Breastfeeding is a normal, natural process, but that doesn’t always mean it’s easy. When you think about breastfeeding before you have a baby, you probably think of all the benefits:

  • Health and immune system benefits for your baby
  • Nutrition that adapts to the changing needs of baby’s growing bodies and minds
  • Reduced rates of breast, ovarian, and uterine cancer, heart disease, diabetes, and postpartum mental health issues for moms

But while we love to talk up the fact that breastfeeding is amazing, there’s another side to the story.

Breastfeeding can be challenging. Even the most successful breastfeeding experience may have bumps. Whether it’s the initial discomfort as you and your baby learn how to breastfeed together or suffering through a bout of mastitis 6 months into your journey, no breastfeeding journey is entirely smooth sailing.

“Learning what is and is not normal in the early days is really valuable. Sometimes after the birth, a situation arises that makes learning a new skill difficult. This could be anything from problems with Mom or baby, normal post partum pain or fatigue or perhaps the fact an IBCLC on the floor isn’t available during your stay. Knowing the basics beforehand and that you have an IBCLC ready to help you after you get home can be a huge benefit for the whole family”.

Joanna Kreyling, PNP, IBCLC

Learning what is and is not normal in the early days is really valuable. Sometimes after the birth, a situation arises that makes learning a new skill difficult. This could be anything from problems with mom or baby, normal postpartum pain/fatigue or perhaps the fact that an IBCLC on the floor isn’t available during your stay. Knowing the basics beforehand, and that you have an IBCLC ready to help you after you get home can be a huge benefit for the whole family

It’s important to talk about the challenges, though, because no mom should feel alone, discouraged, or hopeless during this time.

Our mission at Nest Collaborative is to support moms in all aspects of breastfeeding so that they can get the help they need AND deserve.

Don’t Ignore Breastfeeding Problems

For moms, especially first time moms, figuring out how to fix a breastfeeding problem can feel baffling. You’re learning this whole new skill, after all!

The first thing to do is to get help. Breastfeeding problems don’t go away on their own, but lactation consultants know what to look for. What’s more, they’re here to help you meet your goals.

“If you get to the root of the problem, not only can you resolve it, but you can also prevent it from recurring,” says Joanna Kreyling, IBCLC and Director of Clinical Operations at Nest Collaborative.

And remember, breastfeeding problems are common. If you’re experiencing a problem, take heart in the fact that other moms have dealt with it too!

Breastfeeding doesn’t have to look just one way. Our goal at Nest Collaborative is to help breastfeeding moms find a path that works for them and their families. If you need help, we’re just a video call away.

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Most Common Breastfeeding Problems

While every mom, baby, and breastfeeding experience are unique, some problems are pretty common. If you’re struggling with one of these issues, take heart. These issues can all be resolved!

Breastfeeding and Pain

Breastfeeding pain is common. A study conducted by the FDA and CDC from 2005-2007 discovered that 75% of breastfeeding new moms experienced pain during their first 2 weeks postpartum, but only 54% of these moms sought help for it.

For some moms, nipple injury causes breastfeeding pain.

Nipple Injury

If you’ve never breastfed before, your first couple of feeds can be uncomfortable. It’s a whole new sensation–a strong tugging, pulling feeling as your baby latches and then the “pins and needles” of the letdown. And remember, your baby is new at this and may need help too.

You should get used to the unique sensation of breastfeeding within a couple of weeks, and it should never feel painful. If it is painful, though, you’re likely experiencing a nipple injury. You might notice bleeding, redness, cracks, nipple blisters, and other physical signs of damage.

Nipple injuries can have several causes:

  • Poor latch
  • Lip or tongue-tie
  • Unusually strong sucking/clamping by baby
  • Inverted or flat nipples

Dealing with Nipple Injury

There are two parts to handling a nipple injury. You need to address the cause of the injury and you need to help your nipples heal.

To address the cause of your nipple injury, it’s helpful to work with a lactation consultant. They can pinpoint what’s causing the injury in the first place and teach you techniques and practices to keep it from recurring. For example, if your baby has a bad latch, they can help you practice latching so your baby gets enough breast tissue in their mouth and find the right nursing positions for you and your baby.

To heal the nipple injury itself, you should focus on keeping your nipples dry and protected. After nursing, apply either breast milk or nipple balm and let them dry before covering them with a nonstick nursing pad. If the breasts are especially sensitive, gel-based nipple pads can provide stronger relief. Talk to your doctor about taking an over-the-counter (OTC) pain reliever such as acetaminophen or ibuprofen before feeding.

Other Causes for Breastfeeding Pain

Breastfeeding pain and discomfort often come from the breast tissue itself or a combination of breast and nipple pain.

There is a whole range of reasons for breastfeeding pain, including:

  • Engorgement
  • Clogged milk ducts
  • Nipple blisters
  • Mastitis
  • Thrush

Engorgement

Your body starts producing milk halfway through your pregnancy, but it’s actually colostrum you’re making. While the thick, creamy colostrum is perfect for your newborn baby, your mature milk usually doesn’t come in until 3-5 days after giving birth.

When your milk comes in, it can come in quickly and in large volume. As such, it’s extremely common to have engorgement. In fact, around two-thirds of all women experience engorgement in those first days.

Engorgement can make your breasts feel hard, lumpy, hot, throbbing, or swollen. However, engorgement is a passing phase when you have a baby that is latching well. Once your body and your baby get used to breastfeeding, the engorgement and discomfort will pass.

Engorgement doesn’t just happen when your milk comes in. It can occur anytime you aren’t sufficiently emptying your breasts. Engorgement can happen if your baby sleeps longer than expected, if they miss a nursing session, or during the weaning process as your baby gradually nurses less.

What To Do About Engorgement

The key to relieving engorgement is to nurse frequently, so your breasts are fully emptied. To help with this, consider the following:

  • Use a warm compress before feeding to help encourage milk flow.
  • Massage breasts while feeding to empty your breasts.
  • Hand express or pump your breasts to relieve discomfort, especially if your breasts feel full after a feeding.

Be careful of pumping or hand expressing when dealing with engorgement, though. You want to avoid creating oversupply!

There are many home remedies for issues like engorgement. Think cabbage leaves, potato poultices, and more. While we don’t dismiss home remedies, we always want to ground our recommendations in evidence. If you want to know the science behind our approach, just ask!

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Leaking Breasts

Leaking breasts is another common breastfeeding issue.
But remember—it’s completely normal. As your milk supply gets established during the early weeks of nursing, you may find yourself leaking when you hear your baby cry, think about your baby, or go too long without nursing. Your breasts also might leak right before it’s time to feed your baby. This is quite normal. It’s your body letting you know it’s time to nurse. If you’re looking to avoid leaking, get baby skin-to-skin and feed as soon as you feel your breasts getting full. Feeding when you’re full can help prevent clogs, mastitis, and low supply. (It’s OK to wake up your baby to breastfeed if you’re uncomfortable.)

How To Prevent Leaking

You may be able to apply pressure to your breasts to slow milk flow, especially if your milk supply is established. But while you can’t always prevent leaking, you can keep it from soaking through. If you find you’re prone to leaky breasts, wearing nursing pads can help. Dark and patterned shirts can also help camouflage any milk stains.

Clogged Milk Ducts

Milk ducts deliver your breast milk from the mammary glands to your baby. When things are flowing right, it’s easy to forget about them. But if they get clogged, you’ll recognize it quickly!

Clogged milk ducts may be due to not emptying your breasts fully with nursing or pumping, wearing tight tops or bras, and delaying or skipping a nursing session.

When milk ducts get clogged, your milk will back up and create hard, tender lumps. These clogs, if not resolved, can lead to breast infections like mastitis.

How To Treat Clogged Milk Ducts

Keep breastfeeding while you have clogged milk ducts. Breastfeeding keeps your milk flowing, which helps unclog the duct. Don’t worry. It is safe. Nursing may also help to relieve some of your discomfort from the clog.

You can also try one of these home remedies to treat clogged milk ducts:

  • Apply a warm compress on your breast before nursing
  • Use breast massage to break up the clog
  • Try dangle feeding*
  • Pump until your breasts are empty

If your clog doesn’t resolve, if the tender area becomes red, or if you develop a fever, make an appointment to speak with your medical care provider.

*Dangle feeding is a method of breastfeeding where the mom leans over the baby to nurse. This position uses gravity and the baby’s sucking to move the clog.

Nipple Blisters

There are two types of nipple blisters that you might experience in breastfeeding: milk blisters and friction blisters.

Milk Blisters

Milk blisters, also known as “blebs,” occur when a bit of skin grows over a milk duct opening. These blisters cause milk to back up, creating a painful white, clear, or yellow spot on your nipple or areola. While milk blisters can seem to pop up out of nowhere, they will resolve in a couple of days once the source of the problem resolves.

Milk blisters have a range of causes:

  • Thrush
  • Poor latch
  • Tongue and lip-tie
  • Poorly fitted pump
  • Tight-fitting tops or bras
  • Milk oversupply

Milk blisters often don’t require special treatment to go away, but if you’re experiencing discomfort, try applying moist heat or taking a hot shower. You can help open the blister when nursing your baby, pumping, or hand expressing to clear the duct.

Make sure to talk to your doctor about taking pain relievers or if you’re experiencing ongoing pain. Untreated milk blisters can lead to clogged ducts and mastitis.

Friction blisters

Friction blisters are a different type of blister. Unlike the little white or yellow spots of milk trapped under the skin, friction blisters are actually on the nipple itself. These blisters are from the wear-and-tear of breastfeeding, particularly when a baby has a poor latch, a strong suck, or a mom has a poorly fitted nipple shield or pump.

As with any nipple injury, the key is to allow the skin to heal. Express milk, then air dry. Nipple balms and nonstick nipple pads can help reduce friction, chaffing and provide relief.

Mastitis

While mastitis can start as a clogged duct, it can become a serious breastfeeding issue. While some moms experience mild cases of mastitis that are treatable at home, ignoring the symptoms can lead to bacterial infection, abscesses, and a negative impact on your milk supply.

Mastitis is an inflammation of breast tissue due to a prolonged clogged duct, bacteria entering the breast through a cracked or sore nipple or a general build-up of milk in your breast.

The signs and symptoms of mastitis may include

  • Intense breast pain
  • Warm, red, or sore spots on the breast
  • Fever
  • Fatigue
  • Nausea
  • Aches
  • Chills
  • Swollen, painful lymph nodes

How to Treat Mastitis

As with any health issue, make sure to get plenty of rest and drink lots of fluids.

It’s important to continue nursing or pumping during mastitis—and to empty your breasts fully. Although painful, the milk flow will keep the mastitis from getting worse and will more importantly protect your milk supply. If breast pain is significant, try using warm or cold packs on the infected breast.

Depending on your symptoms, you may need an antibiotic. If you’re prescribed antibiotics, make sure to take them as directed and take the entire course of antibiotics. Note, however, without treating the root of the problem, mastitis can recur even with antibiotics.

It’s important to talk to an IBCLC quickly when you’re experiencing mastitis symptoms— they can help you identify the source of the mastitis and figure out when you need an antibiotic.

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Milk Supply

Milk supply is a perennial concern for moms. Whether worrying about undersupply or oversupply, it’s one of the biggest questions we get at Nest Collaborative.

“Breastfeeding in American culture is conflicting,” says Joanna Kreyling.

“Breastfeeding is best for you and baby, yet it is hard to have a good supply. Many moms believe that it is necessary to use supplements or foods, have a freezer stash, pump to keep milk supply, have large breasts, or even make as much as your neighbor. These messages make breastfeeding harder than it needs to be.”

Undersupply

Worrying about undersupply is understandable. When you’re breastfeeding, specifically when you’re nursing, you can’t see exactly how much your baby is getting at each feed. And pumping isn’t the best way to measure your supply, as many moms don’t respond the same to the pump as they do to nursing.

Most moms don’t have a low supply. Generally, if your baby has enough wet and dirty diapers and is gaining weight along their growth curve, then they’re getting enough milk.

If your baby isn’t gaining enough weight or isn’t producing enough diapers, then it’s time to talk to an IBCLC. They can observe nursing behavior and the baby’s latch, which can help assess milk transfer.

Sometimes moms worry about lack of weight gain, thinking they’ve got a supply issue when in fact, a tongue or lip-tie can cause the baby to work so hard at nursing that they burn more calories than they take in. In those cases, fixing the tongue or lip-tie can often resolve the problem entirely, as long as the tongue or lip-tie release procedure is done correctly and parents carefully follow post operation care instructions.

How to Treat Low Supply

Milk supply is a supply and demand issue. If you’re struggling with low supply, make sure you’re practicing on-demand breastfeeding and allowing your baby to nurse to completion. Incorporating massage and compression can help remove all your milk, which then tells your body to make more milk. This practice benefits your baby too, as the milk at the end of a feed (also known as hindmilk) is fattier and keeps your baby satisfied.

You can also follow a nursing session with a pumping session to help boost your supply.

Moms are often curious about options for diets, supplements, or prescription medications to help boost milk supply. Talk with your IBCLC about these options and whether they’re right for you.

Oversupply

While many moms would love to have too much milk, oversupply poses its challenges.

  • Fast letdowns can make your baby choke, spit-up, or hiccup, as well as cause gassiness, crying, and frothy green stools.
  • Increased risk of nipple injury (baby may clamp down on your nipple to stop a strong flow)
  • Increased likelihood of clogged ducts and mastitis
  • Increased risk of Breast refusal and difficulty feeding in public

How to Treat Oversupply

Treating oversupply while still protecting your milk supply is a balancing act. You can help make your milk flow more comfortable for your baby by nursing in a laid-back, reclining, or side-lying position.

While you should continue to nurse on-demand, you can try block feeding to slowly and safely decrease your supply without risking clogged ducts. Block feeding is a technique where you feed only from one breast per feed rather than from both. Consult with an IBCLC to help create a plan.

Tongue and Lip-Tie Conditions

Tongue and lip-tie conditions are frequently discussed concerns with breastfeeding moms.

Also known as ankyloglossia, tongue-tie means that the frenulum—the tissue joining the bottom of the tongue to the floor of the mouth—is too short or tight. This condition can lead to difficulty nursing because of the tongue’s limited range of motion.

Lip-tie is similar, although less frequently diagnosed, where the upper and or lower gum is too short or tight, causing the lips to have difficulty creating a seal against the breast.

While some tongue and lip-tie conditions don’t cause noticeable problems, others make it difficult for a baby to latch on during breastfeeding. Pay attention to these signs.

  • Baby makes a clicking or smacking noise when sucking
  • Baby’s cheeks dimple when sucking
  • Baby seems sleepy or lazy while nursing
  • Baby drools excessively
  • Baby has poor weight gain
  • Baby chews at the nipple when nursing
  • Mom experiences pain with breastfeeding
  • Mom’s breasts remain full after nursing
  • Mom experiences chronic milk blebs, mastitis, and clogged ducts

It’s common to talk about tongue and lip-tie in degrees of severity but remember, what you and your baby are experiencing is more important than a diagnostic chart. If you suspect your baby has tongue or lip-tie, it’s essential to see a dentist with experience evaluating and treating tongue and lip-tie conditions.

How to Treat Tongue and Lip-Tie Conditions

If your baby struggles to latch or stay latched, speaking with an IBCLC is an excellent place to start. These highly experienced lactation consultants can work with you to see if a tongue or lip-tie is affecting your baby.

If it is the culprit, there are lots of options:

  • Tongue and lip-tie revision surgery
  • Special nipple shields
  • Strategic nursing positions
  • Therapy techniques to improve mobility

While IBCLCs can help identify issues with tongue and lip-tie, they can’t diagnose them. A dentist is the best healthcare provider to evaluate and treat these conditions.

Resolving a tongue or lip-tie goes beyond breastfeeding issues. An untreated tongue-tie or lip-tie can lead to:

  • Difficulty with speech
  • Orthodontia
  • Aversion to solid foods, particularly texture foods
  • Reflux symptoms
  • Sleep apnea
  • Bedwetting

Thrush

Thrush, caused by Candida Albicans, is a breastfeeding issue that concerns both you and your baby. Thrush affects your breasts, nipples, and other parts of your body, as well as your baby’s mouth and bottom area. Thrush thrives in warm, moist areas, so any skin that touches other skin is vulnerable.

Thrush can be identified by:

  • Persistent nipple pain, often burning or itchy
  • Red, shiny, or flaky nipples
  • Rash-like blisters
  • Cracked or damaged nipples
  • Shooting pains in the breast

Thrush is highly contagious, which means not only is it often found on both breasts, but it’s rarely confined just to the mom. If your baby is nursing and you have thrush, he or she likely has it as well. Signs of thrush in your baby include:

  • White patches on the tongue, lips, gums, or roof of the mouth
  • Cracked skin at corners of the mouth
  • Diaper rash
  • Reluctance to feed
  • Fussiness or discomfort

How to Treat Thrush

It’s critical for both you and your baby to receive treatment for thrush. The preferred course of treatment by the Academy of Breastfeeding Medicine (AMB) is nystatin. They also recommend:

  • Topical azole antifungal ointment or cream
  • Nystatin suspension or miconazole oral gel for infant’s mouth
  • Gentian violet (less than 0.5% aqueous solution) for no more than 7 days

Thrush symptoms may take some time to resolve, so it is recommended that you:

  • Continue to offer your baby frequent feedings, starting with the least painful breast.
  • Take oral probiotics
  • Change nursing pads when wet
  • Wash anything that touches your breasts or the baby’s mouth in very hot water
  • Rinse your nipples with clean water and allow them to dry thoroughly after nursing before applying antifungal cream.
  • Talk to your doctor about OTC pain medication.
  • Wash your hands thoroughly after nursing your baby or changing diapers.

When to Call an IBCLC

Breastfeeding can be challenging, but IBCLCs want you to have a rewarding, nourishing breastfeeding experience. There’s a path forward for every problem that will help you meet your breastfeeding goals, whatever they are.

But when is it time to contact an IBCLC?

If you have:

  • Sore or injured nipples
  • Clogged ducts
  • Mastitis
  • Thrush
  • Engorgement
  • Low supply
  • Oversupply
  • Breastfeeding pain
  • Have questions about pumping
  • Need to take medications
  • Needs advice on weaning
  • Nursing multiples or tandem nursing
  • Nursing during pregnancy
  • Induction of lactation for adopting moms or moms having their baby via surrogacy
  • Difficulty nursing a previous child
  • History of breast injury or surgery
  • Stress or anxiety surrounding breastfeeding

If your baby:

  • Struggles with latching
  • Isn’t gaining weight well
  • Fusses during or after breastfeeding
  • Has eczema
  • Refuses the breast
  • Has worrisome stools (frothy, bloody, mucous)
  • Biting and teething at the breast
  • Frequently spits up
  • Is jaundiced
  • Was premature or has special needs

Or any time you have questions or concerns about how breastfeeding is going!

If you’re experiencing any of these problems, book a convenient online video appointment with a Nest Collaborative IBCLC.