#86 | Breastfeeding Mini: The Three Most Common Challenges for Breastfeeding Moms

March 15, 2021

In today's minisode, Trisha reviews the three most common challenges that breastfeeding  moms experience: Engorgement, Nipple Pain, and Supply issues. She briefly explains why they occur and offers simple steps to recognize and resolve each issue so that you may comfortably and easily continue your breastfeeding journey.

See other episodes on breastfeeding:

#33 | Breastfeeding Mini: Out With The Rules, In With Your Instincts

#44 | Breastfeeding Mini: The First Week of Breastfeeding and Why it Matters Most

#56 | Breastfeeding Mini: The Importance of Establishing Your Milk Supply in the First Month

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If you enjoyed this episode of the Down To Birth Show, please subscribe and share with your pregnant and postpartum friends.

Between episodes, connect with us on Instagram @DownToBirthShow to see behind-the-scenes production clips and join the conversation by responding to our questions and polls related to pregnancy, childbirth and early motherhood. You can reach us at Contact@DownToBirthShow.com or call (802) 438-3696 (802-GET-DOWN). We are always happy to hear from our listeners and appreciate questions for our monthly Q&A episodes. To join our monthly newsletter, text "downtobirth" to 22828.

You can sign up for Cynthia's HypnoBirthing classes as well as online breastfeeding classes and weekly postpartum support groups run by Cynthia & Trisha at HypnoBirthing of Connecticut

Please remember we don’t provide medical advice, and to speak with your licensed medical provider related to all your healthcare matters. Thanks so much for joining in the conversation, and see you next week!

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View Episode Transcript

Hey everyone, it is minisode Monday and I am back today to talk about more breastfeeding stuff. So, so far we have talked in Episode 33 about the first three days and trusting your intuition and instinct overrules. We talked in Episode 44, about the first week of breastfeeding and why it's so important, and how to get started. And then again in Episode 56, we talked about why the first month of breastfeeding matters more than anything else. Today, we're going to talk about the three most common challenges that new mothers face, from the mother side, their issues from the baby side as well. But the focus of today's episode is going to be on the challenges a mother may experience. So while each of these three things we could talk in way more detail about because this is a minisode. I'm going to keep it brief. But we're going to talk today about engorgement, nipple pain and milk supply issues. engorgement is the easiest of all these things to remedy and probably the most common thing that people experience. It occurs when milk initially comes in. This usually happens on day four, but can also occur anytime that milk is not removed from your breasts for an extended period of time. So later on, if you oversleep, or you skip a feed or you're out and about and you don't have the opportunity to feed your baby, you can get engorged. The initial period of engorgement is the result of your milk sort of flooding into your breast and the tissues expanding and getting overly taut. So your breasts may feel overly full, they may feel tight, your nipples may get flat, and it may make it difficult if not impossible for your baby to latch. So obviously, not having your baby latch is definitely not a good thing. And we have to find a way to get that baby on the breast, one to feed the baby and to to relieve the encouragement. So the simplest solution to resolve and guardsman in a baby who is able to latch is to feed frequently even every hour until it resolves, then you're past it and you can just go on with a normal feeding cue schedule. If you're not able to latch your baby on to the breast then you will need to use your hand a hand pump or an electric pump to relieve enough pressure in the breast so that your baby may then be able to latch on you may even need to empty the breasts fully. Before you can attempt to latch The baby on the use of warm and cold compresses can also be really helpful with encouragement. So ideally, you would use warm compresses before attempting to feed and cold compresses after. So warm compress could be a warm washcloth. It could also be standing in the shower letting the warm water run over your breast. Some women will even submerge their breast fully into a bowl of warm water and find that that is very relieving. And that the milk will actually just start flowing into the water. cold compresses after feeds are helpful in reducing any inflammation that's happening and also slowing the milk flow as it's coming in and creating the engorgement, the cold compress will help just to slow that down. So the combination of it being anti inflammatory and slowing the milk production can be enough to reduce the engorgement without compromising your overall milk supply. You may also want to take an anti inflammatories such as ibuprofen or Advil that can be really helpful for 12 to 24 hours. Again working on the anti inflammatory process. engorgement should resolve within one to two days. And again, it usually happens on the third or fourth day, or can happen anytime you skip a feed or have a prolonged period of time in between feedings. The second most common problem for breastfeeding mothers is nipple pain. And this one is all too common, and is one of the main reasons that mothers discontinue breastfeeding, even if their intention is to breastfeed for a longer period of time. And the truth of the matter is that breastfeeding should not hurt many of us believe that it's normal for breastfeeding to hurt just a little or maybe a lot and outside of a little bit of discomfort, mild to maybe moderate discomfort in the first seven to 10 days, it should not hurt. And even in those first seven to 10 days it should be a mild discomfort that resolves within the first minute of breastfeeding. If you're breastfeeding pain is lasting longer than that then something is wrong and something needs to be fixed. So clear indicators of abnormal pain in breastfeeding our pain that lasts throughout the entire or most of the feed anything that's toe curling kind of pain, broken skin on the nipple blisters, or blanching of the nipple and that means it's turning white after a feed or just even an emotional sensation of dreading the next feed because you know it's going to hurt that much. So what causes breastfeeding pain? Well, the number one reason is shallow latch and you know you have a shallow latch if your nipple looks pinched after a feed or as As I said before the blanched or white tip at the end of a feed, or if it looks like the tip of a brand new tube of lipstick. So if you're experiencing any of these things, the first thing you're going to want to do is work toward improving the latch. And the best way to do that is to seek the help of a lactation consultant who can guide you on proper latch technique. Don't try to tough it out. Don't just think that you know, if I just keep out this, it's gonna get better because your nipples don't toughen up any improvement that may happen. Naturally over time is a result of you and your baby actually getting better at latch technique, not because your nipples have adjusted to a poor latch. Our nipples are not like our hands or feet that didn't, you know, get tougher and develop calluses over time. They are delicate, and they should never have broken skin, they should never be bleeding, and they shouldn't blister. So if you have sore nipples, and while you're working to improve the latch, it may help to start breastfeeding on the less sore side. Typically, mothers do have one nipple that's a lot more sore than the other. Because babies latch differently on each side and our breasts also are different and our nipples are different. So start starting on the less sore side allows you to be more comfortable, and it allows your milk to start flowing and it allows your baby's appetite to get a little bit satiated. And what we definitely know is that once our milk starts flowing, babies tend to relax their mouths more, and they tend to latch on a little bit more deeply. And the more satiated they get as they eat, the more relaxed they are during a feed. So a relaxed baby is always going to latch better than an overly hungry or just hungry baby. So by starting on the side that is less painful, you may be able to then move them to the more painful side and have a better latch. However, if your pain is persisting through all this and that simple technique is not enough to resolve it, then you may need to take a nursing break. My test for mothers is always that if you are in the shower, and you fear the towel touching your nipples when you get out and dry off, or just letting the water hit your nipples in the shower. If that is causing you to turn your back to the shower water or avoid the towel when getting out of the shower, then that's an indication that your nipples are damaged enough that you probably need or should take a nursing break. I'm not going to go into what it means to take a nursing break in this episode, because that's more detailed and very specific to each mother and baby. But I would advise if you're in that position to definitely seek the help of a lactation consultant to specifically develop a care plan for you and your baby. So another really common reason that mothers have nipple pain is infection, it could be fungal or it could be bacterial infection of the nipple thrush, or yeast overgrowth is the most common reason. And this is something that mothers and babies can both experienced mothers on the nipple, and babies in their mouth and through diaper rash, and they kind of can just keep passing it back and forth between each other. So typically this kind of nipple pain is more of a shooting sharp and burning kind. The nipples may or may not be read. And the baby may or may not have signs of thrush, which is the white plucky things on their gums and on their tongue or the diaper rash. Again, this is best to have it evaluated by a lactation consultant to confirm that this is what it is and then offer treatments. There are numerous ways to treat thrush both with prescriptive medication over the counter medication as well as natural and alternative remedies. As I said before, it's really important to make sure that you treat both the mother and baby otherwise the cycle just continues of mom giving it baby baby giving it back to mom and never getting resolved. So the third most common challenge in breastfeeding for mothers is related to supply either low milk supply or oversupply low milk supply or perceived low milk supply is a top reason that mothers stopped breastfeeding. So sometimes mothers stopped breastfeeding because they believe they don't have enough milk but in fact, they actually do or they're very, very near having supply equals demand and they just need to tweak things a little bit. But true low milk supply is indicated by most importantly poor weight gain and your baby. This can look like slow weight gain which contributes further to low milk supply not gaining at all, or worst case losing weight.

Other indicators that your milk supply may not be meeting your baby's current demand is your baby not pairing your is your baby not appearing satisfied after feeds. They may continue to route after feeds they may suck on their hands. They may have fussiness and crying. If you hold them up on your chest, they may throw themselves down toward your breast and look like they want to latch back on. They may have their hands clenched and just have general tension. So we're always looking for the baby to be in that state of milk drunk after a feed which means that they just look like they are as content is can be there hands are open and relaxed, their face is relaxed, their brow is not furrowed, they're not crying, they may even be asleep. Or better yet, they're just awake, looking around and not asking for anything, that's a sure sign that your baby has been well fed. If they're not looking like that frequently, and they're wanting to feed frequently, or sometimes when weight gain is really poor babies go very long periods of time in between feeds and oversleep, then this can be a sign of low milk supply. Another indicator that there could be supply issues is a baby who's fussy at the breast. babies who are experiencing low milk supply can pull off and be fussy at the breast or be difficult to latch on. And the same is true for babies who are experiencing oversupply they may pull off especially when the milk initially lets down. So in early and mild cases of low milk supply, simply increasing breastfeeds maybe enough. Pumping both your breasts simultaneously after feeds for approximately 10 to 15 minutes can really help to increase milk supply, followed by hand expressing for one to two minutes after pumping. And the reason that the hand expression after pumping, or if you choose just to breastfeed and you feel like your baby really has emptied your breasts, and you don't want to use a pump or you don't feel you need to pump after you can simply hand Express for one or two minutes. And that really gives your brain a very strong signal to increase milk production to increase supply for the next feed. So if you do this repeatedly, each time the baby feeds, your brain is going to get the message that you know what we got to step up the supply a little bit. In addition to pumping breasts or hand expressing an increasing feeds in general, you want to make sure that you feed your baby at all hunger cues. So don't write anything off as oh my gosh, you know, he or she just fed they can't possibly be hungry again or I don't want to overfeed them or you know, they must just be tired and need to sleep, any sign of hunger, which is sucking on their hands licking their lips, rooting reflexes, crying is a late sign of hunger. Anything that comes before that is an opportunity to feed and you want to take that opportunity, you want to abandon all scheduling and just feed your baby on cue. The other thing is when you're feeding your baby, you want to make sure that your baby is alert and active during the feed. So if you're starting to see your baby get sleepy on one side, you may just sort of stroke their back or find a way to sort of wake them up and keep them active at the breast. If they are very sleepy, you may even switch them to the other breast so side switching frequently. During feed sometimes going back and forth to each breast multiple times in one feed is a really effective way to keep your baby awake and also to give your brain and body the message that you need to make more milk. In the case of low milk supply and poor weight gain, your baby's weight will need to be tracked at least weekly, sometimes every few days. And babies who are gaining too slowly or are actually underweight may need a more advanced plan which can involve supplemental milk either donated or even sometimes the use of Formula under the guidance of a lactation consultant. And I say the use of Formula under the use under the guidance of a lactation consultant because I'm I'm speaking to the woman whose plan is to exclusively breastfeed. And if your plan is to exclusively breastfeed, introducing supplemental milk can significantly impact your ability to make milk if it's not done correctly. So finally, we have oversupply or, or an abundant milk production. This can also create breastfeeding challenges and in severe cases, it can be even more challenging than low milk supply. Low milk supply is a fairly simple process to remedy and oversupply in my experience can be a lot more challenging. So one of the things that we run into is mothers who are very concerned about going back to going back to work or they're so concerned about not having enough milk overall that they pump more than they need to driving up their milk production beyond what their baby actually needs. And then they start running into breastfeeding challenges with the baby and trying to get their milk supply to slow down trying to prevent blood ducks trying to prevent mastitis. All these things can be sometimes more challenging. So oversupply as I said can lead to pug ducks it can lead to mastitis it can lead to nipple pain due to the baby pinching the nipple to slow the flow of milk at the breast. So it's almost like your nipples a straw. And imagine if somebody is you know, just when you have a letdown, you have oversupply, you have this rush of milk going into your baby's mouth, and your baby's way of coping with that is to pinch the straw to slow the flow so that they don't choke. So choking gurgling, spitting out milk these are all signs That your baby may be experiencing either a true case of oversupply or sometimes it's just rapid milk ejection reflex. another indication of moms and babies who may be experiencing oversupply are babies who never seem satisfied after feeds. The reason for this is that even though they're consuming large amounts of milk, they're consuming the higher carbohydrate, lower fat, initial for milk that fills their belly and then they don't actually ever get to the fattier, denser milk that keeps them satiated for a longer period of time. So they can be gassy. They can be fussy, they can seem hungry, yet they don't want to eat mothers and babies who are experiencing oversupply can actually look like babies who are experiencing colic symptoms. So that excessive gassiness and you know, the squirming in the long periods of crying, sometimes are diagnosed as colic, but actually it really is just a case of formal kind milk imbalance as a result of oversupply if you think you're experiencing low milk supply, or oversupply both of these are situations where I highly recommend getting a lactation consultant involved so that they can properly evaluate both you and your baby and work with you to put together a care plan that is going to meet the specific needs of you and your baby. So those are the top three challenges for new moms breastfeeding as it relates to mother issues. As always, thank you for tuning in. And if this information was helpful to you, please subscribe to our podcast please leave us a review and please share it with somebody who may benefit from this information.

If you enjoyed this podcast episode of the Down To Birth Show, please share with your pregnant and postpartum friends.

Share this episode: 

Between episodes, connect with us on Instagram @DownToBirthShow to see behind-the-scenes production clips and join the conversation by responding to our questions and polls related to pregnancy, childbirth and early motherhood.

You can reach us at Contact@DownToBirthShow.com or call (802) 438-3696 (802-GET-DOWN). 

To join our monthly newsletter, text “downtobirth” to 22828.

About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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