Breastfeeding Problems: What You Might Encounter

Have you heard through the grapevine that breastfeeding is extremely painful and difficult? Well, it doesn’t have to be. While breastfeeding is no walk in the park, the earlier you get professional help, the easier your journey may be.

How problems start:

Unfortunately, breastfeeding isn’t as instinctual as we would like it to be. There are quite a few things that can hinder breastfeeding, including insufficient glandular tissue, PCOS, diabetes, thyroid problems, blood loss, retained placenta, high levels of stress, and certain medications. But even if you have any of the mentioned causes, that doesn’t mean you won’t be able to breastfeed. Taking prenatal breastfeeding classes and getting help right after delivery may be helpful. There are various interventions that can increase your odds of successfully breastfeeding.

Milk supply:

A pregnant body starts to make breast milk at around 12-18 weeks. Ideally, the breast will grow by at least one cup size throughout pregnancy. The areola can also change color.

The first breast milk is called Colostrum, which can be yellow and thick or clear and runny. It is rich in protein, antibodies, sugar, and fats. Colostrum builds up a baby’s immune system, coats their intestines, and creates a healthy gut biome.

When in the hospital, you may not see a lot of colostrum. This leads many patients to believe they have a low milk supply. Your lactation consultant can help you learn how to hand express to help with milk production and flow. Hand expressing is a great way to get colostrum out if baby is not latching.

Pumping may also be needed, so it is important to have the pump beforehand. Many insurance companies cover the cost of a pump completely. Once you receive the pump, the next step is to make sure you have the right flange size. Bigger breasts do not mean you need a bigger flange, it all depends on your nipple size. Not using the right size can cause damage to the breast and can cause a supply decrease.

If you have a breast pump with the correct flange size, it would be great to bring it along to the hospital so you can start using it after birth. Hospitals rarely provide a variety of flange sizes, which leads moms to using the wrong size.

Breast Milk Transition:

After 3–4 days of making colostrum, your breasts will start to feel firmer and engorged. This occurs because your milk supply is changing from colostrum to mature milk. This can be very painful and uncomfortable.

Ideally, the breasts can be expressed every 2-3 hours by feeding baby or pumping. This will decrease the chances of engorgement and any other painful breast infections like mastitis.

If baby is having trouble latching, doesn’t have a good latch, mom isn’t hand expressing correctly, or the pump flange size is incorrect, the chances of engorgement and infection are greater. This can be anxiety inducing because the mom is in pain and the baby isn’t eating well.

Pain While Feeding:

Many women have heard through friends, family, or the internet that breastfeeding hurts at the beginning, but if you stick with it, the pain will eventually go away. However, breastfeeding should not hurt. If there is breast or nipple pain, that means the baby’s latch is not good, the breastfeeding position isn’t ideal, or the baby is tongue tied or has thrush. Reach out to a lactation consultant to get an oral assessment if you are experiencing pain.

5-12% of babies are born with a tongue, lip, or buccal tie. Some signs are a shallow latch, compressed nipple (shaped like lipstick), painful breastfeeding, fussiness, gassiness, a white tongue, clicking while feeding, and open mouth sleeping. If baby’s tongue does not go out past their lower lip or touch their palate when crying, this can also be a sign.

Your nipples should not be scabbed or bleeding. If you are experiencing pain or soreness, you can find some relief through nipple cream, hydrogel pads, warm or cold compresses, epsom salt soaks, or medihoney. For severe pain please contact your provider to get proper treatment.

Infection:

If your breasts aren’t emptying well, this can lead to clogged milk ducts and mastitis. To help prevent infection, you can massage the breast while baby is feeding or you are pumping. Mastitis can appear suddenly, and symptoms include breast tenderness or warmth to the touch, breast swelling, skin redness, breast thickening or a breast lump, pain or a burning sensation while breast-feeding, flu-like symptoms with a fever. Antibiotics are needed to resolve mastitis. Your provider will also likely encourage you to continue breastfeeding through mastitis.

Mental Health:

Dysphoric milk ejection reflex, or D-MER, is a condition that affects some lactating women. It causes dysphoria, or a state of feeling unhappy, right before your breasts release milk. It shouldn’t last more than a few minutes.

D-MER can lead to intense negative feelings while breastfeeding your baby. Feelings such as sadness, irritation, restlessness, anger, panic, depression, or anxiety can occur. Some women have only mild symptoms, but for others, the feelings can be severe enough to make them give up nursing entirely.

Thankfully, D-MER doesn’t last forever. Most of the time it resolves in a couple of days or weeks. However, for some women, it can last as long as they are nursing.

Some ways to cope can be surrounding yourself with trusted friends and family, having skin-to-skin contact with baby while breastfeeding, watching a show or eating a snack during those first couple minutes, or practicing mindfulness. If these tactics don’t help, talk to your doctor. Dehydration, too much caffeine, and stress can worsen D-MER.

Whether you choose to breastfeed, pump, formula, or bottle feed, there is no one way to do it. Every mom has their own journey, and many mothers legitimately cannot breastfeed or choose not to. There is no reason to feel any shame – fed is always best!

About the Author

Aliza Sternberg, CLC, IBCLC, CBS, CD(DTI)

International Board Certified Lactation Consultant and Doula

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