Common sentiments about breastfeeding in our culture tend towards two extremes. It’s either romanticised with images of mothers smiling gently at their baby in a softly lit room as if they’re inside a bubble, free from the distractions and noise of the outside world.
Or it’s demonised, with horror stories of women whose babies bit them, had terrible engorgement and mastitis, or had a baby attached to them at the nipple 24/7.
The reality is somewhere in the middle: some days and moments are wonderful and sweet and other times are just plain fight-back-the-tears hard. Even though breastfeeding is completely natural, and all of a sudden your breasts know how to produce milk (how cool is that?!), breastfeeding is more complicated than just putting your baby on the breast.
Here are 8 problems that new mums might experience with breastfeeding
1. Slow let-down reflex
In the first few days of breastfeeding, it’s likely that your let-down reflex will be a little slow to start. The let-down reflex is your breast’s response to baby’s nipple stimulation, it’s the ‘green light’ that signals your baby is ready to feed, and milk should be produced. Nerves in the nipple trigger hormones that cause the breast to push out the milk.
One the biggest barriers to efficient let down is your emotional state. If you’re relaxed, comfortable and calm, the let-down is more likely to occur as normal. If you’re stressed, uncomfortable or distracted, the let-down may be slower.
We suggest feeding in a quiet place and avoiding public feeding for the first few days and weeks, while you get to know your baby and their feeding habits. That way you can relax in the comfort of your own home and give your baby the full attention they need.
2. Attachment problems
To mums yet to try breastfeeding, the idea that babies and mothers experience attachment problems may sound odd. Surely there’s only one way to suck on a nipple, right?
Nipple attachment is a learned skill, and your baby, desperate and hungry, may try to take shortcuts to drink the milk in a way which could end up hurting you.
Finding the correct position can take time, but is worth it. The Australian Breastfeeding Association says “the well-attached baby causes no nipple pain and drains the breast well.” This, in turn, helps ensure a good milk supply going forward. It’s worth remembering, though, that in the first few days, breastfeeding may feel painful for some mothers who have sensitive nipples. This does not mean anything is necessarily wrong, though it is good to check with your midwife or healthcare worker if you have any concerns.
The recommended way to help your baby find the best attachment is to let them discover it for themselves, with a technique called baby-led attachment (BLA). There is a fabulous how-to video on the Raising Children website.
What to look for in a healthy, normal attachment:
– Chin pressed into breast and nose clear or just touching breast above nipple
– Lips are spread outwards, not sucked in (in the shape of the ‘Special K’)
– Most of your nipple areola is in the baby’s mouth
– The baby’s jaw may be moving and their ears may be wiggling, which shows they are sucking vigorously and likely getting a decent amount of milk in their tummy
3. Oral thrush
Oral thrush begins as nipple pain (which can occur as a result of poor attachment technique). Sometimes this nipple pain abates, especially if the baby changes their sucking motion, but if the pain is shooting, burning or itching, or if you already have cracked nipples, you may have oral thrush.
Thrush is a fungal infection which can occur in the breast tissue, as well as other parts of the body. If you have a history of vaginal thrush, you may be more susceptible to oral thrush.
See your doctor if you are worried, they will likely prescribe an anti-fungal cream or tablet. Your baby’s mouth will also be examined for thrush, as well as possible transfer to other members of your immediate family.
4. Tongue-tied babies
A baby who has a tongue-tie has a shorter-than-usual piece of skin under their tongue (at the centre) which means they may have trouble moving their tongue side to side and extending and retracting it. Tongue-tie is more common in boys and can be hereditary.
Tongue control plays an important part in breastfeeding attachment, so if your baby is having trouble attaching and getting enough milk, they may have a tongue-tie. Most severe tongue-ties are picked up in the hospital soon after birth and require a simple, anaesthetic-free procedure called a frenectomy. The baby usually feeds straight afterwards.
Less-severe tongue ties may right themselves with age, as the skin loosens naturally.
Symptoms of tongue tie in babies and toddlers:
– Trouble attaching to the breast
– They are not gaining weight
– The tip of their tongue looks ‘heart-shaped’ when they stick it out
– Their tongue can’t move sideways or reach the roof of their mouth
– Their speech is delayed or slurred
If you notice any of the above symptoms, don’t hesitate to see your doctor.
5. Blocked milk ducts
A blocked milk duct is quite common in mothers breastfeeding babies in the first 12 weeks, and fairly easy to treat and prevent.
A blocked duct occurs when one of the hundreds of ducts that carry the milk from the breast to the nipple become blocked, sometimes due to milk being made faster than it is swallowed by the baby, or when the breasts aren’t emptied fully during a feed.
A small lump or lumps will appear (though you’ll feel them before you see them), and immediate action should be taken to express milk and massage the lumps away. Take a warm shower or use warm face washers on the breasts, then gently massage the lumps using long, sweeping motions from behind the lump down towards the nipple.
The milk will drip slowly at first as the duct is clogged, but when the duct is clear the milk will squirt out normally again. Try to breastfeed your baby straight after massaging the lump away and continue to feed regularly. Make sure your bras are well-fitted and not too tight or restrictive.
Mastitis is an inflammation of the breast tissue that occurs when a blocked milk duct isn’t treated quickly enough. It is common in first-time mothers and is more likely to occur when mums are exhausted and sleep deprived (I know, right!).
Inflammation can be visibly seen on the breast. The skin will likely be tingling, red and hot to the touch. You can take steps to treat mastitis at home (see the advice for blocked milk ducts, above), but if this doesn’t work and you start to feel flu-like symptoms (aches and pains, fevers, chills and fatigue) go to a GP straight away.
It is likely that the inflammation has turned into an infection – mastitis – and this can be serious if not treated quickly. It’s important to keep feeding your baby, even though it is painful. Breastfeeding – emptying the breast regularly – is the key to recovery.
7. Too much milk or not enough
Some mothers have enough milk to feed triplets, yet they only have one baby. If your breasts are regularly lumpy, heavy or tight, and don’t seem to empty fully, you may have an over-supply.
Your baby may also gulp a lot during the beginning of the feed, pop off the breast regularly, sputter as they drink, or need frequent burping. They may also be extra gassy later on and awake a lot during the night.
If you think you have an oversupply, try these suggestions:
– make sure that you are switching which side your offer your baby first so that both breasts are emptied as much as possible (preventing blocked milk ducts and mastitis)
– try feeding your baby on demand instead of by a 3 or 4-hourly schedule
– notice your baby’s hunger cues and respond with a breastfeed when they want it
– if your breasts are still full and your baby is finished the feed, express the rest so your breasts are comfortable
– see a lactation consultant or baby health nurse if you are worried
Not enough milk?
Cases of under-supply are pretty rare. If you think you don’t have enough milk, make sure you’re following the above advice on demand feeding, and responding to your baby’s hunger cues. Try to relax when you’re feeding, instead of constantly measuring and wondering whether your baby has had enough.
Take your baby to the baby health nurse to be weighed and ask for advice on increasing your milk supply. Here are some more tips for increasing your milk supply.
8. Biting and fussiness
Most babies go through a biting stage at some point, and this often occurs after the baby has finished drinking, and is just playing with the nipple. Other times your baby may be teething and just looking for something to chew on. Offer them a cold teething toy instead.
Sometimes your baby can bite you at the beginning of a feed too, and if they do it’s worth asking whether they’re trying to wean from that feed.
Put them down and offer your breast again in 30 minutes or so. If they bite again at the second feed or push away, then they are probably trying to tell you they don’t want that feed anymore.
It’s important not to overreact when your baby bites you with a loud ‘ouch’ or by scolding them. Your reaction may make them cry, or for some, laugh and try again. Do be firm, though, and remove a baby from the breast immediately if they bite you, with a gentle but firm ‘no’ so they get the message.
Need some more feeding advice? Our Parent School lactation experts can help. Click to find out more or book a one-on-one session.