The most common breastfeeding problems

Almost every mum can breastfeed her baby. But uncertainty, incorrect information or fear can sometimes cause brand-new mums to doubt their own ability to breastfeed. During pregnancy many mums are not fully aware that breastfeeding starts immediately after the birth and that it is a skill that also needs to be learnt. 

In this section we want to give you confidence and help you to overcome potential problems. If you have problems with or uncertainties about breastfeeding, don’t hesitate to ask an expert for help. Many hospitals employ specially trained breastfeeding and lactation consultants IBCLC who will be glad to help you even after you go home.

Not enough milk

Many mums worry unnecessarily that they will not produce enough milk for the baby. The baby’s weight gain, the content of her nappies and her sucking behaviour are some of the signs showing that enough milk is being produced.

The weight gain per week should be:

• 0 to 2 months: about 170 to 330 grams
• 2 to 4 months: about 110 to 220 grams

The baby regains her birth weight within 10 days of the birth.

In the first 4 to 6 weeks the baby produces at least three dirty nappies every 24 hours; later on breastfed babies can have pauses of several days. The baby should also have 5 to 6 wet nappies every 24 hours and her urine should be light coloured.

During a breastfeed the baby takes the nipple and much of the areola in her mouth. When the milk starts to flow the sucking rhythm gets slower and the swallowing noises can clearly be heard. After a feed the baby’s mouth is moist and your breasts feel softer.

It is also completely normal that your breasts stop feeling full between feeds after a few weeks. This has nothing to do with the amount of milk being produced as the milk is not made until the moment the baby actually sucks.

It sometimes happens that you barely produce enough milk for a few days, perhaps because you’re very tired or the baby is having a growth spurt.

Increasing milk production

You can increase milk production by

• breastfeeding often (every two hours with a longer pause at night)
• changing sides frequently
• having long periods of skin contact
• getting enough rest
• getting help with household tasks
• eating a balanced diet 
• receiving whatever support is usual in your culture

You can also increase the amount of milk by occasionally expressing (for about 5 minutes) after a feed to stimulate milk production. It is not important how much breast milk is in the bottle afterwards.

If your baby does not gain enough weight you should contact a healthcare professional as soon as possible so that she can check the feeding situation.

Engorgement and breast inflammation

Throughout the breastfeeding period, but especially in your first weeks at home, your breasts can become hard and painful after feeding. You feel as if you have the flu (tired, aching limbs, a headache). These symptoms suggest engorgement.

If this happens, we recommend that you act as quickly as possible by carrying out the following:

1. Put a warm, damp compress on your breast for about 10 minutes before breastfeeding so that the milk flows better.
2. Position your baby for a feed so that her chin points towards the lump.
3. Gently massage the lumps while you breastfeed.
4. If the breast still feels hard after breastfeeding, use a gentle breastpump (e.g. Ardo Carum) and massage the hard places at the same time.
5. Cool your breast for about 20 minutes after breastfeeding/expressing by using a cold compress. 
6. Make sure you get enough rest. The best thing to do is to go to bed with your baby. Drink plenty of fluids.

If the symptoms don’t subside within a few hours or if you develop a fever, contact a doctor, a breastfeeding and lactation consultant IBCLC or a midwife as there is a risk of breast inflammation. It is no longer considered necessary to wean your baby if you have breast inflammation or take antibiotics.

Sore nipples

It is normal for your nipples to be tender for the first 3 to 4 days after the birth. If the symptoms continue for longer or if your nipples are painful and sore, cracked, encrusted or bleeding this is usually because the baby is not latching on properly. Perhaps the baby is only taking the nipple in her mouth and not enough of the areola, or is not opening her mouth wide enough, or has her lips drawn in, or perhaps you are leaning forward at the start of the feed, etc.

In rare cases sore nipples can be the result of sucking problems, thrush (a fungal infection producing white patches in the baby’s mouth) or tongue-tie (in which the band connecting the tongue with the floor of the mouth is too short).

Sore nipples are intensely painful. You should therefore seek advice from a breastfeeding specialist as quickly as possible.

The following can be helpful:

• Try to work out what is going wrong and correct it, e.g. ensure your baby is latching on properly.
• Put the baby to the less painful breast first.
• Giving frequent short feeds is easier on you than taking long breaks.
• Breastfeed in different positions.
• Use a lanolin cream e.g. Ardo Care Lanolin. Lanolin aids healing. 
• Apply cooling, soothing and moisturising compresses, e.g. Ardo Care Compresses
• Take a break from breastfeeding and use a breastpump. The ”Sensitive Programme" of the Ardo Carum breastpump was developed for expressing with sore nipples. It begins with an initial vacuum that can hardly be felt and a low starting cycle that can be carefully adjusted according to the sensations experienced by the mum.

The weak, sleepy baby

Some babies are too weak to drink effectively and fall asleep during breastfeeds. It’s important for these babies to get a large amount of breast milk without using a lot of energy. During a breastfeed it can be helpful to pump from the other breast at the same time to make the milk flow better. Alternatively, feed the baby with her lying on your stomach with plenty of skin contact. It is often helpful to drip some expressed breast milk into the corner of the baby’s mouth with a syringe to encourage her to drink.

Another option is to stimulate the baby to suck actively. You can do this as follows:

• Start feeding the baby using a football hold. Support her back well. Make sure that the soles of the baby’s feet can touch a surface and give her something to grip with her hands, e.g. your finger. 
• Support your breast throughout the feed. 
• At the beginning, and as soon as the swallowing noises get less frequent, carry out breast compression. This involves holding your breast close to your chest and compressing it gently and painlessly with your forefinger and thumb so that more milk flows.

The confused baby

Sucking at the breast is fundamentally different from sucking from an artificial teat, which can lead to confused sucking behaviour in some babies. After sucking on an artificial teat or a dummy these babies can no longer suck from the breast or cannot suck as effectively. 

The younger the baby, the greater the risk that she will not be able to alter her sucking behaviour again. This is why some hospitals prefer not to use bottles for additional feeding unless absolutely necessary, often using special containers e.g. Easy Cup as an alternative if required. 

If a dummy is used to delay breastfeeds the baby satisfies her need to suck by sucking on the dummy. This means she sucks less at the breast and may be at risk of getting too little milk. Supply is regulated by demand so the process has a negative effect on supply. It is therefore helpful to avoid using a dummy for at least the first 4 to 6 weeks when milk production is building up.