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Making Milk: Breastfeeding is doable but sometimes challenging

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If you’re pregnant and considering breastfeeding, it’s useful to gather information before you’ve actually got a hungry baby on your hands.

For some women, breastfeeding is a resolute yes. Others, however, may not be as certain: They know the benefits of breastfeeding, but the idea seems overwhelming or intimidating.

Experts can offer advice, and the experiences of other mothers can also illuminate scenarios you might not have considered. What’s more, putting together a list of resources now can give you someone to turn to once you’re at home with your newborn and your baby is having trouble latching on or your nipples are sore, or both.

One way to explore your options is to seek advice from the experts and to consider the experiences of other mothers.

Christine Goldman, owner of Doulas of CNY, is a childbirth and lactation educator. Over the years, she has helped numerous women persevere through the most difficult aspects of breastfeeding. She and her team provide services to mothers in labor, as birth doulas, and after the birth, as postpartum doulas.

Jen Deshaies, owner of Syracuse Lactation, is an International Board Certified Lactation Consultant (or IBCLC) who specializes in challenging breastfeeding scenarios such as tongue and lip tie, low supply and tandem nursing.

Mothers Dana Rinaldo and Mell Fields have learned to breastfeed successfully. But each confronted obstacles as she learned this unfamiliar process, which demands both certain physical skills and a new kind of intuition.

Rinaldo is a working mom with two young children: Joseph, 3, and 6-month-old Ava. Fields currently stays at home with her first-born son, Jonah, who turns 1 year old this month. Rinaldo faced significant complications, while Fields describes an easier journey with her son.

Before the Baby

Both Rinaldo and Fields admit they lacked detailed information about breastfeeding prior to the births of their children, even though they had committed to nursing early on.

“I didn’t do much reading,” says Rinaldo, who believes ingesting too much information can be just as damaging as not enough. When Fields had questions, she sought out her own mother for answers, since she had nursed all four of her children.

Research can be time-consuming, but getting ready by taking a breastfeeding class or informing yourself of some basic facts can set reasonable expectations and alleviate concerns.

Deshaies, the lactation consultant, suggests that planning ahead can make breastfeeding easier. She encourages moms-to-be to think through the logistics that await them when they bring their baby home. For instance, stock up on pre-made meals and line up friends and family to help with routine tasks during the first few weeks. Also, Goldman says, surrounding yourself with people who support your decision to breastfeed is very helpful.

Early Challenges

Rinaldo encountered a complication with breastfeeding right away.

“My son had a tongue tie we had to correct,” she says. “He was sucking so hard because he couldn’t stick his tongue out of his mouth. It cracked my nipples and made them raw. I would involuntarily cry and it would send shooting pains through my entire body.”

A tongue tie is a malformation that restricts the movement of the tongue. At 2 weeks old, the problem was corrected and his latch was “instantly better,” Rinaldo says. “I used a nipple shield until he was 2 months old to let my nipples heal and it was much easier from there forward.” Rinaldo again experienced nipple pain from breastfeeding her second child, but she stuck it out and within two weeks, her daughter was latching perfectly.

When Fields first began to breastfeed, her son would nurse on one side only. The issue was resolved in just a few days, though.

Typically, mothers should aim to breastfeed from both sides at each session, although sometimes a baby will simply refuse one side. That also happens in circumstances such as a flat or inverted nipple.

“A baby can actually get a full amount of milk from one side, especially with good management,” says Deshaies, who suggests a woman in that situation contact a specialist to come up with a specific care plan.

Problems like the ones Rinaldo and Fields describe can be overcome quickly when help is obtained early. Other difficulties new mothers may face include breast engorgement, thrush, mastitis, plugged ducts, and people pushing formula, says Goldman. “All of these can be addressed with the help of a lactation educator,” she adds.    

Deshaies frequently consults with her clients about low supply. “I often see moms who are not producing as much as they’d like. You can tell if you have enough milk by the baby’s weight gain, how many dirty diapers they have, and if the baby is satisfied after a feeding.”

The first milk a mom produces is called colostrum, which is typically thicker than later breastmilk and is rich in antibodies. It takes from two to five days for the colostrum to transition into mature milk. When that takes place, the baby should be gaining about an ounce a day, Deshaies says.

As far as milk production goes, the more milk you get out of your breasts, the more you’re going to make. Deshaies says a mother should be nursing on average eight to 12 times within 24 hours.

“And that’s with a baby that’s not only latching but also transferring milk effectively. When those things are happening, then most of the time babies are getting what they need.”

If the baby’s needs are not being met, talk to an IBCLC, doula or doctor.

Nursing Positions

Learning different positions and proper latch is essential to ensure the transfer of milk and proper swallowing—as well as to prevent or minimize nipple soreness, says Goldman. Some moms and babies favor one position, but switching among a few draws the milk out of different glands in the breast.

Typical breastfeeding positions with newborns are the football hold, the cradle hold or the cross-cradle hold.

“One position we hear less about is called ‘laid back’ breastfeeding,” says Deshaies. But that position is worth a look because it promotes relaxation. “When I get moms set up in the laid back breastfeeding position, they often look at me and just smile because they feel so much more comfortable and their baby often nurses so much more effectively.”

Involving Your Partner

If your partner would like to feed the baby but you are exclusively breastfeeding, there are many other ways that he or she can bond with the baby. He or she can give baths, change diapers, or take the baby on walks.

“All those are so important (in supporting) the breastfeeding relationship,” says Deshaies. On the other hand, if a spouse “helps out” by feeding the baby a bottle of pumped breastmilk or formula, it often results in more work for the mother since it represents a missed feeding on the breast.

“In order to keep up supply, the mom would need to pump (to compensate for) that bottle feeding. I see many families choose a different way to bond with the baby until the baby is a little bit older and takes bottles more regularly.”

But each family needs to find the practices that work best for them, in their unique circumstances. Rinaldo says when she went back to work, she would pump her milk so her husband, Joe, could bottle feed their son and now, Ava. At night, Rinaldo nurses while her husband sleeps: “He wakes up early for work. Two sleep-deprived parents do not work in this household.”

When both are home during the day, Rinaldo says Joe will grab her water bottles and burp cloths. But he also does what’s most helpful of all: “Take care of our 3-year-old.”

Be Gentle With Yourself

“When moms educate themselves about the ‘mechanics’ of breastfeeding, they understand that there is not a reason to feel guilty, and that it is not ‘their fault’ if breastfeeding is difficult or a decision is made to stop,” Goldman says.

Several factors may contribute to decreased milk production including a difficult labor, a cesarean, medications, the mother’s age, how strong the baby’s suck reflex is, the mother’s apprehensions concerning breastfeeding versus formula, the amount of encouragement and support the mom receives, or anxiety about pumping and returning to work.

“There can be lots of guilt and shame about both having breastfeeding challenges and choosing not to breastfeed for personal reasons,” Deshaies says. “I work with many families that wish they could nurse or make more milk, but for many reasons cannot.

“Breastfeeding and/or exclusive pumping does not work for everyone and, in the end, any amount of breastmilk a baby drinks is valuable.”

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