Problem: Pain during nursing
"Breastfeeding should not hurt," says Ann Seacrest, RN, IBCLC, executive director of MilkWorks. "It's normal to feel a gentle tugging or pulling sensation when nursing, but pain indicates a problem, and you need to see a lactation expert."
While breast pain may be a symptom of clogged milk ducts, a breast infection or other conditions, it's more often caused by the baby failing to pull the nipple far enough into her mouth or clamping onto it incorrectly—in other words, by her latching on improperly. A lactation consultant usually can show you how to position your baby so nursing won't hurt; this often is a simple matter of placing the baby in a different position (belly to belly, for example) or guiding the baby to open her mouth wide and take in the entire nipple and a good portion of the areola.
Unfortunately, even with help, nursing can continue to be a challenge for some women. "Breastfeeding, like everything in nature, is not perfect," Seacrest says. "There are some babies who never latch on completely pain-free no matter what we do, although these cases are rare. Most problems are fixable, and the majority of babies learn to latch on properly over time." In such cases, a combination of pumping and nursing can help keep pain at a minimum.
Problem: Supply concerns
Many moms worry that they won't produce enough milk, but this rarely happens. Newborns feed up to 12 or more times a day, not because milk is in short supply, but because their stomachs are so small—about the size of a large marble, says New York City lactation consultant Catherine Watson Genna, IBCLC.
But if a baby isn't gaining weight as she should, a low milk supply may be the cause. Breasts work on a supply-and-demand basis, so if you skip feedings or give your baby formula, or if the baby doesn't drain enough milk from the breast, your body may produce less. To increase supply, lactation consultants recommend nursing more frequently and pumping after breastfeeding sessions. Increased demand for milk sends a message to the body to boost its output.
Sometimes having too much milk sends women to lactation consultants. If a baby does not nurse often enough, or if the breasts produce excess milk or aren't emptied completely during feedings, they may become engorged. This fullness can make it difficult for a baby to get the nipple in her mouth. Frequent breastfeeding can prevent engorgement because it keeps milk from building up in the breast, Birdseye says. Lactation consultants also recommend pumping or hand-expressing a small amount of milk before nursing so it's easier for the baby to latch on.
Problem: Special needs
Lactation consultants can help in other ways too. "My clients have many concerns," Genna says. "Some have chronic diseases and are worried about the impact of their illness or medications on their babies. Some have babies who were born preterm. I work with a wide variety of situations, from babies with heart malformations and Down syndrome to mothers who have had breast-reduction surgery or who are nursing adopted babies."
Finally, lactation consultants can deliver the TLC that new moms often need when trying to master breastfeeding. Says Seacrest: "We can hold the mom's hand and guide her through it."