Sore nipples, low milk supply and other common problems, plus simple ways to overcome them.
Honest women will tell you that breastfeeding can be challenging, especially at first. While 3 out of 4 new moms begin nursing after giving birth, about 67 percent are no longer exclusively breastfeeding at three months, according to the U.S. Centers for Disease Control and Prevention. To help keep you on the good end of those statistics, here are some of the more common difficulties you might encounter, along with ways to overcome them.
Sore Nipples: This is by far the most common problem that breastfeeding moms face, says Jack Newman, M.D., co-founder of the Newman Breastfeeding Clinic and Institute in Toronto and co-author of The Latch and Other Secrets to Breastfeeding Success (Hale Publishing) and The Ultimate Breastfeeding Book of Answers (Three Rivers Press). A poor latch, meaning the baby's mouth and tongue aren't positioned properly on the nipple and areola, is often the culprit. In fact, a study of 570 mothers in Denmark found that after one week of breastfeeding, about half of the women were using a less-than-ideal breastfeeding technique, mostly due to a poor latch or improper positioning of the baby.
Many hospitals have lactation consultants available to help during those first days after delivery. Use them. If your hospital doesn't offer that assistance, consider hiring a consultant on your own—even if you aren't having problems. "Some babies are born with their mouths open wide ready to latch on, while others need support," says Sarah Coulter Danner, R.N., C.N.M., CPNP, a pediatric nurse practitioner, midwife and lactation consultant in Rapid City, S.D., and acting president of Baby-Friendly USA.
Sore nipples, which can crack and bleed in the worst cases, usually get better once you've learned how to position and latch the baby correctly. In the meantime, placing glycerin gel pads in your bra between feedings can help. So can using a nipple cream to soothe traumatized nipples and keep the skin moist, which aids in healing, says Corky Harvey, M.S., R.N., IBCLC, co-founder of the Pump Station & Nurtury in Los Angeles. (For some of our favorite remedies, see "Breast Friends: Nipple Creams")
There's no reason to use a nipple cream as a preventive measure, Harvey adds; the nipples and areola make their own lubricant. What's more, you want to avoid unnecessarily using creams that could mask your natural smell, as your scent helps trigger your baby's urge to nurse.
Tongue Tie: Affecting about 4 percent of babies, tongue tie occurs when the frenulum (the tissue that connects the tongue to the floor of the mouth) is too tight, restricting its mobility and making breastfeeding difficult. One study found that moms of tongue-tied babies were three times more likely to give up nursing after a week than babies without the condition.
To check your baby for tongue tie, look closely at his mouth when he's crying: A tight frenulum can prevent the tongue from extending past the gums and can pull the tongue into a slight heart shape with an indentation at the tip. If you're suspicious, call your pediatrician or a lactation consultant right away; in addition to causing sore nipples, tongue tie can prevent your baby from getting enough milk. The good news is that doctors can easily fix it by snipping the tissue with surgical scissors— no stitches or further care required.
Low Milk Supply: Studies indicate that low milk supply is often cited as the primary reason that women stop breastfeeding. Yet experts contend that an improper technique (such as a poor latch) and not feeding frequently enough are more often to blame than an inability to produce enough milk. Regardless, call your pediatrician if you're concerned that you don't have enough milk. And consider scheduling an appointment with a lactation consultant. Signs include not being able to hear your baby swallow while nursing and poor weight gain. Also, your baby may repeatedly pull off the breast in frustration and have fewer than six wet diapers a day and/or irregular bowel movements.
If your doctor or lactation consultant does determine that you're not making enough milk, she will likely advise you to breastfeed more often, aiming for eight to 12 times a day. (Generally, the more the baby nurses, the more milk your body produces.) She may also instruct you to use a breast pump between feedings to further stimulate production.
As a last resort, your doctor may prescribe a medication called metoclopramide, says Ruth Lawrence, M.D., a professor of pediatrics at the University of Rochester School of Medicine in New York and a former chairwoman of the American Academy of Pediatrics breastfeeding section. While it is most commonly given to stimulate premature newborns' breathing, this drug can also spur milk production; however, it can have side effects, so it is usually only used for short durations. An herbal alternative is fenugreek, sold at health food stores, although it's not safe for mothers or babies with peanut allergies, Lawrence says.
Mastitis and Other Problems: About 10 percent of breastfeeding mothers will experience mastitis, signs of which include a sore, red or swollen area of the breast; blood in the milk; and possibly fever, chills and malaise. The infection can occur when bacteria enter the breast through the ducts or a crack in the skin. It can also arise from a clogged duct, which may feel like a lump or knot in the breast, Harvey says.
Clogged milk ducts can occur for many reasons, including skipped feedings and a poor latch, which prevents milk from fully draining from the breast. Remedies include warm compresses; massaging the area before and during breastfeeding; and pointing the baby's nose toward the plugged duct during feedings.
If you suspect mastitis, see your doctor, as you'll need antibiotics. Whatever you do, don't stop nursing. The antibiotic used to treat the infection is safe for the baby, and he won't "catch" the illness. Plus, continued breastfeeding will help the infection clear faster, Newman says.
Another condition linked to breastfeeding is Candida albicans, a yeast infection of the nipples and ducts. While you can experience Candida at any time, you can be particularly susceptible after taking antibiotics; signs include burning pain during and after breastfeeding. Candida likes to grow in moist, dark areas, Newman says; to treat and prevent it, let your nipples air-dry after feedings before relatching your bra.
If you think you have Candida, contact your doctor, who will likely suggest an antifungal cream or medication. You can pass the infection to your baby; this will cause thrush in his mouth, so you'll want to treat him as well, even if he doesn't appear to have the infection, Harvey says. Thrush can look like white patches on the tongue or insides of the cheeks.
Breast Friends: Nipple Creams With prices in the $10 to $15 range, the biggest factor to consider when choosing a nipple cream isn't so much cost, but whether you want a product with or without lanolin, a gooey substance that comes from sheep's wool. While many experts say few ingredients do a better job at coating and protecting sore nipples, some moms would rather not use animal products or are hesitant because they have a wool allergy. (Manufacturers say their lanolin goes through a rigorous purification process that renders it hypoallergenic and safe for babies and moms, even those with allergies.)
Beyond that, read labels and steer clear of products that have to be washed off before breastfeeding, as this can further irritate the skin, says Barbara Emanuel, executive director of La Leche League International. "Moms need to make sure they are informed," she says. "Be aware of additives you might have sensitivities to." With that in mind, here are several mom-tested products we like:
- Belli Pure Comfort Nursing Cream From a line of skin-care products created by an M.D., Belli's nipple cream contains nothing but ultra-purified lanolin. $10, belliskincare.com.
- Earth Mama Angel Baby Natural Nipple Butter Featuring organic olive oil infused with calendula (an herb traditionally used for wound healing), as well as shea, mango and cocoa butters, this is a favorite among vegan moms. $15, earthmamaangelbaby.com.
- Lansinoh HPA Lanolin The iconic brand that's been around for 25 years, Lansinoh's nipple cream is made from ultra-purified lanolin and is endorsed by La Leche League. $12, lansinoh.com.
- Medela Tender Care Lanolin Ultra-purified lanolin, along with small amounts of coconut oil and oat-derived beta-glucan, make this cream easy to spread. $10, medelabreastfeedingus.com.
- Motherlove Nipple Cream Certified organic by the USDA, Motherlove's Nipple Cream is made from olive oil, beeswax, shea butter, calendula and marshmallow root. $10, motherlove.com.
- Simplisse Lanolin-Free Nipple Cream Contains aloe vera; sweet almond, apricot kernel and grapeseed oils; zinc; vitamin C; and lactoferrin. $15, simplisse.com.
Be a latch master! Learning the right latch can help prevent many problems. We've got step-by-step instructions and photos as fitpregnancy.com/breastfeeding/latch.