Part friend, part coach, a lactation consultant can make all the difference when nursing problems occur. we've got the pros' top tips.
When Alexia Scott Morrison's daughter, Audra, was born last November, Morrison wanted very much to breastfeed—but she wasn't sure she could. "I had extremely flat nipples," she explains. Hospital nurses gave her a nipple shield, a thin silicone device that can draw out a nipple and make it more accessible to a baby, but they didn't offer a lot of advice on how to use the shield. Audra tried to nurse but couldn't latch on successfully, even with the device.
The day Morrison left the hospital, she called MilkWorks, a breastfeeding center in Lincoln, Neb. She met with a lactation consultant who taught her how to use the nipple shield properly, and soon Audra was breastfeeding beautifully. "Without the support of a lactation consultant, I don't think I would have been able to breastfeed," Morrison says. "But I've been nursing for a little over eight months now."
Some women may think that because breastfeeding is natural, it will be easy for mother and baby to master. But that's not necessarily the case. "You're told it's natural, but you're not told it's a learned experience," says Sharon Birdseye, RN, IBCLC, owner of Lactation Consultants of Atlanta. "It can feel awkward at first."
Do you think that you, too, might need a little help? Read on to find out some of the reasons women just like you seek help from an expert—and how they learn to breastfeed like a pro.
Problem: A difficult latch
"The biggest area of concern is latching on," Birdseye says. Without a good latch, sore nipples, breast infections and other problems may occur, and your baby may not get enough milk.
Take the case of Laura Ayo of Knoxville, Tenn. When Ayo gave birth to her daughter, Chloe, two years ago, she felt pain whenever she nursed. "I knew something wasn't right, but I didn't know what it was," Ayo says. Within a week, her nipples were sore and cracked, so her pediatrician referred her to a lactation consultant, who was able to see her right away.
During the visit, the lactation consultant examined Chloe's mouth and found that the baby had ankyloglossia (also known as "tongue-tie"), a condition in which the tongue is restricted because of a short frenulum, the tissue connecting the tongue to the base of the mouth. Ankyloglossia can prevent a baby from latching on to the breast and sucking properly.
The lactation consultant told Ayo that in severe cases, doctors make a cut in the frenulum to allow the tongue to move. But she predicted that Chloe's frenulum would stretch naturally over time—which it did. In the meantime, the consultant taught Ayo the "football hold," which made it easier for Chloe to pull the nipple into her mouth than with the cradle hold Ayo had been using. But that's not all she did.
"She showed me a different way to nurse Chloe," Ayo says. "I basically had to squish my breast to get the nipple far into her mouth, past the tongue-tie. We practiced, and by the time I left, I felt confident I could do it on my own. Within days we were fine." Ayo breastfed Chloe for 15 months.
Though Ayo's case involved a physical cause for a difficult latch, many breastfeeding moms simply need a few pointers on proper technique and positioning. For our simple, step-by-step tips, plus photos, visit fitpregnancy.com/latch.
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."
Plan For Success
Don't wait until your baby's born to educate yourself about breastfeeding. Take the following steps while you're pregnant to help guarantee a good experience:
Enroll in a class Many hospitals, obstetric practices and health clinics offer prenatal breastfeeding classes. Once the baby's born, attend a few La Leche League meetings (for information, call 800-525-3243 or visit llli.org).
Line up a lactation consultant "Find out ahead of time who you'll call if there's a problem," advises lactation consultant Ann Seacrest of MilkWorks. To find a certified lactation consultant, contact the International Lactation Consultant Association at 919-861-5577, ilca.org.
Make a connection Meet with a lactation consultant before delivery if you anticipate complications—for example, if prenatal testing has indicated that your baby may have a health problem, if you are expecting multiples, or if you have inverted nipples, a history of breast surgery or other conditions that might make breastfeeding difficult.
Check out your hospital Find out if the hospital where you'll deliver has a lactation department. "If the hospital does not offer such help, find a board-certified lactation consultant who will visit you in the hospital," Seacrest advises.
State your intentions Tell your doctor and nurses that you want to breastfeed your baby after the birth. Experts recommend nursing within an hour of delivery, if possible.
Ask for help Once you're back home with your baby, ask family and friends to help out with chores and meal prep so you can focus on nursing your baby and taking care of yourself. Or consider hiring a postpartum doula (for information, contact Doulas of North America at 888-788-DONA, dona.org).