Common Breastfeeding Concerns

These are some of the common breastfeeding concerns you may encounter during your breastfeeding journey. Things often change during the course of breastfeeding and concerns may arise and most are easily resolved. Breastfeeding help is available throughout your first year and beyond. Many of our patients come in for help at the beginning and keep coming back as challenges arise. Here are some tips to help get you through!

Breast Abcess

Requires Immediate Attention

A breast abscess is a collection of pus in the breast. It can be serious so be sure to seek medical help right away. It can follow a case of mastitis. The skin can look very thin and weepy like there is a collection of fluid inside and is on one area of the breast, typically only on one side. It is treated with antibiotics and sometimes will need to be drained. Many women will continue to breastfeed with an abcess and after it is healed. Working with an IBCLC to help you through is important.

Bleb (Milk Blister)

Use below for clogged ducts and blebs
Breast Health ™
Sunflower Lecithin

A bleb looks like a whitehead on the face of the nipple. It is a blocked nipple pore and is often associated with a clogged duct. The milk is blocked at the exit site of the nipple and then a clogged duct may form on the breast. Blebs can be exquisitely painful or they can present with no pain at all. Check with your health care provider if you are having a lot of pain.

Blood in Milk (Pink Milk)

Pink milk, can I use it?

Sometimes if there is a crack on the nipple, blood can get into the milk and the result is pink milk when mom pumps. Your milk is made from your blood, so we really don't have restrictions to breastfeed. Also, some moms will see blood when their baby spits up if there is perhaps a small crack. It is ok, but causes much distress if you don't realize where it is coming from.

Blood in spit up

Spit up

This can look terrible and can be very scary. In almost 30 years of being an IBCLC, I have seen this many times and it has always been from baby swallowing a small amount of blood. This happens when there is a tiny crack in your nipple. Call your Dr. if this happens but also know that it is likely that your baby swallowed some blood. And by the way, your milk is made from your blood so don't worry! It is fine for baby to keep nursing. Just need to get the nipple healed.

Bottle Feeding

Paced Bottle Feeding

Whether you are breastfeeding and using some bottles or are bottle feeding with formula, all babies will benefit from this method of bottle feeding, especially in the first month or two. Notice in the picture above how the mom is holding the baby more upright and the bottle more horizontal? This allows the baby to pace the feeding and take breaks when needed without being waterboarded by the fast flow of milk coming too quickly. It can help baby form getting to much air from gulping the milk too fast. If you are breastfeeding, paced bottle feeding can help baby return to the breast easily.

Bottle Refusal

Bottle Feeding Aversion Book

Bottle Refusal can be a difficult thing to deal with and often comes out of the blue. Many moms will say, "my baby took a bottle just fine and now he won't take it." It often comes at the most inopportune time like when going back to work or taking a trip. There is often no quick fix to this problem. It often takes patience and perseverance. Often we will try other methods of getting milk into baby. Check out book above by Rowena Bennett. Schedule a visit with your IBCLC.

Breastpumps

Which pump should I get?

It is hard to believe breastpumps are not needed to breastfeed a baby! Breastpumps have become almost a necessity when it comes to breastfeeding with the majority of women returning to the workplace at just 3 months, at least here in the United States. Expressing milk has been going on forever but in the beginning, women used to use their hands to pump or other women might have helped out if a mom wasn't produce enough. Choosing a pump is harder than ever because the market is flooded with so many pumps nowadays. Click link above to learn more about which pump may be best for you.

Breastpumps - Wearable

Yay or Nay?

I never thought wearable pumps would become a thing, but I am glad they did! I think they can be such a great tool for a mom that is trying to do it all while being hooked up to a machine unable to move. That being said, as they have gained in popularity, we are also seeing the downside to these pumps. If you happen to have an amazing supply, which most moms don't, it can be great for a main pump. However, we are finding many moms use it more as an adjunct pump but still find they need their workhorse pump too. Watch for my video coming soon about choosing a pump.

Burping

Is there a certain way to burp my baby?

This is another question that always comes up in our consults. Do I need to burp and for how long? What is the best position? It is a good idea to burp your baby after you nurse or bottle feed. Sometimes they can swallow some air and their GI system is getting used to getting milk every few hours. Often just holding them upright or changing their position will yield a burp. The most common positions are over your shoulder, sitting on your lap as pictured, or even laying them on your lap. There are other ways too, and you will surely find one that works best for you and your baby.

Clogged Ducts

Breast Health ™

Clogged ducts are a common complaint of breastfeeding women, especially in the early weeks before your breasts reach a level of homeostasis. Clogged ducts can also occur as your baby starts sleeping longer stretches, starts solids or during time of illness. Probiotics can really help combat this as well as sunflower lecithin. Getting to the root cause of the issue is key. Schedule your consult today with your local IBCLC.

Cluster Feeding

Nature's way of increasing your supply
Reaching for bottle may sabotage your supply
Concerned? Schedule appt with IBCLC

Cluster feeding is when your baby is nursing in very frequent intervals. This often happens in the evening when both you and your baby may be on low reserve. Remember, you are your baby's happy place where they feel safe, warm, and happy. This is also a way that baby builds your milk supply. Many women feel that they are not making enough when this happens and they reach for a supplement. This is nature's way of building up your supply.

Engorgement

Light Lymphatic Massage

Engorgement is the stage of lactation usually associated with when your milk first comes in and becomes plentiful. Some women describe it as a full feeling and breasts feel warmer. Some women find their breasts are hot and throbbing and it can be quite painful and baby who was nursing well may have trouble latching. Cold compresses are the current treatment for engorgement. We do recommend some light lymphatic drainage but not to much pressure which can lead to inflammation and worsen engorgement

Flat or Inverted Nipples

Many women can still nurse successfullly

Flat Nipples and Inverted Nipples are just a variation of the nipple. They can present some challenges with breastfeeding. Bear in mind, the baby nurses from the area around the nipple but at the beginning a more protractile nipple can make it easier for baby to find the target. Often, women receive a lot of IV fluid that can make the breast more full of fluid and can cause the nipple to appear flat. We often work with moms with nipple variations and most most do just fine. Contact your local IBCLC for assistance to schedule an appointment.

Flange Sizing

Flange Inserts

When I first started as a lactation consultant in 1996, there was one size flange and it was a 24mm. Fast forward to today, there are flanges ranging from 10mm to 36mm. We finally realized women come in different shapes and sizes. The key to flange sizing is finding the flange that is comfortable and yields the most milk. When choosing a flange size, you may want to get a bunch of flange inserts that fit into the 24mm flange and a measuring tool so you can try them out. If you are dealing with low supply, the flange size may not be the silver bullet that suddenly increases your supply drastically but it may help to increase your supply over time.

How to tell when baby is done

Schedule a Consult

This is another one of those top questions we are asked when moms come in for consults. I wish I had the answer, but honestly, we (LC's) don't always know either. We advise to watch and see if baby seems satiated. Feel your breasts, are they softer after a feed? If baby younger than 6 weeks, are they having 5-6 wet diapers and 3 or more poopy diapers? Have you nursed about 10 minutes per side?Have you seen an IBCLC and had a pre and post weight? You can always put baby back onto the first breast if they still seem hungry. Be sure and contact your pediatrician or IBCLC and go in for a weight check if you suspect your baby is not getting enough.

Latch

The all important latch should feel good and your baby should be getting the milk he or she needs. We do know that many women do experience some nipple pain in the first 30 seconds or so when baby when baby first latches. While we do look for certain visible signs of a good latch, the most important thing is the way it feels. I always say position preceeds the latch, so making sure you and your baby are positioned well is just as important as the latch itself. Having baby positioned nose to nipple so baby has to come up to the breast (think of drinking a water bottle, you lift your head upwards to take a drink) baby needs to do this too! Have baby's tummy facing in towards you. Be sure and seek help if you are struggling.

Leaky Breasts

Leaky breasts are actually not very common. Most women do not leak colostrum (the early milk) during pregnancy or leak after giving birth. This does not mean you do not have enough milk. It has no indication on your volume of milk. For those of you who leak, it can be messy at first when you are nursing on one side because the other side may start dripping. The good thing about leaking is that you take a milk catcher and put it on the leaking side and catch that milk. This can be nice because you can collect extra milk without pumping. Leaking or not, you likely have enough milk.

Low Milk Supply

Low milk supply can be a difficult. We don't know why this sometimes occurs, but we do know low milk supply often happens because of poor management at the beginning of breastfeeding. Remember, even if your baby appears to be nursing well, it is crucial to know that your milk is transferring from you to your baby. If it is not, your body doesn't know to "replenish" the milk and your supply quickly starts to go down. This is one of the reasons I urge you to take a breastfeeding class or even better a one on one prenatal visit. Then, see an IBCLC around day 4,5 or 6 postpartum. If you can't see someone in person which is preferred, then do a telehealth consult. The guidance you need should start early. This will set you on the right path for success.

Mastitis

Mastitis means inflammation of the breast. Mastitis is now thought to be an inflammatory condition that can progress to a bacterial infection if not treated early and can progress to an abcess. It is most common in the first 6 weeks but can also occur later at any point while breastfeeding. It presents with reddened area on the breast, fever over over 101.4, chills and flu like symptoms. While in the past we used warm compresses, massage and frequent nursing and pumping, current treatment is now cold/ice compresses, no massage and nurse/pump as usual without adding extra pump or nursing sessions. Specific probiotic strains have helped with mastitis and sometimes antiboitics are needed.

Nipple Confusion

Moms always wonder if it is OK to give baby a bottle early on (in the first 2-3 weeks) or will this cause "nipple confusion." There is no actual evidence in the literature that it does. Most babies do just fine going breast to bottle and vice-versa, especially at the beginning. The research suggests that perhaps rather than nipple confusion, it may be "flow confusion" that causes some babies to prefer the bottle. When giving a bottle, the milk flows more readily, but with breastfeding baby needs to nurse for about 15-30 seconds before the milk starts to flow. This instant gratification of milk flow may make some babies agitated at the breast. Contact an IBCLC and schedule an appointment for help. This is something that you want to get on right away to avoid breast aversion.

Nipple Confusion