Having a tough time nursing? Learn about common breastfeeding problems, and find a solution that works for you.

By Kristen Finello and Nancy Gottesman
Lumen Photos/Shutterstock 

Whether you're planning to, trying to, or nursing your baby as you read this, we can all agree on one thing: Breastfeeding exclusively for six months—as recommended by the American Academy of Pediatrics (AAP)—is invaluable for the health of you and your baby.

According to the Centers for Disease Control and Prevention (CDC) stats from 2016, about 81 percent of new moms agree and start out breastfeeding their babies. But, by the six-month mark, only 52 percent are still nursing exclusively.

What's going on? According to a study, there's a mismatch between a new mom's expectations and the realities of day-to-day life. When a mom's weariness, discomfort, and anxiety increase, her happiness—as well as that of her family—supersedes the goal of exclusive breastfeeding. "Women introduce formula or stop breastfeeding in an attempt to improve the situation, and this can lead to feelings of failure and guilt," says Pat Hoddinott, Ph.D., lead author of the study and chairwoman of primary care at the School of Nursing, Midwifery and Health at the University of Stirling in Scotland.

Here's an important point to remember: Any amount of breastfeeding confers vital health benefits to your baby. And, while experts strongly encourage exclusive breastfeeding for six months, at the same time, new moms shouldn't be stressed out in order to meet this goal—nor should they be guilt-ridden if they decide to supplement with formula or stop nursing.

To that end, here are the most common breastfeeding problems with suggestions on how to make nursing work for you.

Leaking

Many new moms experience milk leakage at one time or another—especially early on when milk production levels are still being established. While leaking is harmless physically, it can be kind of embarrassing.

How to Avoid It: Try not to miss feedings or go longer than normal between feedings.

How to Treat It: Place disposable nursing pads in the cups of your bra to absorb wetness and prevent milk from leaking through your shirt. Avoid pads with plastic liners that can trap moisture against your skin and cause sore nipples. If you feel your milk letting down in a situation where you can't nurse your baby, gently pressing your breasts to your chest wall (you can do it inconspicuously by crossing your arms and squeezing your arms against your breasts gently) will often stop the leaking.

Engorgement

It is normal for your breasts to feel full and heavy during the first few weeks of nursing, but if you find that you are feeling discomfort beyond that time – specifically, your breasts feel hard and uncomfortable – you may be experiencing engorgement. The cause is usually inadequate milk removal. For example, your baby doesn't nurse often or long enough and your breasts become overfilled with milk.

How to Avoid It: Nurse your baby often – eight to 12 times a day with both breasts, if you can. Don't skip feedings, and continue to nurse your child during the night as well as during the day. Be sure that your baby is positioned correctly and is latching on well so that your breasts are emptying of milk.

How to Treat It: Express milk between feedings, either manually or with a breast pump. Take a warm shower or place a warm compress on your breasts to encourage milk flow. Some doctors recommend using a warm compress while nursing and following up with a cold compress between feedings. If you are severely engorged, warmth may aggravate the situation (by increasing blood flow to the area), so consider trying cool compresses as you express the milk.

Nipple Confusion

Babies who are given a pacifier or bottle in the early weeks of breastfeeding may become confused when faced with their mother's breast. The result: Baby may not be able to latch on correctly or may reject the breast completely. This means that he may not get enough milk and your breasts can become engorged from not emptying.

How to Prevent It: Don't give your baby a pacifier or bottle until your nursing routine is firmly established – usually at least three to four weeks after delivery.

How to Treat It: Depending on how long your baby has experienced nipple confusion, you may want to contact a lactation consultant for advice. In the meantime, monitor your baby's diapers to determine whether he's getting enough to eat.

Cracked or Sore Nipples

Improper positioning of your baby during breastfeeding is the most common cause of cracked or sore nipples. When your baby is positioned correctly, your nipples will be at the back of his mouth, safely away from the pressure of the gums and tongue.

How to Prevent It: Make sure your baby has the proper latch-on technique. If you feel pain, gently remove your baby from your breast and let him latch on again. Also, position your baby close to your body with his mouth and nose facing your nipple to make it easier for him to latch on properly.

How to Treat It: When nursing, start with the less painful side since your baby is likely to suck most vigorously early in the feeding. At the end of the feeding, apply some fresh breast milk to your nipples to soothe them. Human breast milk has antibacterial properties so it can reduce the chance of infection, say the breastfeeding experts at La Leche League. If you are still in pain, talk to your doctor about using a cream or vitamin E on your nipples. He can also check for signs of infection.

Not Producing Enough Milk

In a Pediatrics study, this was the number one reason women stopped breastfeeding or introduced solids before their baby reached 6 months old. Yet, "the true prevalence of mothers who are unable to produce enough milk to accomplish their infant's weight gain is only about 5 percent," says Ruowei Li, M.D., Ph.D., a breastfeeding researcher in the Division of Nutrition, Physical Activity and Obesity at the CDC in Atlanta. In other words, 95 percent of nursing moms can make enough milk, but those who stop breastfeeding, supplement or introduce solids perceive that they aren't.

How to Prevent It:

Weigh your baby before and after a feed. You'll be amazed at how the number on the scale goes up (and up!). If your baby is gaining weight and pooping like a champ, you're producing enough milk. Don't be fooled by the pump. Some women don't let down easily when expressing milk, says Nancy Hurst, R.N., Ph.D., I.B.C.L.C., director of Lactation and Milk Bank Services at Texas Children's hospital Pavilion for Women in Houston. "They see they're not getting much when pumping and believe that's what the baby is getting," she says.

Talk to your pediatrician about infant nutrition. "Breast milk alone didn't satisfy my baby" is one of the top three reasons women quit and/or introduce solids before recommended. "Early introduction of solid foods is concerning as developmentally, younger infants are not prepared for solid foods," says Li. Discuss the signs of infant hunger with your pediatrician.

Take a "babymoon." Do nothing but nurse on demand for two to three days. "the more your breasts are stimulated, the more milk you'll produce," says Lebbing, who is also a lactation consultant at Silver Cross hospital in New Lenox, Ill. During your babymoon vacation, get rid of the pacifier and bring your baby into your bedroom at night. the trick is to be with your baby constantly and nurse when she's hungry and when she needs comforting.

Rent a hospital-grade pump. These are used in hospitals by mothers of preemies who need to establish milk production quickly. the "limo of pumps," as Lebbing calls them, is more effective at expressing than any pump you can buy. Visit Medela (medelabreastfeedingus.com) or ameda (ameda.com) online to find a rental outlet near you.

Finding Time to Pump

Returning to work is one of the most common reasons women stop breastfeeding exclusively or wean altogether. In fact, women whose maternity leave was less than six weeks are four times as likely to stop nursing than women who don't return to work. Those with up to a 12-week leave fare a little better: they're only twice as likely to stop altogether than moms who don't return to work. "Going back to work at six weeks is really tough," says Hurst. "You're just getting into a breastfeeding groove and then both mom and baby have to switch gears."

How to Prevent It:

See a lactation consultant before you return to work. She'll help you find a super-comfortable, double-electric, hands- free pump that will allow you to express milk while you're busy doing something else. "I know a doctor who performed general surgery while pumping her breasts," says Debi Page Ferrarello, M.S.N., M.S., I.B.C.L.C., director of family education and lactation at Pennsylvania Hospital in Philadelphia. 

Buy at least two sets of pump attachments—as well as bottles, caps and nipples—so you always have a clean set.

Practice pumping a few weeks before returning to work and build up a reserve in your home freezer.

Find a friendly child care center. According to a new study in the Maternal and Child Health Journal, continuing to breastfeed at the six-month mark was significantly associated with a nursing-friendly child care setting. Find one that allows you to breastfeed before and after work.

Use the right flange. Women's nipples come in every shape and size, so make sure you use a flange that's the perfect size for you. "When your flange fits properly, you'll express more milk," says Katy Lebbing, B.S., I.B.C.L.C., R.L.C., a La Leche League leader who served on the expert panel for the 2011 Surgeon General's Call to Action to Support Breastfeeding. Using the wrong size will not only result in getting less milk, it can also be painful and inefficient. Best bet: get flange-fitted by a certified lactation consultant.

Be flexible. If pumping proves to be too much of a headache, breastfeed your baby before and after work and tell the babysitter to feed her formula during the day. Again, it's important to remember that any amount of breast milk is better than none.

Wanting to Share Feeding Responsibilities

Studies show that quite a few women cite family harmony as a higher priority than breastfeeding exclusively. they don't want to ignore the 3-year-old sister who is "desperate to help" by feeding baby a bottle; or they want dad and grandparents to bond with baby, too.

How to Prevent It:

During the first weeks after birth, you should nurse the baby. "The first week is critical," says Hurst. "Getting that stimulation in the beginning will really ramp up the hormones that influence your milk volume."

Don't pump until you reach four to six weeks. Nursing will be smooth sailing and you'll have an easier time pumping milk. Then everyone can join the baby-feeding party via bottles of your expressed milk.

Let dad bathe the baby. Bottle-feeding isn't the only way to bond with baby. Bathing, rocking, dressing, changing, singing and cooing are all meaningful ways for Dad, gramps and Big Sister to connect with the newest member of the family.

Being Too Shy to Breastfeed in Public

Thanks to all the controversy surrounding this issue, even the boldest and bravest of women think twice about nursing outside the home. Even though it's legal, breastfeeding in public can be difficult, especially in areas where it's not widely accepted. Many nursing moms don't want to deal with uncomfortable stares, glares, and ogles and will choose a bottle over the breast in public.

How to Prevent It:

Look for the international breastfeeding symbol. Wherever the blue-and-white symbol of a nursing mom is posted, it means that the store or restaurant welcomes breastfeeding moms and may even provide a lactation Go undercover. With Hooter Hiders, Bebe au Lait. or any other type of nursing cover (including a simple blanket), you can cover your breastfeeding infant so well that nobody will look twice at you.

Build your confidence before stepping out. You don't have to be a "lactivist" to nurse in public, but you do need to develop your breastfeeding chops. Wait till you get the hang of breastfeeding before you and your baby head to the mall for an hours-long shopping excursion.

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