Solutions to Common Challenges

Q. My baby is 2 weeks old, and breast-feeding is agony. The nurse at the hospital said I was doing everything right, but now that I'm home, I've started to dread nursing sessions. Is this normal?

A. Let's not mince words: Breast-feeding can hurt, even when you're doing everything right. But fortunately, the pain usually passes after the first few weeks. "Your nipples and breast tissue have to get used to the sensation of a baby sucking -- voraciously -- and that can take several weeks," says Chris Ann Beard, a nurse-midwife in Portland, Oregon. "But there's a big difference between discomfort and agony," Beard says. "If you're in a lot of pain, call a certified lactation consultant."

It's no surprise that your problems set in after you left the hospital. "It takes a few days for your milk to come in, so breasts don't become engorged until you get home," says Cecelia Deslauriers, a certified lactation consultant in Highland Park, Illinois. Fuller breasts make it harder for the baby to latch on correctly. Also, your baby is more alert and hungrier now than he was in the hospital, which means he's sucking harder -- another reason for pain. Finally, you may not be positioning your baby properly. A lactation consultant can help you adjust your holding style for easier feeding.

Q. All the books say that mothers who nurse lose weight faster than those who bottle-feed, but I've been nursing for five months and am still ten pounds overweight. What gives?

A. "Your body may be holding on to that extra weight to preserve energy, as a way to protect your baby from malnutrition," says Paula Meier, DNSc, director of the neonatal intensive-care lactation program at Chicago's Rush-Presbyterian St. Luke's Medical Center. Don't cut back on calories without discussing your diet with your doctor. Assuming that you're eating sensibly, you'll probably drop the pounds once you stop nursing.

Q. I don't own a baby scale, so I have no idea if my 2-week-old is getting enough to eat. My doctor said to count the number of wet diapers, but I'm finding that difficult -- disposables are so absorbent, it's hard to tell if they're wet. Any suggestions?

A. The "count the wet diapers" advice worked great in the era of cloth diapers. But it is hard to tell if an ultra-absorbent disposable diaper is moist -- especially because a newborn may pee as little as one tablespoon at a time. But it is important to keep track, because if your baby has fewer than six wet diapers in a 24-hour period, it could mean he's not getting enough milk, putting him at risk for dehydration and inadequate weight gain.

One way to know if your baby has urinated is to place a square of toilet tissue in each fresh diaper and then check to see if it's wet. You can also do the pinch test: If the diaper feels the slightest bit mushy, it's holding liquid. Parents reader Athena Williams, of Oak Park, Illinois, arrived at yet another solution. She used a lower-priced disposable until she was sure her preemie was gaining weight. "The cheap ones are less absorbent," she notes, "so it's more obvious when the diaper is wet." Of course, you can also use cloth diapers for a few weeks -- you'll have no trouble deciding whether or not one of those is moist.

However, you shouldn't rely merely on wet diapers to gauge your baby's health. Look at him: If he seems listless; has a weak cry; has a sunken soft spot or dry lips; or his skin doesn't spring back when you pinch it, he may be dehydrated and require emergency medical attention. Finally, pay attention to your gut feelings: If you're worried for any reason that your newborn is underfed, take him to the pediatrician immediately.

Q. My baby thrashes around during nursing, almost as if she's fighting my breasts. Our feeding sessions are like wrestling matches. Where are the blissful, bonding moments I was looking forward to?

A. Basically, your baby sounds frustrated. Why? One possibility is that your milk is coming out like gangbusters, making it hard for her to keep up. "This torrential-letdown effect often happens in the first few weeks of nursing," says Meier, "before your body gets into a rhythm of producing the right amount of milk."

If your breasts are engorged, that could be another reason your baby is having a hard time. "When breasts are full, it's difficult for her to latch on, because your nipples are flat," explains Meier. Expressing some milk before each feeding should help both engorgement and heavy milk flow.

Finally, your baby may have gas and need to be burped more often.

Q. Miraculously, my 8-day-old infant sometimes sleeps through her 2:00 a.m. feeding. I have never felt so exhausted in my life, so the last thing I want to do is wake her up. Must I?

A. To a sleep-deprived new mother, waking a peacefully snoozing infant seems almost sacrilegious -- and, in fact, it may be unnecessary. "As long as your baby nurses a minimum of eight times in 24 hours, regains her birth weight by 2 weeks, and continues to gain four to seven ounces a week, you don't have to wake her to nurse," Deslauriers says. On the other hand, if she is not gaining enough weight, don't let her sleep through feedings, even if you have to set an alarm to wake yourself up. Inadequate calories can weaken a baby and make her sleep instead of cry, which can turn into a vicious cycle of more sleepiness and insufficient feedings.

Q. If I do say so myself, I used to have pretty nice breasts before I became pregnant. Now they have purple stretch marks and thick blue veins that crisscross them like highways -- and they droop too! Will my breasts ever return to their formerly perky selves?

A. They may not, but don't blame breast-feeding. Many women find that their breasts are less firm after childbirth, but these changes are primarily brought on by age and pregnancy, not by nursing, according to Lisa Schafer, R.N., founder of BabyBeginnings, a prenatal-education company in Houston.

"Wearing a supportive bra should help prevent further sagging," Schafer says. The road-map effect will go away once you stop nursing, she adds, and the stretch marks will eventually fade as well -- though they will probably not disappear entirely.