Expert Answers to Breastfeeding Questions
Hear from a lactation consultant about common issues.
Susan Reulbach Wirtjes, RN, IBCLC, a lactation consultant at Covenant Medical Center in Waterloo, Iowa, answers readers' breastfeeding questions:
I've been nursing for one week and it still hurts, especially my right nipple. I know the key to comfortable breastfeeding is getting my baby latched on correctly, but I'm positive that her mouth is covering my entire areola. What could be the problem?
I suspect the problem is with your latch. It sounds like the baby's lower lip is not grasping enough of the bottom of the areola. To tell for sure, look at your nipple after you're done nursing. If it's crooked and tipped, you need to slightly fine-tune the way you're positioning the baby.
If you're nursing while cradling the baby in your arms, the tendency is to hold baby's head in the crook of your arm, near your elbow. Instead, move her down a few inches closer to your wrist. This should put her in a position where her lower lip can take in more of the underside of the areola. Don't worry if you see some of the areola exposed on top -- that's okay.
Fussiness and Breast Milk
My baby is extremely fussy and gassy. I suspect she has colic, but I'm wondering whether her symptoms could have something to do with my breast milk.
Her fussiness could have something to do with your diet. But before you start eliminating foods, I have another thought. Your baby could be suffering from something called hindmilk-foremilk imbalance. When your baby nurses, she first gets foremilk, which has more lactose than the milk that comes afterward, called hindmilk. In addition to containing more fat, hindmilk also contains an enzyme to help the baby digest the lactose from the foremilk. If you switch your baby from one breast to another too quickly, she may not get enough hindmilk to digest the lactose; when she's put on the second breast, she's once again starting off with foremilk. And if she's typical of many newborns, she'll fall asleep before she's nursed long enough on the second breast to get much hindmilk. All that undigested lactose makes babies gassy and fussy.
This is especially likely to be the problem if you watch the clock when you nurse and meticulously switch breasts after 10 minutes of nursing, if your baby is slow to gain weight, or if your baby has greenish stools.
Instead of switching breasts each feeding, let your baby nurse for an entire session on one breast. Switch to the other breast for the next feeding. That way, you're assuring that she'll nurse long enough to get both foremilk and hindmilk. As your baby gets older and her fussiness subsides, try going back to nursing on both sides.
My 2-month-old seems to have an endless appetite and wants to nurse all the time. Could he really be that hungry?
The insatiable baby is telling us that he needs something. It's normal for newborns to nurse around the clock, but by 2 months of age, you'd expect a baby to last longer between feedings. If he's gaining weight normally or gaining more weight than expected, his nonstop nursing may be due to discomfort. I suspect he's reacting to something in your diet that's making its way into your breast milk. The most common culprit is cow's-milk protein, which some infants find hard to digest. The resulting bellyache, ironically, may make him want to nurse even more. While the baby is sucking, endorphins are released, which make him feel better. And, of course, he associates feeding at your breast with safety and warmth.
Try cutting your dairy intake in half. Some mothers with extra-sensitive babies need to eliminate all dairy from their diets. (Of course, it's important that you continue to get 1,200 milligrams of calcium a day, but there are many alternative sources, such as spinach, almonds, sardines, and calcium-fortified orange juice.) It will take about two weeks for you to notice a difference. If eliminating dairy doesn't help, talk to a lactation consultant about other foods in your diet that could be triggering your baby's discomfort.
A friend of mine suggested that I give my baby a pacifier as a way to end nursing sessions that go on for longer than half an hour. Is this okay? How can I tell when he's had enough?
As long as breastfeeding is well established, it's fine to offer a pacifier. Many newborns try to replicate their earlier life in the womb. Before birth, your baby was able to suck on his thumb, wrist, or fist for hours at a time because his arm was in a fixed position right next to his mouth. Now he doesn't have the coordination to easily bring his fist to his mouth, so instead he wants to suck on your breast.
Look at your baby's hands for clues to when he's had enough to eat. At the start of a feeding, his hand is high and clenched in a fist. When he's satisfied, his hand should be limp by his side.
When it's about time for the feeding to come to an end, try massaging or compressing your breast, which will express the rich hindmilk quickly, providing a tasty end to the meal. Then try letting him suck on your finger or hold a pacifier in his mouth so he can continue sucking on that.
Supplementing with Formula
Breastfeeding is going well, and my 4-week-old baby is gaining weight normally. I'd like to start supplementing with formula because I'll be going back to work in two months and want him to be used to it. What's the best way to begin?
To start, let your partner (or someone else besides you) give the baby his first bottle. Have him or her feed the baby in a different position from the one in which you normally nurse (so your baby will be less likely to associate the feeding with nursing), such as sitting up in a car seat, being carried around the room, or nestled on the person's legs.
I also suggest that you leave the house and let your baby and partner figure out the new routine on their own. If you're around and things aren't going well, you might be tempted to give up on the bottle and try again another day, which will only prolong the process.
If you have a breast pump, you might want to express some breast milk for the first few bottles. Your baby might be less resistant if at least the taste of the milk is familiar and he just has to get used to the mechanics of drinking from a bottle. After a few successful bottles, try introducing formula.
Pumping Breast Milk
I'm going back to work but would like to pump so I can continue to give breast milk exclusively. Should I be pumping after every feeding so I have a lot of milk on hand once I'm no longer home?
Many breastfeeding mothers feel like they need to have a freezer full of milk "just in case," but this mentality can lead to some problems. First of all, you're training your body to produce more milk than your baby needs, and you will still make the extra milk even if you don't pump after a feeding. If the breast isn't emptied, it could lead to a plugged milk duct, which could turn into a painful breast infection called mastitis. Second, if you're committed to exclusive breastfeeding, you're going to have to pump two or three times a day at work -- even if you've got a supply of frozen breast milk at home -- to maintain your milk supply.
But it would be helpful to get used to pumping at home, which will make pumping at work less stressful. It's also handy to have a small supply in the freezer to get you through the transition of returning to work.
I suggest you pump first thing in the morning, when your milk supply is most plentiful. Some moms prefer to nurse first and then pump the other side, while others pump first. You may be adept enough to pump one breast while breastfeeding on the other. It comes down to whatever works best for you. Once you return to work, morning pumping may not be necessary or practical. You'll have to see how it goes.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.