Get expert answers to the breastfeeding questions you may not feel comfortable asking your Ob-Gyn.

By Kate Kelly and Elizabeth Passarella
Priscilla Gragg

When you decide to breastfeed your baby, one thing is for certain: You'll have questions about whether you're doing it right. We've got judgement-free answers from the experts.

Milk Production

I’m constantly nervous that my baby isn’t drinking enough milk. How do I know he’s getting the right amount?

Try to focus on these two things instead: your baby’s sucking and his poop. “Think of it as you do microwave popcorn: You don’t want long pauses—you want constant suckling,” explains Maya Bunik, M.D., professor of pediatrics at the University of Colorado School of Medicine. And look for several watery, yellow stools each day. Your baby needs to learn that when he’s at your breast, it’s time to eat. Otherwise, he might nurse on and off for a prolonged time and cause soreness for you in the early weeks. But if you are concerned, call your pediatrician and go in for a weight check, even if it’s not scheduled.

Do smaller breasts produce less milk?

"Most women are capable of producing enough milk for their babies, no matter what size their breasts are," says Deedee Franke R.N., a board-certified lactation consultant and maternal child nurse at Mercy Medical Center in Baltimore, MD. In fact, some small-breasted women produce plenty of milk (even an oversupply in some cases), while some large-breasted women have a hard time producing enough.

Why do some women produce more milk than others?

"Different breasts have different storage capacity," says Leigh Anne O'Connor, an international board-certified lactation consultant. "The amount of milk is not dependent on breast size— it depends on mammary tissue." However, if you're having problems with nursing—or suspect that your supply is low—you should seek help. "There are many problems that can have a negative effect on a woman's milk production, so it is so important to get expert guidance early to prevent a decrease in milk supply," says Franke.

Does breast-reduction surgery impact breastfeeding?

"If you've had breast reduction surgery, that could impact your ability to make milk, but just because you've had the surgery doesn't mean you won't be able to breastfeed," says Aliza Bancoff, a birth and postpartum doula and director of the International Doula Institute. Talk to a lactation consultant or your doctor to see what options are available to you.

Breastfeeding Pain and Discomfort

Are my nipples supposed to be sore?

"Sore nipples are a common problem in the early weeks of breastfeeding," Franke says. "Usually that means the new mother needs some help with her positioning and latch." Make sure to untuck your baby’s lips so they are flared out like a fish. Pain early on is often simply from the frequency of nursing, so keep gel pads and lanolin on hand for soothing your breasts. Getting help from a lactation consultant can make a huge difference.

I think my baby is latching on well, but breastfeeding still hurts like crazy.

Babies are like vacuums—and we’re guessing you haven’t had a vacuum stuck to your nipple before—but breastfeeding shouldn’t be painful. “You should feel a slow, rhythmic pressure. Although it takes getting used to, if it’s extremely painful, your baby probably isn’t attached correctly,” says Diane L. Spatz, Ph.D., director of the Lactation Program at the Children’s Hospital of Philadelphia. Even if you had the hang of it in the hospital, his latch can change once your milk comes in and your breasts are fuller. “If you’re in pain, don’t wait and see. The first three to five days are critical for establishing your milk supply, so call a lactation consultant,” says Dr. Spatz.

My baby is sleeping along stretch at night (hallelujah!), but I’m waking up in pain from engorged breasts (ouch!). It’s a blessing and a curse. The question is: Do you set an alarm to wake up and pump?

If your baby is less than 6 weeks old (congratulations, by the way, you have a champion sleeper), it’s probably best to get up and pump a couple of ounces so that your supply doesn’t decrease, says Dr. Bunik. More likely, your baby is older and simply sleeping through the night. If you can, too, we say do it. But if you’re uncomfortable, you should pump.

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Breastfeeding Side Effects

My nipples are bleeding. Can I still breastfeed?

If you have sore, cracked or bleeding nipples, you can and should still breastfeed, says Bancoff. "A small amount of blood in the milk will not hurt the baby." However, cracked nipples could indicate problems with your latch. Again, a few sessions with a lactation consultant can help.

Why are my breasts hard as rocks?

Engorgement may happen three to five days postpartum and can make your breasts feel hard and painful, says Chandra Campana, LPC, IBCLC. "Warm compresses can be used prior to nursing, to aid in the removal of milk, and cold compresses after you nurse, to reduce tissue swelling," she notes. She also advises not to wait too long between feeds to avoid engorgement. "Babies should eat every three hours, or sooner with cues."

My joints ache as if I had arthritis. I’ve heard breastfeeding can leach calcium from your bones. Is this permanent?

Some women experience achy or loose joints when pregnant or breastfeeding. And yes, it does leach calcium from your bones. But aches and pains could also be from holding your baby or hunching while you nurse. Your estrogen levels are also higher during pregnancy and while breastfeeding, and that can loosen your ligaments. Your bone density will go down while you’re breastfeeding but should return to normal when you stop, says Dr. Bunik. “Continue taking a prenatal vitamin, which has extra calcium, and a vitamin D supplement for bone health.”

How do I loosen clogged ducts?

To ease the pain and loosen the clog, try applying hot compresses or massaging while nursing or pumping. “Using the butt end of an electric toothbrush as a massager can also be helpful,” says Dr. Bunik. Press on the area while you are nursing, take an over-the-counter pain reliever, and if you spike a fever or see a red, triangular pattern on your breast where the clog is, there’s a good chance you have an infection or mastitis. Then it’s time to call your doctor

Should I stop breastfeeding if I have thrush or mastitis?

As much as you may be tempted to stop nursing, breastfeeding your baby through thrush and mastitis actually helps. "Often nursing will help to release the clogs, and with mastitis you really need to have the milk flowing to get the infection out and to prevent more clogs," says O'Connor. However, you do want to treat the thrush and the mastitis as you continue nursing. In all cases, you want to heal the breasts and find the root of the problem.

Breastfeeding and Your Baby

I ate broccoli for dinner last night, and I’m worried it will make my baby extra gassy.

Do you stop eating broccoli because it gives you gas? No? Then don’t worry about your baby either. (Besides, everybody toots!) “Babies’ intestinal tracts are pretty immature during their first 3 to 4 months, and any gas or poop can cause them some distress,” says Dr. Bunik. “But it’s not dangerous and it’s no reason to eliminate things.”The gas will pass, usually in about six hours. If it’s upsetting to watch your baby squirm, or if the gas keeps him (and you) up all night, then feel free to skip serving yourself broccoli or beans next time. But overall, you should eat what you love and try to have a well-balanced diet, suggests Dr. Spatz

I came home from a night out—whoop!—and nursed when I was a little tipsy—whoops.

While not drinking is the safest option for breastfeeding mothers, up to one alcoholic beverage per day is not known to be harmful, especially if you wait at least two hours after having a single drink before nursing, according to the CDC. Alcohol is a sedative, so watch for excessive sleepiness or changes in your baby’s breathing, says Dr. Bunik. Call your doctor if something seems off. Next time, plan ahead by pumping a couple of bottles to get you through the night if you know you’re heading out to enjoy a cocktail.

She keeps biting me!

Once your baby is old enough to have teeth, she’s also an efficient eater, so she’ll finish quickly and start chomping with those new, sharp tools. “Be attuned to your baby. When she finishes actively sucking, take her off so she doesn’t get bored,” says Dr. Spatz. “If she does bite, give a strong ‘No,’ to send a message.”

My baby is extremely fussy and gassy. Could her symptoms could have something to do with my breast milk?

Her fussiness could have something to do with your diet. But she 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.

A foremilk-hindmilk imbalance 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. — Susan Reulbach Wirtjes, RN, IBCLC, a lactation consultant at Covenant Medical Center in Waterloo, Iowa

Romanova Anna/Shutterstock

Breastfeeding in Public

Is it normal to leak in public?

"As a new mom's milk supply gets established it's not uncommon to experience some leakage," says Tracy Donegan, midwife and founder of GentleBirth. "Breast pads can be your best friend in the beginning as things settle down." Some moms have their breast milk let down just by thinking about their baby or hearing a baby cry. "If that happens, bring your arms up firmly over your breasts for a minute or two and that will stop it," Donegan advises. Also, she notes that you you might leak during sex—and that's totally normal.

Is it okay to breastfeed in public?

While you may feel self-conscious at first, it's perfectly acceptable to nurse your baby in public. "In the United States, breasts are seen and advertised more on a sexual basis," says Franke. "In other countries, breastfeeding is more accepted in public." If you feel uncomfortable, you can always use a nursing cover-up; but don't feel pressured to do so. Breastfeeding is a natural activity and shouldn't be a cause of shame.

Breastfeeding vs. Pumping vs. Formula Feeding

I don't enjoy breastfeeding at all. Is it okay just to pump?

"There are some mothers that physically don't enjoy the act of breastfeeding, but want to provide breast milk for their babies," says Franke. "It is an individual choice and an act of love and commitment." Basically you know what's best for you and your baby. If pumping and giving her breast milk works for you and your child, then don't feel guilty about doing that. You're providing her great nutrition and plenty of love.

At my baby’s two-week appointment, my pediatrician said he needs to gain more weight and wants me to supplement with formula. I’m devastated.

First of all, the most important thing is to have a healthy baby and a (physically and mentally) healthy mom, so take a deep breath. What’s likely happening is that he isn’t nursing effectively for some reason—maybe he’s having a hard time latching on or is just a slow, laid-back eater—which has resulted in your supply going down. If the goal is to keep breastfeeding, you need to pump—essentially, the pump will do the work your baby isn’t. Dr. Spatz recommends a hospital-grade pump for maximum efficiency. Your doctor may suggest that you nurse for a short amount of time, then feed the baby some formula, and then pump to stimulate milk production.

What's the best way to begin feeding Baby with a bottle? 

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. 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, if that's the end goal.  — Susan Reulbach Wirtjes, RN, IBCLC, a lactation consultant at Covenant Medical Center in Waterloo, Iowa

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Comments (2)

Anonymous
December 11, 2018
Help!!! My baby is 2 months and for over a month th now my breastmilk has stopped flowing.Even at the time it was flowing it was extremely low so the doctor advice that I supplement with formular yet my baby prefers the breast despite the fact that the breastmilk isn't flowing and will only take the formular when very very hungry.Before the little breastmilk that was flowing stopped I started experiencing sharp pains in my breasts.
Anonymous
December 2, 2018
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