How to Enjoy Nursing

My daughter nursed like a champ. She had a great latch, a top-notch suck. I felt almost suspicious of how easy it all was. Then at 10 weeks, everything changed. When I'd offer my breast, she'd scream wildly, frantically trying to push it away with her tiny fists. Within a day, she was staunchly refusing the breast altogether. As far as I could tell, nothing about me, her, or our routine was any different. So I put a lactation consultant on the case, and within an hour, she'd solved the mystery.

"This baby has reflux!" exclaimed Freda Rosenfeld, of Brooklyn. "It's what we call silent reflux because she's not spitting up a lot, but you hear that cry of pain after she burped? Classic." Rosenfeld pointed out that my daughter was just at the age when reflux -- silent or not -- starts to develop in babies. She told me to hold her upright so that she was sitting rather than lying down to nurse and recommended that I eat fewer acidic foods (like citrus fruit and soda). Voilà! Our nursing nightmare was over.

Of course, to an exhausted, aching, not to mention hormonal mom, getting to the root of what's wrong can be overwhelming. The only way you learn to breastfeed is through intense on-the-job training, says Portland, Oregon, lactation consultant Meg Stalnaker. To help you succeed at nursing, we sleuthed out the top five hang-ups. Identify your culprit and you'll soon be on the trail to breastfeeding bliss.

The Challenge

"When my baby latched on, it was excruciatingly painful, my nipples felt bruised and were nearly bleeding, and there was no sign of the pain getting better after almost a week." Nadia Hefni Foster, Los Angeles

The Clues

• Sharp nipple pain while nursing
• Cracks, scabs, and blood on nipples
• Nipple looks long and pinched afterward

The Culprit: Poor latch

Successful breastfeeding begins with a good, deep latch. To do this, you want your baby's mouth to be wide open, so that she takes as much of the breast into her mouth as possible, says Mona Gabbay, M.D., an internal medicine specialist with a focus on nursing issues, in New Rochelle, New York. As soon as your baby's mouth opens wide to an angle of 90 degrees or more, bring her to your breast, aiming your nipple at her nose so that it ends up near the roof of her mouth. If you have trouble getting your little one to open wide enough, touch your nipple to her upper lip, tickle her chin, or pull down gently on her chin when she opens, to coax her a little wider. Baby's back, neck, and shoulders should be in a nice, straight line; she shouldn't need to turn her neck to nurse.

You'll know you're on target if the nipple looks round, almost as if it wasn't touched, when your baby comes off. If it looks distorted (for instance, the shape of a lipstick or screwdriver head), or if you can see a crease or fold, that means the nipple is getting pinched and you need to adjust your latch, says Dr. Gabbay.

The Challenge

"I seemed to choke my baby with every meal. It was disturbing to hear him gag and cough while trying to keep up with the waterfall of milk." Dana Marlowe, Silver Spring, Maryland

The Clues

• Baby sputters, gags, or cries at the start of nursing session
• Milk shoots out of breast at intervals
• Lots of leaking

The Culprit: Forceful letdown

Leaking is incredibly common, and many women will experience milk spraying out of the breast, especially if it's been a while since you nursed. Neither of these things means there's a problem with your letdown. But if your baby is choking, gagging, or gasping at the start of the feed, or if he clamps down on the nipple or keeps pulling off, it may well mean he is getting too much milk too fast.

If you're dealing with an overactive letdown, the choking and gagging should last, at most, a few minutes. It may be repeated later in the feeding, however, when you let down again once or twice more, says Stalnaker. Fight gravity by starting off a nursing session lying down or leaning back, with your baby in a vertical position, says Stalnaker. She also suggests expressing milk for a minute or two before you nurse, either manually or with a pump. That way, you release the most powerful torrent of milk before your sweetie latches on. The good news: A forceful letdown tends to correct itself after a few months, as your milk supply becomes more regulated and your little one learns the ropes of breastfeeding.

If your munchkin sputters and coughs for the entire feeding session, the problem is more likely to be an over-abundance of milk. You can reduce your milk production several ways, says Dr. Gabbay. Try offering only one breast per feeding, applying frozen cabbage leaves to your breasts for a day or two, and sipping sage tea.

The Challenge

"My baby Max made a lot of noise when nursing and he kept falling off my boob. My nipples were getting chewed to bits -- raw and red." Allison Garber, Brooklyn

The Clues

• Nipple pain and wounds even with a deep latch
• Baby tires easily while nursing
• Tongue looks heart-shaped

The Culprit: Tongue-tie

Garber's son had a tight frenulum (the band of skin that attaches the midline of the underside of the tongue to the mouth). Because of this, his tongue couldn't extend as much as it should, making breastfeeding a lot of work. "Babies use the tongue in a wavelike motion to express milk from the breast," says Dr. Gabbay. "So if the tongue is restricted, it may be difficult for your baby to get milk or it may require more energy, tiring him out." A tight frenulum can also cause nipple pain because the baby's tongue keeps rubbing against the nipple rather than the areola. A low milk supply and poor weight gain in babies are additional side effects of a tongue-tie.

If you're continuing to suffer from nipple pain despite a good latch, or your baby isn't packing on the pounds the way he should be, have a lactation consultant or pediatrician look to see if a tongue-tie might be to blame. "I took Max to an ear, nose and throat specialist who snipped the frenulum, giving his tongue more wiggle room," Garber explains. "The procedure took minutes in his office, and Max nursed easily for the first time that same day."

Blocked Milk Ducts and Acid Reflux

The Challenge

"When my son was one month, I woke up with chills and was feeling lethargic. My right breast was hard as a rock and felt painful to the touch." Shiri Sarfati, New York City

The Clues

• A hard, tiny knot in your breast that is tender to the touch
• Redness or inflammation of breast
• Fever, chills, flu-like symptoms

The Culprit: A blocked milk duct

Clogs in the milk ducts tend to occur in the early months of nursing. Even slight changes in supply and demand -- maybe Baby has started sleeping longer in the morning, so you're nursing an hour later -- can make a duct go haywire. "If your baby isn't nursing when your body expects her to, the milk sits in the breast longer than it should, becoming thick and coagulated," explains Stalnaker.

As soon as you feel this hard knot, nurse your baby on that breast while simultaneously massaging the sore area gently in little circles with your fingers. Loosen the hardened milk before feedings by applying a warm wet towel for three to five minutes, says Dr. Gabbay. (Some moms swear by massaging the area with a water-dampened diaper warmed slightly in the microwave.)

Certain women are more prone to clogged ducts and if they keep happening to you, express some milk for a few minutes every two hours or so to keep it flowing. If the clog persists and you develop a fever and chills, you likely have mastitis, an infection in the breast that will need to be treated with antibiotics.

The Challenge

"At 3 weeks, Cole became very cranky -- crying and squirming, especially after feedings. He was spitting up

large amounts, which made me think he must be hungry, so I kept feeding him, which made it worse." Kelley

Jacobson, Nixa, Missouri

The Clues

• Baby cries or is fussy during and after feedings
• Projectile vomiting or large quantities of spit-up
• Poor weight gain

The Culprit: Acid reflux

A certain amount of acid reflux (called GER, for gastroesophageal reflux) can be normal and stems from an immature digestive system, says Stalnaker. If your baby is putting on weight and seems happy while nursing, there probably is no reason to be concerned, no matter how much he spits up. But if he's cranky while nursing or right after, not gaining weight the way he should, and spitting up buckets, he may have GERD (with a D, for gastroesophageal reflux disease). GERD babies will also show obvious discomfort when spitting up or breastfeeding. They may cry, pull their legs up, gag, and burp.

Both varieties of reflux typically peak between three weeks and two months of age, says Dr. Gabbay. You'll need your pediatrician to diagnose GERD; he'll likely recommend starting with position adjustments (keeping Baby upright during and after feedings) and smaller but more frequent feedings. If those don't help, your little one may need medication. Jacobson saw a dramatic improvement in Cole once his doctor prescribed Prevacid.

There are plenty of ways to solve these breastfeeding challenges, so don't be shy about asking for help. It may not quite take a village to nurse a baby, but it does take a team.

Originally published in the November 2013 issue of American Baby magazine.

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