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Breastfeeding Questions and Concerns Every New Mom Should Know

Inverted Nipples

Before your baby is born, check your breasts for flat or inverted nipples. Place your thumb and forefinger around your areola in a “C” shape, about an inch from the base of your nipple, and gently press thumb and forefinger together. Your nipple should project outward. If your nipple pulls back into the breast or remains flat, seek advice from your doctor, a certified lactation consultant or a La Leche League leader.

Wearing plastic breast shells during the last few months of pregnancy can help your nipples project outward. However, some authorities suggest that a baby who is attached to the breast properly will nurse effectively regardless of the size or shape of the mother’s nipples. Either way, it will be helpful for you to understand proper positioning and talk to a lactation consultant or doctor about this issue before your baby is born.

Engorgement

Uncomfortable breast fullness, which can cause your breasts to feel hard, hot and sore, can occur because a baby is not removing enough milk. To get rid of this engorgement, breastfeed your baby more often or use a breast pump. Pumping to comfort or pumping for just a few minutes, just long enough to get your breasts comfortable, will not produce an oversupply of milk. Applying cold compresses between feedings and/or warm compresses and circular massage just before and during feeding can also be helpful.

Sore Nipples

Sore nipples are a common complaint at first. This may be a new experience for you, and it may indicate that your baby is not positioned correctly at the breasts. If the pain subsides in a minute and you are comfortable for the rest of the breastfeeding session, there is nothing to worry about. If not, call a milk consultant or La Leche League leader for suggestions.

Causes of sore nipples include:

• Baby clings too close to the nipple, not taking up enough areola tissue.
• A baby’s lower lip is tucked in instead of flanged.
• A baby pops the nipple into his mouth instead of opening wide to accept the breast.
• A baby’s gums rub against the nipple when coming off the breast.
• Baby stretches the tissues and causes pain trying to pull out inverted or flat nipples during the early days/weeks of breastfeeding.
• Moisture remains on an inverted nipple for a prolonged period.

Suggestions:

Clogged Ducts

Too much milk remaining in the breast can cause a blocked duct. This can happen for a variety of reasons and can result in a sore spot on your breast that is red and slightly warm to the touch.

Treatment measures for a blocked duct include:

• Wearing loose clothing and a bra that doesn’t bind.
• Getting plenty of rest.
• Nursing as often as baby will cooperate and/or pumping between feedings.
• Nursing baby 8-12 times every 24 hours.
• Apply moist or dry heat to the painful area before breastfeeding.
• Starting each nursing session on the chest with the painful point.
• Positioning baby so his chin lines up with the sore spot.
• Massage the sore spot while breastfeeding.

Breast Infection

If you develop other symptoms, such as fever, chills, pain, or chest pain that is widespread instead of in one place, you may have a breast infection, also known as mastitis. Contact a certified lactation consultant, La Leche League leader or healthcare provider for advice. Some breast infections will go away with the same treatment you would use for a blocked duct.

If your symptoms persist, or if you have a high fever, you may need an antibiotic prescribed by your doctor. Most antibiotics are safe to take while breastfeeding, but discuss this issue with your doctor to be sure.

Is baby getting enough milk?

Weight gain is the most accurate way to tell if your baby is getting enough milk, so weigh your baby. Normal weight gain is about four to eight ounces per week. As your baby gets a little older, the weight gain will become more obvious. If you are concerned about your baby, talk to your doctor or a lactation consultant.

Also, keep an eye on your baby’s diapers, because what goes in must come out. At first your baby will only have one or two wet diapers a day. Once your milk supply increases, baby should have five to seven wet diapers (six to eight if you use cloth diapers) and three to five bowel movements each day. Some babies may have a small bowel with each diaper change.

The first intestines will be dark black, with a tarry consistency. Both color and consistency will change within a day or two of your milk supply increasing. The color of breast milk stool is most often mustard-yellow, but it can vary from tan to yellow to yellow-green. The consistency is loose and runny and will remain as long as your baby receives only human milk. Also, when breastfeeding, your baby needs to swallow after every couple of feeds, so listen for swallowing. Other indicators include that your breasts become softer after feeding, your baby’s skin feels smooth and firm, and baby seems content after feeding.

However, if your baby shows any of the following signs, contact your doctor immediately:

• A faint cry
• Skin without stamina (when pinched it stays pinched looking)
• Dry mouth and dry eyes
• Less than the usual amount of tears
• Minimal urine output (less than two wet diapers in 24 hours)
• Fever
• A fontanel (soft spot) on the baby’s head is sunken or depressed

If you’ve had breast surgery before, be sure to tell your doctor. Many mothers were able to fully breastfeed their babies after breast surgery. However, it is important that your doctor is aware of your history and past breast surgery(s) so that you and your baby are closely monitored to ensure that your milk supply is good and that baby is gaining weight.

Increasing Your Milk Supply

The amount of milk you produce depends on how much and how often milk is removed from your breasts. As baby’s demand increases, your body will increase its supply, but you may find the following suggestions helpful if you’re concerned about your milk supply:

• Nursed baby on both breasts at each nursing session.
• Nursed baby twice on each breast at each nursing session.
• Use the lying position occasionally so you can rest while baby is nursing.
• Nurse at the earliest signs of a baby.
• Drink plenty of fluids (based on your individual needs).
• Use a light pump between feedings.
• Refer to a certified lactation consultant for a complete breastfeeding evaluation.

Baby Constantly Wakes At Night

There are many reasons why a baby wakes up at night. You may have a newborn who is a light sleeper and wakes easily. Plus, human milk digests twice as fast as formula, so breastfed babies get hungry more often than bottle-fed babies.

Baby Always Sleeps

Certain medications used during labor and delivery can make a baby extremely sleepy. If baby sleeps constantly in the first week, it is important to wake him up to breastfeed so that your milk supply becomes established and baby grows and gains weight normally. Try to nurse often at night when it is quieter. Contact another mother or a breastfeeding counselor for advice on waking a sleeping baby.

Breastfeeding and Mother’s Medications

Most antibiotics and pain relievers are compatible with breastfeeding. However, you should always discuss certain medications with your doctor or pharmacist.

The potential risks of medication, whether prescribed by a doctor or bought over the counter, should be weighed against the risks of weaning and providing artificial milk.

When to Ask for Help with Breastfeeding

Seek help when:

• Your newborn has fewer than five to seven really wet diapers, or three to five bowel movements per day, even after your milk supply increases in the first week.
• A baby’s urine is dark in color or has a strong odor.
• Nipple or breast pain worsens and persists between feedings.
• Breastfeeding becomes painful. (A little soreness at first is normal, but it should fade as your baby learns to nurse.)

Baby Seems Full of Gas You may have heard that babies react to foods in their mothers’ diets, but this is quite rare. Infant formula is much more likely to cause some kind of problem rather than a reaction to a mother’s diet.

Infant massage often helps calm a baby who seems to have gas, so you might read books on infant massage to find a technique that your baby likes. You could also try the colic hold to see if it helps baby become more comfortable. Drape your baby face down over your forearm with his head in the crook of your elbow, your hand supporting his midsection, and his legs hanging down.

Supplements and Artificial Nipples

Supplements of water or artificial milk (formula) in the early weeks of breastfeeding can contribute to poor milk supply, prolonged engorgement, jaundice or cow’s milk allergy or intolerance problems for you and your baby.

Avoid artificial nipples and pacifiers as they can confuse your baby when learning how to breastfeed. A baby uses mouth and tongue differently when taking a bottle or pacifier versus a human breast. Among other things, artificial nipples are firmer than your breast, and a baby holds them in front of his mouth. If a baby does the same while breastfeeding, he may not use enough suction and he won’t get as much milk.

Your nipples may become sore during the process. Some very sensitive babies even refuse to breastfeed after using artificial nipples.

Since there is no way to tell ahead of time whether your baby will be able to switch back and forth easily, it is best to avoid artificial nipples until your baby has been nursing well for at least three or four weeks and the likelihood of confusion is reduced. . If you need to feed your baby other than at the breast, use an alternative to bottles, such as a spoon, eye dropper or small feeding cup. Consult an experienced lactation consultant about these options.

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