Navigating Common breastfeeding Challenges and Finding Support
Understanding common challenges empowers you to find solutions and enjoy your journey.
B.A.S.I.C.S. of Breastfeeding
The B.A.S.I.C.S. model is a helpful way to approach breastfeeding and self-care:
Be patient
Affirmations
Soothe your body
Information
Comfort
Serenity
Milk Flow and Supply Challenges
1. Worries About Milk Production
A baby receiving an adequate milk supply should be wetting six to eight diapers a day. The size or shape of a client’s breast has no bearing on milk production. Consistent breast/chest feeding is the primary stimulant for building supply. Clients experiencing supply issues should consult an IBCLC (International Board Certified Lactation Consultant).
2. Engorgement
Engorgement is common, often during the first week postpartum, as the milk transitions from colostrum to mature milk.
What happens: Fluid is trapped in the breast/chest, making them feel hard, painful, and swollen.
Solutions: Applying cold packs can relieve mild symptoms (heat should be avoided as it can increase inflammation). Expressing milk, either by releasing milk by hand or by pumping, can also help and will encourage more production.
Common Challenges with Nipple and Latch
1. Sore Nipples
In early breastfeeding, it's normal to expect some soreness. This is because the nipples have never been used in this capacity before.
Solution: Focus on achieving a proper latch. Ask a lactation consultant (IBCLC) to help assess the client and teach them to use their finger to break the suction when taking the baby off the breast/chest.
2. Dry, Cracked Nipples
Avoid: Encouraging clients to eliminate perfumes, soaps, creams, or body products that contain alcohol, as they cause dryness.
Solution: The best approach is to hand express some milk and spread it over the nipple, and let it air dry. Applying nipple ointments and gel pads (or prescription All Purpose Nipple Ointment) can help the skin heal faster using the protocol for "wet wound healing."
3. Flat or Inverted Nipples
If the nipple is flat or retracted into the breast/chest, an IBCLC can encourage the client to try manual stimulation or use a pump to gently pull the nipple forward.
Alternative: Use a nipple shield as recommended by an IBCLC.
If flat nipples are caused by engorgement, the client can use reverse pressure softening to soften and draw out the nipple before latching the baby.
Ductal Inflammation, Mastitis, and Stress
3. Ductal Inflammation / Blocked Ducts
A single sore spot on the breast, which may appear red and hot to the touch, can signal inflammation in the ductal tissue, which can slow or hinder the easy flow of milk.
New Guidance: The Academy of Breastfeeding Medicine now recommends using a cold pack along with over-the-counter anti-inflammatories (like ibuprofen) to relieve the inflammation and reduce the ductal narrowing. Heat should be avoided as it can further inflame the tissue.
Other Solution: More frequent nursing is also beneficial.
4. Inflammation/Infection (Mastitis)
Mastitis is now viewed as a spectrum of conditions resulting from inflammation of the supportive tissues as well as inflammation of the ductal structures.
Symptoms: Swelling, warmth, redness, and red streaking extending out from the area of infection. The individual may have a fever of $101.3^\circ\text{F}$ or higher, along with flu-like symptoms.
Action: Contact your healthcare provider or an IBCLC for diagnosis and treatment.
5. Stress and Let-Down
Being overly anxious or stressed can interfere with the letdown reflex, which is the body's natural release of milk into the milk ducts. The let-down reflex is triggered by the hormone oxytocin and can be triggered by hearing the baby cry or thinking about them.
Solution: Staying relaxed and calm before and during feeding sessions can help milk let down and flow more easily.
🦠 Thrush (Yeast Infection)
Thrush is a form of yeast. If suspected, encourage the client to see their physician, midwife, or IBCLC for diagnosis.
Symptoms (Parent): May include pink or red discoloration on or around the nipples and sharp pain (almost like shards of glass) in the breast/chest.
Symptoms (Baby): Include white patches on the tongue, cheeks, and gums.