A lactation consultant answers your top Q&As

By: Jennifer Abdul-Rahman, BSN, RN

Being a new mom is overwhelming, and support is everything. When it comes to feeding and lactating, you may have a lot of questions and not a lot of answers. But registered nurse and lactation consultant Jennifer Abdul-Rahman is here with so much of the info you need when breastfeeding–and also some knowledge about newborn feeding and development overall.

Why do I feel like an emotional mess?

Postpartum, women experience a sudden decline in estrogen and progesterone. This drop can affect your mood and leave you feeling emotional, irritable, or moody. Even thirsty. Breastfeeding is controlled by several hormones, especially prolactin and oxytocin. Prolactin is a “milk-making” hormone. When your baby is at your breast, the message to release more prolactin gets sent to your brain. Prolactin can also make you feel tired, or ready to fall asleep. The combination of all of these hormonal changes and the stress of becoming a parent can make many moms feel anxious or overwhelmed. Parents usually feel comforted knowing that once their body adjusts, and their hormones regulate, that those feelings become less overwhelming with time.

My baby wants to nurse or eat all of the time, and it’s wearing me out. What should I do?

Humans are a “carry” species. That means, for the first 3 to 4 months of life, our babies are meant to be carried. It is wired into their biology. The second they are put down, they immediately think they are in danger. Babies do feed a lot in the early months. But this won’t last forever and is very characteristic of newborn feeding. Their bellies are very tiny and can only hold a small volume of milk at a time, so they need to eat frequently. I don’t sugarcoat the feeding part of parenthood. The newborn phase is exhausting, no matter how you’re feeding your baby. It’s hard, and knowing that can help. It is really common for parents to have super high unrealistic expectations that lead to frustration. These tips can help:

1. Prepare yourself (and let go of expectations of perfection) Usually, I start my prenatal classes by telling parents to lower their expectations. Then, lower them again. Okay, now, you are ready to be a parent. Taking a prenatal class helps expecting parents better prepare for what life with a newborn will be like. We live in a culture that perpetuates the myth that mothers are supposed to do all the things and do it all well. Anthropologically speaking, we as a species have never raised children alone. There has always been a community or village behind us, helping us every step of the way. From postpartum recovery to learning to feed our babies. As a lactation consultant, I see firsthand that this is not the norm for most of us anymore. The new parents I work with greatly suffer because of it.

2. Prioritize you and your baby, including rest My best advice: focus on you and your baby. Let almost everything else wait. Ask your partner to pitch in with things around the house. If you have a family member or friend you trust with your baby, have them come by to help watch the baby. Take the change to rest. Remember it took 10 months to grow a baby. It takes more than 6 to 8 weeks to feel like you did before pregnancy.

3. Know what’s normal for feeding and waking Babies should be waking 8 or more times throughout the day and night to feed. This reduces their risk for sudden infant death syndrome (SIDs), promotes milk production, and ensures they are feeding enough to meet their growth and developmental needs. Babies typically double their birth weight within 3–4 months, which means they need to eat a lot. The breast/chest is their home, their comfort, their food, their water, their life, and their safety.

4. Get the emotional support you need, including a from a lactation consultant if needed Breastfeeding is not just about nutrition. It can be difficult feeling like you are the only person that can fulfill your baby’s needs most of the time. Feeling “touched out” from time to time comes with being a mom. Nap when you can, get some extra rest, rearrange your priorities, enlist help from those you trust, stay hydrated, eat well, and do something for yourself each day, even if it is something small. Reach out to support groups, a lactation consultant, or friends who have been there and know what it’s like.

What should breastfeeding feel like? I’m not sure what’s normal.

As a lactation consultant, I tell moms to expect some soreness and discomfort at first. But breastfeeding should not be painful. That being said, pain and discomfort are subjective, and different people may feel varying degrees of sensations.

What is a normal sensation during breastfeeding?

A normal sensation during breastfeeding is a strong pull or tug of the breast. This feels comfortable for some and overwhelming for others, until your breasts become accustomed to this feeling. It should not be painful. This strong pull/tug sensation indicates your baby is latched deeply and feeding effectively. A biting, pinching, stabbing, toe-curling, get- this-baby-off-me type of pain is not normal. At this point, remove your baby from the breast gently but immediately. Place your finger in the corner of the baby’s mouth to break suction and minimize nipple damage. Try again to achieve a deeper latch.

How do I know if my baby has a deep latch?

If you are not sure if your baby is latching deeply, there are several indicators you can look for during feeding. First, listen and look closely. Clicking noises are a sign of a shallow latch, and so are quick chin motions. For deep latches, you want to hear swallowing sounds and see jaw movement. You can also gently pull down your baby’s bottom lip and check to see if you can view the tongue. Babies use over 60 different muscles in their body just to suck at the breast, so as they feed we should see a lot of the facial and head muscles moving from their jaw back to their ears. I usually tell parents to look for these muscles being used, a wide latch on the breast (think an obtuse angle), flanged lips like a fish, and no sound effects except for swallowing. A shallow latch usually looks more like a child sucking on a lollipop with the checks pinching in. Typically, the baby is only on the nipple. When this happens, you pain and the other signs mentioned.

The latch is deep, but my nipples feel sore and raw. Is that okay?

Shallow latches are the most common cause of sore nipples. If you have had a few shallow latches, your nipples may feel pretty raw and uncomfortable. Continue breastfeeding but ensure deep latches are achieved to prevent nipple breakdown. In these instances, nipple pain (biting, pinching, burning pain) happens sometimes for the first 20–30 seconds of the feed as the nipple is sucked back. But the pain should dissipate and lessen significantly with a deep latch. Deep latches let your nipples heal and pain at the start of the feed goes away.

Why are my nipples so sore, and nothing seems to help?

Sore nipples are common but there can be many different reasons why the soreness is occurring. The recommendation for followup with an International Board Certified Lactation Consultant (IBCLC) is within 1–4 days of discharge from the hospital. I typically give 2 weeks as a deadline. If you have not seen significant improvement in latch and nipple pain/soreness within 2 weeks of delivery, reach out for help. Soreness can occur from cluster feeding, which happens around day two of life, due to frequent feeding. Your nipples have never experienced this before and that can take some adjustment. Many parents find lanolin, nipple butters or hydrogel pads work well to soothe soreness. Common household oils (like coconut and olive oil) also help nipple soreness. Lactation consultants also identify oral restrictions (“tongue tie”), structural issues (muscle tightness) directly contributing to latch issues, fungal infection of the nipples, vasospasm (Raynaud’s), or other things that may need to be assessed to determine why the soreness is persisting.

If I supplement with a bottle, will my baby still breastfeed?

You have the right to decide how your baby is fed. Empowering yourself with this knowledge beforehand can enhance your feeding or breastfeeding experience. Each person’s situation is different. If you want to breastfeed and use bottles, try and wait 4 to 6 weeks to introduce bottles. That way, your baby learns to breastfeed first. Babies are smart. They quickly learn that the flow from a bottle is much easier than working at the breast. But, once they learn to breastfeed really well, they can generally switch back and forth between breast and bottle. Breastfeeding is a skill that both parent and baby need to learn, and this takes time, practice, and patience. Bottle feeding is also a learned skill. When babies can take the time to learn one skill first, they perform much better overall. Sometimes things don’t go as planned. In this event, there are ways to maintain breastfeeding goals. This includes using alternative feeding methods when possible, paced bottle feeding methods, and feeding appropriate volumes consistent with infant’s stomach size to avoid overfeeding (which can delay the transition back to the breast).

Breastfeeding versus bottle-feeding at the hospital

If you are worried about your baby being given a bottle at the hospital, I encourage you to reach out to the hospital. Inquire about their policies. In the early days, Baby-Friendly Initiatives and state-based programs to improve lactation care advise using alternative feeding methods over a bottle if a supplement or expressed breast milk needs to be given. These alternative feeding methods are spoons, cups, finger feeding with syringes, or using a supplemental nursing system. I would recommend learning about alternative feeding methods prior to delivery, so you have an idea of what to expect. Lactation consultants are a good resource for other feeding methods, too. Bottles are not the only alternative to feed your baby, you do have other options available. If bottles are used prior to 4 to 6 weeks, Paced Bottle Feeding is encouraged. This method reduces the risk of your baby developing a flow preference from the bottle, which can cause an aversion to breastfeeding. It is not that babies don’t like the breast or don’t want to breastfeed. But sometimes there are obstacles that make it difficult.

I’m not exclusively breastfeeding. What do lactation consultants recommend I look for in a bottle?

Companies make a lot of claims that are not based in facts or research. It would be impossible to make a bottle that is anything like a breast. Babies have terrible eyesight in the beginning and can’t tell the difference in artificial nipples just because one has a “flesh tone” teat. They look for the darkened areola and nipples, which are like a big bullseye to them on a breast, not necessarily the color of the breast. The breast, when in a baby’s mouth, expands and stretches significantly so the nipple is all the way towards the back of the throat at the soft palate. For an artificial nipple to do this, it would need to be made of a very soft and a stretchable material. This material would likely not hold up well or be at risk for breaking.

What to focus on in a bottle

As a lactation consultant, I recommended finding an artificial nipple that works with a baby’s mouth and mechanics rather than finding one that is “breast like.” Bottles that many lactation consultants have found to work best is a narrow-neck teat or one with a gradual slope from the nipple to the neck of the teat. Using a paced bottle-feeding method can also ensure that the feeding session is more similar to breastfeeding in the pace, length and mechanics of a breast feed. I have had families that need to introduce bottles sooner than 4 to 6 weeks because we are still one of only three countries in the whole world that does not have any type of paid parental leave. So, many need to return to work earlier than they want. In these situations I recommend working with an IBCLC to develop a plan that meets your specific goals and they can give you the interventions you need to make it work even when circumstances may not be favorable to what the ideal course would be for breastfeeding.

What are some lactation consultant-approved home remedies for mastitis pain? Should I stop feeding?

Mastitis is an infection of the breast, commonly occurring after a clogged duct that was unable to release. You do not need to stop feeding your baby, mastitis is an infection of the breast tissue, not the milk itself. Your milk is safe to continue feeding to your baby. Continuing to breastfeed ensures the breast continues to be effectively emptied. This aids in removing the clog and reducing further complications that could occur. Abrupt cessation of breastfeeding could cause additional complications.

Deciding to pump with mastitis

Some moms have felt significant pain when feeding with mastitis. They felt more comfortable pumping the breast until the infection resolved. If you feel this may be necessary, I recommend reaching out to an International Board Certified Lactation Consultant (IBCLC). We can make sure your pump is effectively emptying the breast. We may also be able to help you find a comfortable way to feed until the infection clears. Still continue to breastfeed on the unaffected breast, and if you can, the affected breast as well.

Signs of mastitis

• redness, swelling, or tenderness of the breast, usually occurs on one breast only

• sudden onset of flu like symptoms, like fever

• pain and warmth of the breast

• waking up and feeling as if you were “hit by a truck”

Interventions you can try at home

Continue feeding with mastitis, but make sure you empty the affected breast completely after each feed. If your baby feeds but your breast still feels full, either hand express or pump breast until the breast is soft. For clients with mastitis, I recommended warm compresses and breast massage prior to feeding/pumping. You can also massage the breast while feeding or pumping.

Epsom salt soaks

Epsom salt soaks of the breast help. Fill a bowl with warm water (not hot–test it on your elbow first to make sure it is warm). Add one to two handfuls of epsom salt and soak your breast for 5–10 minutes. Do this up to 3 times a day to help pull out the clog and reduce inflammation. It’s okay to soak prior to a feed. Just wash breast after the soak to remove the salty taste.

Vibration

Use vibration to massage the clog. Position your baby with his or her chin closest to clog. This is the strongest part of baby’s mouth and may be more effective at massaging the clog out during a feed. (Vibrating toothbrushes work great in a pinch!)

When to call your physician

If you develop a fever or your fever is unresolved in 24 hours, reach out to your primary care or ob-gyn. You may need antibiotics. The antibiotics typically prescribed for mastitis do not interfere with breastfeeding. You can continue to feed normally. No pumping and dumping required. If you receive pump-and-dump instructions, please reach out to a certified lactation consultant or local breastfeeding support group for a second opinion. Breastfeeding usually does not needs to stop in order to take this medication.