What Should I Do Differently To Make Breastfeeding Work?

QUESTION

Dear Lactation Consultant,
I am a mom of three with another baby on the way. I tried to breastfeed my second child but I had alot of problems. My nipples were cracked and bleeding before I even left the hospital. The nurses and consultants said that the baby was latching on correctly, and that it was because the baby had a very strong suckle. I used breast shells to ease the pain between feedings, I soaked my breasts in warm water before feedings to help with letdown, I massaged them, I tried nursing the baby in different positions -- nothing seemed to work.

The beginning of each feeding was the most painful, so bad that I wanted to scream, but after a few minutes the pain would lessen. The baby was feeding every 1-2 hours so my nipples did not have much time to rest. I tried pumping with an electric pump so that I could use a bottle to let my nipples rest, but after pumping for 20-30 minutes from each breast my total amount of milk was less than one ounce.

Could it have been that I had such low milk supply that she was feeding so often? And what could be causing my pain if she was latched on correctly? I also wonder if it is because I have large breasts and large areolas. I really want to try again with my next baby that is due in a few months, but I really want to make it work this time, and I'm also thinking of taking the Fenugreek this time. Should I try again or would it be a waste of time? What should I do differently this time? Also, I should mention that the baby will be delivered by c-section.

Alicia

ANSWER

Hi Alicia,
I think it is wonderful that you are planning to nurse your second baby in spite of the problems you had nursing with nursing your second baby. Of course I encourage you to try again! The incidence of mothers who can't physically produce an adequate supply of milk is very small, and it is highly unlikely that you would be unable to successfully nurse your next baby. Chances are that you didn't have a successful breastfeeding experience due to any physical problems with you or your baby, but instead due to the fact that you didn't receive the support you needed from the very beginning to prevent or correct the problems you were having.

There is no way to predict whether you will have any breastfeeding problems at all with this new baby (including nipple soreness), but the best way to prevent them is to educate yourself beforehand about the basics of positioning and what to expect when the baby is born, and to have a good support system in place in the event that problems do develop.

I don't know what kind of support/advice you had before, but if you gave up on nursing due to severe nursing soreness, then something was terribly wrong. Breastfeeding is not supposed to hurt! Most mothers do experience some tenderness in the early days, but the severe pain and nipple damage you described has some medical explanation and treatment, whether the cause is improper suck, yeast infection on the nipples, tongue tie, etc. A good lactation consultant will be able to work with you to discover the cause of the problem and make recommendations to correct it.

Your previous breastfeeding problem may have been caused by a yeast infection. If you had a c-section with your second baby, then you were automatically given antibiotics, and they can trigger an overgrowth of yeast. Yeast can cause excruciatingly sore nipples, and the pain doesn't go away no matter what positions you use or how much lanolin you apply. For more information, see the article "Information Sheet and Care Plan for Yeast Infections".

Mothers with large breasts and nipples tend to have a higher incidence of flat/inverted nipples and latch on problems. Tiny newborns often have a hard time achieving a good latch when presented with a large, flat nipple. This can cause both nipple trauma as well as a reduced milk supply. You may need to use a nipple shield, or a larger than average breastshield when you pump in order to prevent or overcome this problem.

It is very important for every nursing mother to to have a good support system in place so that she will have someone to call for advice at the first sign of problems, but it is even more important if she has experienced breastfeeding difficulties in the past.There are several ways to find out what your local resources are for breasffeeding help.

  • Ask nursing mothers in your community for recommendations on "breastfeeding friendly" doctors in your area.
  • Attend La Leche League meetings. You'll get to meet other nursing couples, as well as have access to tons of excellent breastfeeding information. La Leche League is a great source of support for all expectant and nursing mothers.

Find out if there are any IBCLCs (International Board Certified Lactation Consultants) in your area. These are health care professionals who have received extensive training in lactation, above and beyond the training that doctors or RNs receive. They are the only members of your health care team whose focus is primarily breastfeeding. Most major hospitals have IBCLCs on staff, and some IBCLCs are in private practice. Lactation Consultants in private practice often have more time to spend with you, but this is not always the case. Check around to find out what services are available and prices in your area. Insurance often covers lactation services, especially during hospital stays or in the case of hospitalized or premature infants.

You can find an IBCLC in your area by contacting ILCA (International Lactation Consultant Association) at 312-541-1710 or by e-mail at ilca@erols.com. You can also get information about local LCs at medela.com.

You can find out how to locate your nearest La Leche League group by calling 1-800-LALECHE or going to their website: lalecheleague.org

There are some other articles on my website that might have some helpful information for you: "Establishing Your Supply: Starting Off Right" and "Sore Nipples".I hope that everything goes smoothly for you this time around.

-- Anne, IBCLC

Kathleen Tackett

Dr. Kendall-Tackett is a health psychologist, International Board Certified Lactation Consultant, and Research Associate Professor of Psychology specializing in women's health at the Family Research Lab, University of New Hampshire. She is a Fellow of the American Psychological Association in both the Divisions of Health Psychology and Trauma Psychology. Dr. Kendall-Tackett is a La Leche League leader, chair of the New Hampshire Breastfeeding Taskforce, and the Area Coordinator of Leaders for La Leche League of Maine and New Hampshire.

Dr. Kendall-Tackett is author of more than 140 journal articles, book chapters and other publications, and author or editor of 15 books including The Hidden Feelings of Motherhood (2005, Hale Publications), Depression in New Mothers (2005, Haworth), and Breastfeeding Made Simple, co-authored with Nancy Mohrbacher (2005, New Harbinger). She is on the editorial boards of the journals Child Abuse and Neglect, Journal of Child Sexual Abuse and the Journal of Human Lactation, and regularly reviews for 27 other journals in the fields of trauma, women's health, interpersonal violence, depression, and child development. Dr. Kendall-Tackett is the "Ask a Lactation Consultant" columnist on Pregnancy.org and serves on the Board of Directors of Attachment Parenting International.

Dr. Kendall-Tackett received a Bachelor's and Master's degree in psychology from California State University, Chico, and a Ph.D. from Brandeis University in social and developmental psychology. She has won several awards including the Outstanding Research Study Award from the American Professional Society on the Abuse of Children, and was named 2003 Distinguished Alumna, College of Behavioral and Social Sciences, California State University, Chico.