Breastfeeding problems and solutions

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If you’re finding breastfeeding hard in any way, it can be a great help to speak to your maternal and child health nurse, GP or a lactation consultant. An Australian Breastfeeding Association counsellor can also help.

You’re bound to get lots of different advice – take the advice of the person you trust most, and stick with it.

• Sore nipples
• Not enough milk
• Too much milk
• Full, sore breasts
• Mastitis
• Baby won’t feed
• Biting
• Returning to work

Sore nipples

The idea of sore nipples can be frightening. While having sore nipples isn't uncommon, it usually doesn't last more than a few days. If this happens it may discourage you from breastfeeding, so it's good address the problem as soon as possible.

Sore nipples are often caused by not feeding correctly, so a good start is to check your breastfeeding technique.

If you’ve checked your technique and your nipples are still getting sore, it’s good to address the problem before this discourages you from breastfeeding. There’s a lot you can do to stop soreness from getting any worse, and your maternal child health nurse or lactation consultant will be able to help.

Some tips for alleviating soreness are:

• applying an ice-pack after feeding, or a warm cloth before feeding
• expressing a little milk to lubricate the nipple before feeding
• wetting your nipple and areola with milk after feeding and allowing them to dry while exposed.

Another tip is to try avoiding using nipple shields or breast pumps, rough towels and any creams or liquids (such as shampoo) that may dry out your nipples.

It is unusual for sore nipples to persist, and worth speaking to your maternal and child health nurse if they do.

Not enough milk

Many mums worry that they aren't making enough milk for their baby. This is particularly the case in the early days when a newborn's main way of communicating is to cry, and a baby might cry after a feed. Mums and dads are still trying to work out which cry means ‘hungry’, which cry means ‘tired’ and which cry means ‘I'm not hungry now, but I've got a tummy ache’.

You don’t need to give your baby a bottle to make sure she has enough food. If your baby has at least six to eight wet cloth nappies or five very wet disposables in 24 hours, you have plenty of milk. If you don't think your baby has that many wet nappies, there are ways to increase your supply of milk.

By breastfeeding often, you'll be helping to ensure you have enough milk. Your baby will let you know when she is hungry, and responding to this (even if it seems very frequent) will increase your supply.

If you are already breastfeeding every two hours (a gap of two hours between feeds, not two hours from the start of one feed to the start of the next), you could try to fit in a few snack breastfeeds in between.

If your baby is asleep for a long time, it can also help to express for a couple of minutes – but if this makes you tense or tired, don’t bother.

You can also try the following:

• Feeding regularly at night, as this is when prolactin levels are higher.
• Avoiding using a dummy and/or bottle; when feeding expressed breastmilk, use a cup.
• Using the feeds as a time for you to rest.
• Making sure you are taking care of yourself by eating properly, drinking plenty of water and getting some rest.

If you are concerned about your baby’s weight gain or anything else, talk to your maternal and child health nurse.

Too much milk

If you feel like you have too much milk or a fast flow and your baby is being swamped, you might like to try any of the following:

• Letting her finish the first breast before offering the second; she may not want both breasts at each feed, and this can help regulate your supply.
• Expressing a little before feeds to help your baby attach and make the flow of milk less overwhelming for her.
• Checking your positioning and technique. 
• Expressing a little when you can. Do this to relieve pain only – too much expressing will stimulate you to make more milk.

Full, sore breasts

To gain relief from engorged breasts, try the following tips:

• When feeding, limit the sucking time.
• Take your bra off completely before beginning to breastfeed.
• If your baby is asleep for a long time, express for a minute or two rather than waking your baby to feed.
• Warm your breasts with a warm cloth before breastfeeding.
• Massage your breast gently while breastfeeding.
• Vary breastfeeding positions.
• Place an ice-pack wrapped in cloth on your breast to relieve pain after breastfeeding.

Mastitis

If you have a breast that is inflamed, sore, swollen or red, or if you have the chills or just feel like you have the flu, you may have mastitis, which is a serious infection. If you think you may have mastitis:

• Consult your GP as soon as possible. You will probably be prescribed antibiotics; you can continue breastfeeding while taking these.
• Go to bed, rest and try to get someone to look after you. Take your baby to bed with you.
• Feed frequently to empty the affected breast. Although you have an infection, the milk is still safe for your baby to drink.
• Warm your sore breast with a warm cloth before feeding.
• Give your baby the affected breast first.
• Massage the breast gently while your baby feeds.
• Vary feeding positions, so that all your milk ducts are being emptied – sometimes mastitis can start from one or two ducts that aren't being emptied fully.
• Place an ice-pack on your breast to relieve pain after a feed.

Sometimes, women may develop nipple or breast thrush (candidiasis) following a course of antibiotics. Symptoms of nipple or breast thrush may include sore nipples, shooting pain in the breast, and possibly white nipple discharge. Not only is nipple thrush particularly painful but it can be passed back and forth between mother and baby.

Research has not come up with a standard treatment for nipple or breast thrush. Different doctors treat it differently, depending on their own clinical experience. Treatment is likely to involve an oral gel for baby’s mouth and an ointment for mum's nipples and, sometimes, baby’s bottom. Antifungal tablets may also be prescribed for the mother.

Many women feel overwhelmed when they experience mastitis and may find it difficult to continue breastfeeding. Many do overcome mastitis and continue to breastfeed for some time with great success. Getting the support you need to get over this hurdle will help. You are not only learning to look after this new baby and are tired because of it, you are also unwell. You need help!

Baby won’t feed

Once you are at home with your baby, she should generally want to feed. If your baby is persistently not feeding it's best to consult a professional in case there is a problem.

Having said that, now and then, a baby refuses the breast. There are many possible reasons for this, some related to the baby and some to the mother, and it is often just a passing phase.

Here are some possible causes of breast refusal (but there are many more):

• Your baby has a cold.
• Your baby is having trouble attaching.
• Your baby is overstimulated or overtired, or distracted (this is normal in older babies – try breastfeeding in a quiet place).
• Your milk tastes different, possibly because you are taking medication, are experiencing hormonal changes (you may be about to have a period again) or have eaten something unusual.
• Your milk flow is faster, lesser or slower to ‘let-down’ than usual.

Most of these causes of breast refusal will either go away on their own or can be solved with a few simple changes to your routine. None of them mean you have to give up breastfeeding.

If your baby is feeding but you are worried that she might not be getting enough milk:

• check that the milk flow is not too fast or too slow
• try different positions
• work out whether she prefers one breast to another.

Biting

As babies grow older they get more playful, and they get teeth. It’s almost physically impossible for a baby to bite while sucking, but she might find it fun to bite your nipple once she’s finished (particularly if she thinks you’re not paying her enough attention!). If your baby does bite, say ‘No’ calmly and remove her from the breast. If you protest too loudly, this will just contribute to her amusement. Luckily, biting is usually a passing phase and probably won’t happen more than once or twice. You can also try offering your baby something else to chew on, like a teething ring. Some mothers switch to expressing if their baby keeps biting, but try to avoid this – it's just more work for you.

Returning to work

While many women keep breastfeeding when they go back to work, many still feel that their only option is to wean their baby. If you are thinking about going back to work and want to keep breastfeeding, here are some issues to consider:

• Can I delay my return to work?
• Can I work from home?
• Can I organise flexible hours with my employer?
• Can I breastfeed while at home, and can the carer give the baby expressed milk or formula while I’m at work?
• Is there a child care facility near work?
• Will I be able to express milk while I’m at work?
• Do I know any other mums who have successfully balanced work and breastfeeding? Could they help with tips or advice?
• How do I express? Can I express? How do I store breastmilk? How often? Read more about expressing and storing breastmilk.

Many women worry about talking to their employer about this issue. According to the Federal Sex Discrimination Act, it is illegal to discriminate against a woman on the basis that she is breastfeeding. That means that employers must make reasonable attempts to accommodate you if you want to breastfeed or express milk while at work.

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