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Solve those breastfeeding challenges

Lactation consultant Stacey Zimmels of Feed Eat Speak gives her expert advice

Author Stacey Zimmels
Categories   Breastfeeding

The Edit

Whilst breastfeeding is the natural way to feed our infants, for some parents it can be challenging, particularly at the start.

Breastfeeding your baby is something you both need to take the time to practice and learn. It is a dance between two partners and in the early days and weeks you will adjust the steps and find the right beat for you both. Here, International Board-Certified Lactation Consultant Stacey Zimmels highlights some of the common challenges breastfeeding parents in the UK face, with tips to help you to overcome them.

Not understanding normal baby feeding behaviour and how breastfeeding and breastmilk production works

We live in a society with extremely low breastfeeding rates and so many of our ‘norms’ with regards to infant feeding are based on formula fed infants. Formula feeding is not the biological norm.

So, when our breastfed babies want to feed very frequently every two hours or more, when they cluster feed, when they fall asleep feeding, when they want to be close to their mothers and will only settle to sleep in our arms, we may consider something is wrong. This is because we are conditioned to think feeding 3-4 times hourly and then being placed down to sleep is what should happen and this is, in fact, not the case.

In order to overcome this challenge, it’s important to educate yourself around normal infant and newborn feeding behaviour and be responsive to those.

Avoid making changes because it is very possible these could be detrimental to your breastfeeding journey. Access breastfeeding courses which should help highlight what to expect from a newborn. Find friends and family members who are, or who have, successfully breastfed and look for Instagram accounts or Facebook groups that share this information. Usually just a dose big of reassurance is required, so if know where to go to get that, you will be OK!

After the first few days of birth, breastfeeding works on supply and demand - the more you feed, the more milk you will make. Feeding needs to be effective and frequent for this to happen. Responsive feeding is recommended by the World Health Organisation and NHS – meaning you should respond to your baby’s needs by offering the breast. Understanding this and staying away from dummies, feeding schedules and spacing out of feeds will help you avoid any challenges that may come with misunderstanding how breast milk production works.

Sleepy newborns

Babies can be particularly sleepy on the first day of life after their first feed and this may continue for the next 24 hours. Some infants may develop jaundice in the early days which can also make them sleepy. This means they may not reliably wake for feeds, stay awake for feeds or even latch onto the breast.

Tips for helping a sleepy newborn include waking to feed and aiming for a minimum of eight feeds in 24 hours and ensuring the baby is actively drinking milk at each feed. This means using slow deep sucks rather than fast fluttery sucks. If your baby falls asleep during a feed, wake them with a nappy change and put them back on the breast.

You should always offer both breasts per feed. If your baby starts to fall asleep during a feed, try using breast compressions to keep them awake and actively feeding. If, despite all these attempts, your baby is not achieving eight active breastfeeds in 24 hours, then begin to pump or hand express to feed your baby and seek immediate breastfeeding support.

Pain and nipple trauma

Pain when breastfeeding is not normal. Some women notice discomfort on latching for the first few days or week following birth, which usually lasts around 30 seconds, then lessens and the rest of the feed is pain free. This is considered within the normal spectrum.

Any more pain than this is a sign things aren’t as they should be and a prompt to make some changes. Pain that lasts throughout a feed, pain that lasts beyond the first few days/week, damage to nipples or white nipples that feel stingy after a feed are all signs that you need to get some support.

In the meantime, you can check some of the basics of positioning and attachment (see point 4 on latching). If the pain or nipple trauma is unbearable you may need to take a break from direct feeding for some or all feeds and express and give your milk via a syringe, cup or bottle using paced bottle feeding.

Moist wound healing is recommended as a treatment for nipple damage. You can purchase Jelonet gauze from most pharmacies. Place the gauze on the nipple after the feed and leave until the next feed.

Latching difficulties

Difficulties with latching can come in lots of shapes and forms. The majority of mothers and babies who have latching issues either find latching is painful or sub-optimal. This can cause issues for the baby in transferring milk, which can then impact on milk supply and baby’s growth.

When it comes to latching your little one, you need to start by getting the position right - the better positioned your baby is before they latch, the better the latch will be.

So how should you position your baby?

  • Bring your baby close to your body. Ideally there are no gaps between you both.
  • Your baby should be in a straight line from ear to shoulder to hip, not twisted.
  • Line up your baby so its nose is level with your nipple.
  • The chin should touch the breast. This will help baby trigger the reflexes to find the breast and latch.
  • Ensure your baby's head is free to move backwards.

And now let’s get them latched…

  • Your baby will tilt their head back and open their mouth wide (wait for this).
  • Now gently guide your baby on to the breast. Bring the baby to the breast rather than bringing your breast to the baby.
  • Your baby should have a big mouthful of the underside of the breast in its mouth and the latch should be asymmetrical, this means you should be able to see more of the areola at the top of the breast than the underside.

Despite trying this, some babies may slip away from a deep latch to a shallower latch where they tend to have less areola in the mouth. If you find that your baby is doing this then you can try using the exaggerated latch technique.

  • Hold your breast and shape it so that your nipple is pointing up against your baby’s nose.
  • Shape your breast like a hamburger in line with the baby’s mouth. The orientation is important. When shaping your breast like a hamburger the piece that they take a bite from needs to match the alignment of your baby’s mouth and lips. More information with infographics can be found here.
  • Wait until your baby roots and opens its mouth very wide and then guide your baby to the breast with your other hand.

There are certain breastfeeding positions which can facilitate getting a deeper latch. It is important to find the one which works best for you and your baby.

Click the links below for more information:

Low milk supply

Low milk supply is commonly cited (reports of up to 35%) as the reason women stop breastfeeding. What is interesting is that only around 2.5 % of women have physical issues producing milk.

You may be affected if you have any of the following conditions:

  • Previous breast surgery/injury or trauma.
  • Damage to the nerves such as spinal cord injury.
  • Unusual breast or nipple features which can be a sign of breast underdevelopment which can affect the milk making tissue also.
  • Some hormone conditions.

We clearly need to differentiate between women who can’t produce enough milk and the women who think they can’t, or who can but their milk supply is compromised due to issues with supply and demand. As milk supply is driven by your baby, the more your baby goes to the breast the more milk your breasts produce. This is why responsive breastfeeding is the most effective way of establishing and maintaining a milk supply.

Why may you have a non-biological low milk supply?

  • Baby does not remove milk effectively. For example, poor latch or tongue tie.
  • Baby does not remove milk frequently. For example, a jaundiced or sleepy baby may not wake to feed.
  • Only offering one breast per feed. You half the potential milk your baby can get and you also half the potential breast stimulation.
  • Supplementing. By offering formula instead of the breast means feeds are missed and your breast milk supply will reduce.
  • Spacing out feeds/feeding to a routine. This will include using a dummy to ‘stretch’ baby to go longer between feeds. This may lead to less frequent feeds and reduce supply.
  • Thinking you have low milk supply when you don’t and then supplementing. If your baby is growing well and peeing and pooing as they should, then milk supply is not an issue.

You can help by…

  • Getting breast feeding support to identify and treat any baby related issue that is stopping frequent or effective milk removal. You may also need to pump after breast feeds to ensure your supply is maintained until the issue is resolved.
  • Feeding responsively. If in doubt feed! If your baby has just fed and is still unsettled - feed again! If your baby wants to feed for three hours straight - keep feeding… and so on.
  • Avoiding dummy use, especially whilst establishing breastfeeding – see my blog about this.
  • Offering both breasts at each feed - if baby only takes one that is fine.
  • Avoiding supplementation with formula unless advised by an appropriate professional.
Author Stacey Zimmels

Stacey Zimmels is a feeding and swallowing specialist, speech therapist (SLT) and International Board- Certified Lactation Consultant (IBCLC). Stacey has worked for almost 20 years supporting infants and children with a wide range of feeding and swallowing difficulties. Her breadth of knowledge and experience runs across the spectrum; including but not exclusive to feeding difficulties associated with preterm infants, breast and bottle feeding, weaning difficulties, feeding challenges secondary to food allergies and reflux, swallowing difficulties and fussy eating.

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