Breastfeeding, like parenting, is not always easy – especially in the first few weeks after birth. While it may be a natural thing to do, breastfeeding is also a learned skill for both mother and baby. Like all new skills, it can take a while to figure out and become really good at.
With practice and patience (and perhaps a little help from a health professional), breastfeeding is something most women and babies eventually get the hang of.
Here are 10 common breastfeeding problems and tips to help solve them:
- Engorged breasts
- Latching pain
- Sore, cracked nipples
- Blocked ducts
- Inverted or flat nipples
- Low milk supply
- Baby too sleepy to feed
1. Engorged breasts
A few days after the birth, your milk supply comes in. For some women this happens very quickly, often overnight, and your breasts may become swollen, hard, hot and painful.
What can you do about engorged breasts?
There is no greater relief for engorged breasts than a feeding baby. Feed your baby on demand until they have had enough. Put your baby to the more painful breast first. Try using one side for each feed rather than offering both breasts. If your baby is still hungry offer the other breast.
If your baby has difficulty latching on because your breasts are so engorged, try expressing a little excess milk by hand to relieve a little pressure. Apply a warm compress to the breast or take a warm shower before expressing, to help the milk to flow.
A technique called ‘reverse pressure softening’ can also help. This involves applying gentle but firm pressure on either side of the areolar (the ring of coloured skin around the nipple) using the finger and thumb and pressing towards the chest wall. Keep the pressure constant for up to 60 seconds – the swelling will feel like it is shifting backwards, making it easier for baby to latch on.
After feeding, applying a cold pack or cabbage leaves that have been stored in the refrigerator over your whole breast can be very soothing.
2. Latching pain
It’s normal for your nipples to feel tender when you first start to breastfeed, especially if it’s your first time, but it isn’t supposed to really hurt. If your nipples really hurt or look squashed when they come out of your baby's mouth, you may need to check how your baby is 'latching on'. It is very difficult to establish a healthy breastfeeding pattern if you are in pain, so ask for help as soon as possible.
What can you do about latching pain?
Try to achieve a latch where baby’s mouth covers more of the areola below the nipple rather than above it. Before your baby latches on, their mouth should be open wide, their chin pressed into your breast and head tipped back so their nose is away from the breast. When your baby is correctly positioned, you shouldn’t see your nipple or the lower areola.
If your baby does not latch on to the breast well, remove them from the breast and get them to latch on again. Take care to release the suction by gently sliding your finger between their mouth and the breast. Pulling them off the breast while they are enthusiastically sucking can be very painful and damage your nipple.
If breastfeeding still hurts, get an expert to watch you feed so they can help you and your baby.
Watch videos about getting a good latch
Image credit: Canva
3. Sore or cracked nipples
Not all women experience sore or cracked nipples; however, if you do, it may really test how much you want to breastfeed. Sore nipples are most common about 3 to 7 days into breastfeeding. At times you will feel that it is not worth it, and that breastfeeding is just not for you. It is very difficult to establish a healthy, breastfeeding pattern if you are in pain, so ask for help as soon as possible.
What can you do about sore or cracked nipples?
If you have sore or cracked nipples, seek help from your midwife or a lactation consultant. Sore and cracked nipples can be the result of many different things including latching problems, sensitive skin, a tongue-tied baby or inverted nipples. You may need help to work out what is causing yours.
Your midwife or lactation consultant will help you position or latch your baby to the breast correctly. In most cases, once the baby is correctly positioned the nipple heals within 2 or 3 days.
If one nipple is more sore than the other, start feeding on the less painful side so that your baby does not feed furiously on the sore breast. Some women find that feeding from one breast per feed (rather than both) allows them to rest the nipple for a longer time and helps with healing.
Try expressing a little milk first before breastfeeding. This will soften and lubricate the nipple. Don't use creams or drying agents on your nipples. Check with your health professional if your nipples are not healing.
Paracetamol is considered safe to take for the pain. If you are reluctant to take pain relief, talk with your doctor or midwife.
4. Blocked milk ducts
Blocked ducts are caused by milk glands that haven’t emptied due to a blockage or lack of drainage. It can cause pain, redness and hard lumps over an area of the breast. Unless the pressure is relieved, blocked ducts can lead to mastitis.
What can you do about blocked ducts?
To reduce blockage of milk ducts, it is important to empty breasts completely. Emptying the breast will help to reduce the blockage and keep your milk flowing. Although babies often prefer one breast, make sure that they feed from both breasts throughout the day to avoid blocked milk ducts.
While feeding, gently massage the area over the blocked duct in long, firm strokes towards the nipple. Provided baby is feeding well, you should feel the pressure relieving.
It is important that you have a bra that isn’t too tight and offers good support without constricting the breast tissue, allowing for expansion when your milk supply comes in. You will notice that your breasts will fill up in between your baby’s feeds.
Watch videos about blocked ducts and mastitis.
Mastitis is inflammation of the breast that happens when pressure builds within the milk cells from stagnant or excess milk. Sometimes this may be accompanied by a bacterial infection. Typical symptoms are tender hot swollen area of breast, fever, chills, headache, muscle aches and flu-like symptoms. Mastitis affects approximately 1 in 5 women, most commonly in the first 4 weeks of breastfeeding.
What to do about mastitis
Continue to breastfeed your baby, starting with the sore breast. Though it may be painful, emptying the breast is essential to help clear the blockage and relieve pressure. It is quite safe to feed your baby from the affected breast.
Keep the sore area warm with a wheat pack or wrapped hot water bottle, or cold pack if preferred – whatever will help you to feel more comfortable. Rest as much as you can and drink plenty of fluids. Paracetamol and ibuprofen are considered safe to take for pain and inflammation.
If the pain and redness in your breast haven't gone in 24 hours or you feel 'fluey', notify your midwife or see your doctor – you may need antibiotics.
Read more about mastitis.
6. Thrush infection
Thrush is a yeast (fungal) infection that can cause sore, itchy or cracked nipples. There may be pain, like sharp needles going deep into the breast, which is not relieved by improving the way your baby latches on. Thrush can also affect your baby. You may notice that they start fussing at or pulling off your breast. There may be some redness or white spots like patches of cottage cheese when you look inside their mouth. If your baby has oral thrush, there's a chance that they may also develop a yeast infection on their bottom.
What can I do about thrush?
Thrush is easily treated with antifungal medication from your midwife or doctor. Breast and nipple thrush is treated with antifungal medicine and antifungal nipple gel/creams. Thrush in your baby’s mouth is treated using an oral gel or drops; an antifungal cream is used for their bottom.
You should continue breastfeeding.
Read more about thrush
7. Inverted or flat nipples
You can tell if you have inverted or flat nipples by doing a simple squeeze test: gently grab your areola with your thumb and index finger – if your nipple goes in rather than out it is a sign of an inverted nipple.
What can I do about inverted or flat nipples?
The first thing to remember is that babies breast-feed, not nipple-feed. It is very rare for women to not be able to feed because of an inverted nipple.
Often, nipples begin to protrude more in pregnancy and once baby has started breastfeeding on a regular basis, the nipple shape shouldn’t affect the latch.
If you are concerned, seek advice from your doctor, midwife or lactation consultant. Silicone nipple shields may help with latching as long as your milk supply has been established. It is important that a professional helps assess whether shields will be useful or not.
Tongue-tie is when the skin between the underside of the tongue and the floor of the baby's mouth is shorter than usual. Some babies who have tongue-tie don't seem to be bothered by it. In others, it can restrict the tongue's movement, making it harder to breastfeed.
What can I do about tongue-tie?
Tongue-tie is sometimes diagnosed during a baby's routine newborn check, but it's not always easy to spot. It may not become clear until your baby has problems feeding.
Talk to your midwife, lactation consultant or GP if you're concerned about your baby's feeding and think they may have tongue-tie.
Tongue-tie affects around 4–11% of newborn babies.
Read more about tongue-tie.
9. Perceived low milk supply
A common reason women give up breastfeeding is because they feel like they don’t have enough milk. Their baby may be feeding very frequently but never seem satisfied. In most cases, the baby is getting all the milk they need.
What can I do if I am concerned about my milk supply?
It is normal for babies to feed frequently (cluster feeding) in the first few weeks, especially in the evening. They also breastfeed more often when they’re going through a growth spurt. Sometimes they are fussy and unsettled, but that’s just because they are new babies and going through normal newborn unsettled periods.
At about 6–10 weeks, your breasts tend to settle down and feel ‘soft’. Many mothers often worry their milk supply is drying up. In fact, it usually means your milk supply and your baby’s needs are completely in sync, and that you're making exactly the right amount of milk for your baby’s needs.
Providing your baby is putting on weight, having plenty of wet and dirty nappies and sleeps well between feeds, then your supply should be enough for your baby.
True low milk supply is rare but if you have concerns, check with your health professional.
If your milk supply does need a boost, try feeding your baby more often for a couple of days. The more often breast milk is removed from the breast, the more milk will be produced. Expressing after feeds may also help to boost your milk supply. Offer lots of skin-to-skin cuddles (this will boost your breastfeeding hormones), rest, drink plenty of fluids and eat healthy foods.
10. Baby too sleepy to feed
It’s common for babies to be sleepy during the first few weeks and months of life, so falling asleep during feeding is common.
What can I do if my baby is too sleepy to feed?
To keep your baby nursing actively, try compressing your breast firmly in one hand between your thumb and fingers while your baby feeds. This will increase milk flow and encourage your baby to take more milk. When you notice your baby’s sucking slowing down and their eyes closing, gently remove them from your breast. Try to stimulate them by burping or gently walking your fingers up and down their spine, before returning them to the breast.
You can also try rubbing your baby’s hand, to help stimulate a reflex that connects the mouth and hand (you may notice your baby opening and closing their hand as they suck). You can also try gently stroking under their chin to encourage sucking.
As your baby gets older they will be able to stay awake longer, so don’t worry too much.
Breastfeeding should be an enjoyable time for both you and your baby. Breast milk is tailormade for your baby – offering nutrients and important protective properties. If you are having problems, ask for support from your midwife and or lactation consultant.
The following doctors practise breastfeeding medicine and are available for online or face‑to‑face consultations:
- Dr Yvonne LeFort, Auckland firstname.lastname@example.org
- Dr Katie Fourie, Hamilton email@example.com
- Dr Whitney Davis, Tauranga firstname.lastname@example.org
- Dr Heather Johnston, Palmerston North email@example.com
- Dr Danuta Amelung, Lower Hutt firstname.lastname@example.org
- Dr Sophie-Lee Mace, Nelson/Tasman Sophie@babyclinic.co.nz