Troubleshooting Common Breastfeeding Challenges

Breastfeeding is a way to feed your baby that offers several benefits, both physical and emotional. Studies have shown breastfeeding reduces the baby’s risk of some infections, diabetes and obesity. And for moms, breastfeeding might decrease the risk of breast and ovarian cancers.

Perhaps most importantly, breastfeeding is a great way to bond with your baby and can be enjoyable.

However, breastfeeding also can be challenging and doesn’t always come easy. Many women deal with struggles large and small when nursing a baby. UNC Health lactation consultant Jerrianne Webb offers advice for common breastfeeding roadblocks.

Your newborn nurses all the time, around-the-clock.

When breastfeeding a newborn, aim for at least eight feedings in 24 hours. But feedings may be more frequent than that, or you may experience a feed that never seems to end. This nonstop eating is called “cluster feeding,” and while it’s tiring for mom, it’s a good sign, Webb says.

“It’s important for a baby to be at the breast early and often in those first few days and first few weeks,” she says. “The baby’s drive to suck is what establishes your milk supply.”

Newborns will suck even if they’re full, and that’s OK, Webb says. Around 4 to 6 weeks old, babies tend to become more predictable and start to eat on a schedule, every two to three hours.

Promoting the baby’s sucking reflex is why Webb and other lactation consultants recommend delaying the use of a bottle or pacifier for a month, if possible. That way, all the baby’s sucking can be at mom’s breast. Sometimes you might need to pump and use a bottle, or to calm the baby with a pacifier, and that’s OK, too.

Your newborn has trouble latching.

Getting a deep latch—that’s the connection between baby’s mouth and mom’s breast—is challenging for a lot of moms and babies. In fact, most newborns don’t latch well for at least the first 24 hours of life, Webb says. Small and premature babies may struggle even more.

If latch problems persist, it’s important to use a double electric breast pump every two to three hours; this tells your body to keep producing milk. Then, your partner or another caregiver can feed your baby the bottle of breast milk. While you’re in the hospital, the hospital will provide the pump; have a pump ready at home for after you are discharged. Ask your insurance provider which pumps are covered by your plan.

Some latch problems can be remedied with the use of a plastic device called a nipple shield, which fits over your nipple and gives the baby an easier place to latch. A lactation consultant may use one to help your baby learn to latch, and they are available for purchase at many stores. However, nipple shields place a barrier between mom and baby and can lessen the amount of milk transferred, so it’s important to have a lactation consultant’s guidance.

“The shields can save breastfeeding, but they can also cause problems if you didn’t need it,” Webb says.

Your baby sleeps too much to eat.

You know the old adage “don’t wake a sleeping baby”? Ignore it, at least in the early weeks, Webb says. Newborns sleep a lot and sometimes want to snooze right past feedings. But it’s important to feed the baby every two to three hours to establish milk supply and help the baby gain weight.

“We want you to wake a sleeping baby if the baby isn’t asking to eat before that three-hour mark,” she says, meaning three hours from the start of one feeding (not the end) to the start of the next feeding. For example: If the baby starts eating at 8 a.m. and finishes at 8:45 a.m., his next feeding should start no later than 11 a.m.

After two weeks, once your supply is established, “you can trust your baby to get enough milk,” and you don’t have to wake the baby to eat, Webb says. “If the baby sleeps more than three hours, you can say, ‘Thank you, God.’”

Your baby is losing weight.

It’s important to know that virtually all babies lose weight in their first few days of life, and breastfed babies are likely to lose a bit more than formula-fed babies as they learn how to eat.

The typical pattern goes like this, Webb says: Baby loses 5 to 7 percent of body weight in the hospital and maybe the first day or two at home. Around day four, weight plateaus as colostrum (protein- and antibody-rich first milk) changes into milk, and from then on the baby gains 0.5 to 1 ounce each day for the first six months.

Your baby’s healthcare provider will keep a close eye on his or her weight, so you don’t need to stress about it, Webb says. You can trust that your baby is getting enough to eat if his or her weight is going up at the baby’s 1-week and 2-week checkups.

If your baby loses more than 10 percent of his or her weight, your baby’s healthcare provider will probably recommend you feed your baby formula or donor breast milk. If your baby is drinking from a bottle, be sure to keep pumping every two to three hours to maintain your supply, Webb says.

Your milk supply starts to drop.

Sometimes, moms build up their milk supply and then it starts to decrease. The most effective way to increase it again is to keep nursing and pumping around-the-clock, Webb says; unfortunately, this means waking up throughout the night to pump, even if the baby keeps sleeping.

At this point, of course, some sleep-deprived moms may choose to stop breastfeeding, or they’ll do a hybrid of breastfeeding and formula feeding. For those who want to try to keep breastfeeding, Webb recommends a three-step plan: First, increase pumping. Then, see a lactation consultant. Finally, take an herbal supplement, such as fenugreek or blessed thistle (a lactation consultant can help you figure out what and how much to take).

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