Troubleshooting Lactation Challenges

There are so many rewards in store for parents who feed their infants their own milk. Human milk naturally provides infants with optimal nutrition, immunity, and strong emotional bonds. Babies receive protection from several diseases, and breastfeeding is the most economical way to feed an infant. Once feedings are well established, most families find nursing super convenient! There’s no need to mix and warm bottles or pack up supplies for outings. Human milk even boasts a smaller carbon footprint than formula manufacturing. Despite all these known benefits, many families encounter roadblocks in their efforts to breastfeed. Here are some of the most common problem areas for families along with ideas for addressing them. 

The Latch. Getting your infant to latch takes a lot of practice. When they do so improperly, breastfeeding can be painful, frustrating, and ineffective. If you are having trouble latching, the best solution is to ask for help! Your nurses and the lactation consultants (LC) at SVMC are all experienced in helping families breastfeed in the early days of baby’s life. There is typically an LC scheduled every day of the week, so you will have time to work on things right from the beginning. Once you are discharged home, your lactation consultants are available for outpatient follow up appointments as well as by phone or text to answer your feeding questions.

Engorgment. Between 65 and 75 percent of breastfeeding parents will experience engorged breasts at some point, most often in the first few days of feeding when mature milk is “coming in.” It can be quite uncomfortable, may lead to shallow latching, and if severe can lead to blocked milk ducts, inflammation, an even infection. Depending on the cause and timing of engorgement, it can even decrease your milk supply. After you have your baby, your consultant will give you tips for managing engorgement in the early days of breastfeeding. Feeding frequently, working on good latching, and occasional ice packs are usually all that is indicated, but sometimes hand expression, pumping, warm packs, warm showers, and other measures may be utilized.

Low Supply. Low milk supply is by far the most common breastfeeding challenge most families will face. Knowing how much milk your baby needs, especially early in their lives, is helpful in feeling confident about baby’s intake. Weight checks as well as diaper counts are the most reliable ways to determine if milk supply is adequate for your baby’s growing needs. Breastfeeding classes, like the one offered at SVMC, can be helpful in becoming familiar with infant feeding patterns and expectations. If your milk supply truly is low, increasing the frequency of feedings or adding some pumping sessions into your routine can help boost supply. For the most part, milk supply maintenance is all about supply and demand.

Power pumping, a technique designed to mimic cluster feeding can be used to increase that demand and let your body know that you need more milk. Another great way to ensure that your supply is high all day long is to be feeding around the clock with good stimulation at least once between the hours of midnight and 5 a.m. Some parents find that even if their baby is sleeping, they can wake to pump for even ten minutes in the middle of the night and this will keep their supply higher throughout the rest of the day! It’s a great way to give your body the message that you have a young baby that needs more milk.

If you are still struggling with supply even once you increase demand, your LC can discuss other options to help you increase your supply. They can also help identify any potential risk factors for low supply such as hormone conditions, birth control use, return to work, etc.

Medications. New parents are understandably very concerned about passing medications through their milk. While almost any drug that is present in your blood can transfer into your milk, most medications transfer at levels that pose little to no risk to your growing infant. Some medications are unsafe or can become concentrated in human milk, so it is important to ask your healthcare provider, lactation consultant, or pharmacist about your specific medication needs. Many over the counter analgesics, medications for anxiety and depression, and allergy medications are considered compatible with lactation.

Return to Work. Going back to work can pose a real challenge for many nursing families. It usually takes a little planning and forethought to make things run smoothly after that return to work. Many workplaces support breastfeeding already or would like to, so don’t hesitate to ask. They are often bound by law to make accommodations for you as a new parent. You will need a private and hygienic place to pump milk as well as access to a sink. Make a plan for storing your milk until you return home, either a refrigerator or cooler bag with ice packs. Pumping can be accomplished in as little as 10 - 15 minutes two or three times during a typical work day. It is not necessary to have a huge stock pile of milk in your freezer before returning to work. A small stash of 20 - 40 ounces of milk is adequate to get started, and then you should try to focus on your current supply. The milk you pump on Monday should cover the needs for Tuesday, the milk you pump on Tuesday should cover the needs on Wednesday, etc.

Throughout the course of lactation, there are bound to be a few challenges. With a little support, families can identify roadblocks and brainstorm manageable, realistic solutions that can help mitigate those challenges. In many cases, simple changes to your routine can help make feeding your infant easier, more enjoyable, and a memorable life experience.

Nicole Troop, RN, is a lactation consultant at Southwestern Vermont Medical Center in Bennington.