Breastfeeding Survival Guide

Breastfeeding is not for the faint of heart. It’s hard work, and sometimes ­­— for all kinds of reasons — things don’t go as expected. As a result, 60% of breastfeeding moms do not end up breastfeeding for as long as they had originally planned. 

“There is so much misinformation out there about breastfeeding — the biggest of which is that breastfeeding is going to be this perfect and effortless experience, but that’s not the reality of things,” says lactation consultant Leila Nassar. “The truth is breastfeeding is not a fluid journey and every mom’s experience is different — even from one child to the next. Our goal is to help empower moms to reach their breastfeeding goal or help them adjust their breastfeeding goal to align with what’s best for mom’s body and mental, physical, and emotional health.”

Here are some challenges that can arise during your breastfeeding journey and some helpful information to get you through because, as Nassar says, “Breastfeeding should be enjoyable and if it’s not, something is wrong.”

One of the most common issues faced by breastfeeding moms is sore or cracked nipples. While ice and other cold remedies are helpful, pain is not a required side effect of breastfeeding. In fact, in many cases, it’s solvable. 

“For centuries, women are told they just have to deal with the aches and pains of breastfeeding, which is a false aspect put in our heads,” Nassar says. “As a mother, you’ll do anything for your child, but you should not have to deal with pain if it can be fixed or resolved.”

While there are a few reasons why women experience sore or cracked nipples — such as an assortment of nipple anomalies or issues with the structure of the baby’s mouth — they are mainly caused by a bad latch. Nassar says, “If you can fix the latch, you won’t have sore nipples. Connect with a lactation consultant in your area who will be able to help identify and address the issue.”

Breastfeeding is exhausting in many ways. Not only is your body producing milk for your baby — which requires up to 25% of your body’s energy — but exclusively breastfeeding moms also often wake up frequently in the night to feed their baby — especially during the newborn stage. You can maximize your sleep by sleeping when your baby does, but sometimes that’s still not enough. And for many moms, between caring for other children or trying to keep up with life’s to-dos, sleeping when the baby sleeps isn’t a consistent option.

“Sleeping when the baby sleeps is helpful. However, the reality is the around-the-clock feeds are grueling and can be too much, and we can only handle so much until we reach a breaking point,” Nassar says. “That’s where pumping can help. It allows mom and dad or partner to share the feedings. If mom can pump after feeding, then dad or partner can give the baby a bottle of breast milk in the middle of the night. This allows mom to get a few more hours of uninterrupted sleep, which can be beneficial both physically and mentally because a well-rested mom is best.”

Both nursing and pumping are excellent ways to feed a baby breast milk, and people should choose the feeding strategy or combination of strategies that works best for them and their baby. Women do not have to choose exclusively between pumping and breastfeeding, as many who breastfeed a baby or infant decide to pump at times as well. As Nassar says, “It comes down to whatever is best for mom is best.”

While most women’s milk starts coming in three or four days after their baby is born, it can take up to six weeks for some women to produce their full milk supply.

“Breastfeed whenever your baby shows feeding cues. It sounds like a lot, but your baby needs your milk, and your breasts need the stimulation to bring in an abundant milk supply,” Nassar says.

Pumping breast milk is another way to address breast milk supply issues. Try to pump after a breastfeeding session two to three times a day to help stimulate a better milk supply. It also can help you build a freezer stash of milk if you’re concerned about low supply.

Formula also can be a helpful companion for feeding your baby. “Yes, breast milk will always be the liquid gold of everything, but it’s OK to use formula, and we can combine both feeding options together if mom’s body isn’t able to provide for every feeding,” Nassar says. “We want moms to feel proud of who they are, how much their body can produce, and what they are able to provide to their child. We want to empower them to keep going because any amount of breast milk, even if it’s a small amount, is great for the baby.” 

Because producing milk draws water, vitamins, and minerals from your own body’s reserves, establishing and retaining a good milk supply requires replenishing your body’s electrolytes — sodium, potassium, and magnesium.

“Drinking coconut water, eating whole foods such as bananas, avocados, and leafy greens, getting more protein and carbohydrates into your diet, and adding electrolyte mixes to your water are great ways moms can make sure they’re giving their body the fuel it needs to keep producing,” Nassar says.

Conversely, Nassar urges breastfeeding moms to avoid mint and sage.

“You should avoid anything with mint or sage, which work as a natural anti-lactation herb,” Nassar says. “This goes beyond just foods and teas. Anything with mint or menthol — from menthol or mint candy and gum to menthol nasal sprays — can negatively affect your milk supply, drying it up.”

Frequent feedings are normal for certain ages, such as newborns who need eight or more feedings each 24-hour period. Growth spurts also can cause an increase in feeding. However, there could be a chance your baby isn’t effectively feeding — which means they’re not getting the amount of milk they need.

You can tell if your newborn is meeting their needs by following this rule: Look for one wet diaper according to your baby’s age until day six. For example, three wet diapers on day three, four on day four, and so on. Continue with six wet diapers and two to three stools daily. More is fine, but if you are not getting these minimums, call a lactation consultant or your baby’s primary care clinician for evaluation of your situation and advice.

“Ultimately, we want to teach the baby how to effectively feed on mom’s breast so they can be more satiated and mom can go longer between feeds,” Nassar says.

To help ensure your baby is effectively feeding, Nassar recommends that you:

• Wake up your baby well before feedings. A drowsy baby will not feed for long. Undress to the diaper, rub the tummy and back, and talk to and rock your baby until the eyes open. A good strategy is to put the baby naked (except for a diaper) on your chest skin-to-skin for a half-hour prior to feeds. If your baby drifts off to sleep, bug them to keep them awake.
• Keep your baby sucking through the feeding. Look for vigorous sucking on each breast. Massage, use cool wash cloths, blow on baby’s face, and talk to your baby to keep them feeding.

Some degree of breast fullness is expected and normal as your milk comes in. However, breast engorgement is painful overfilling of the breasts and can cause swelling, tightness, and an increase in size of the breasts. Moderately severe breast engorgement results in hard, full, tense, warm, and tender breasts with throbbing and aching pain. Engorgement is natural in the early days of breastfeeding and occurs when your breasts make more milk than your baby can drink, when you are unable to breastfeed or pump, and when you stop breastfeeding your baby.

“Emptying your breasts helps,” Nassar says. To help with emptying your breasts, massage your breast while your baby is feeding. If that is not enough, you may use a breast pump prior to feedings to get the milk flowing and shape the nipple, then feed the baby. After a few feedings, if you are still overfilled, use the breast pump again. 

Another issue with engorgement is that it can make it harder for your baby to latch onto your nipple, which then makes breast engorgement worse. If your baby cannot successfully latch and breastfeed, you can relieve breast engorgement by manually expressing milk or pumping, and then trying to breastfeed again.

To help prevent engorgement:

• Breastfeed often, every 1-3 hours when your baby is showing signs of hunger, to avoid severe breast engorgement.
• Let your baby breastfeed on the first breast until it is soft before switching to the other breast.
• Change your baby’s position occasionally to make sure that all parts of your breasts are emptied.
• Put a warm, wet wash cloth on your breasts before breastfeeding. This may help your breasts “let down,” increasing the flow of milk. Or you can take a warm shower or use a heating pad set on low.
• Reverse pressure softening can be performed to soften the area around the areola to make it easier for the baby to latch. Using your fingertips, apply gentle firm pressure to your areola for 30 seconds. This will move some of the fluid back into your breast.
• Cold packs applied to the breast are a good way to slow down breast milk production, reduce swelling, and provide comfort.
• Take a warm shower and express some milk before you feed your baby, or lean over a bowl of warm water before you feed your baby to help your milk let down.

Getting help early is the best way to avoid some of the more serious breastfeeding issues. However, recognizing problems early can be tricky because sore nipples are often considered an inevitable part of learning how to breastfeed; aches and pains associated with mastitis might be confused with the tiredness of being a new mother.

You should see your clinician if you’re experiencing severe pain or have plugged or blocked milk ducts, thrush, or mastitis. Red flag symptoms include:

• Breasts that are red and hot to the touch
• Fever
• Flu-like symptoms