Cassat, Mother Rose Nursing Her Baby, courtesy of ProMom's Breastfeeding Gallery
 

Breastfeeding Joys & Challenges
(Last updated March 2005)

I love nursing my babies!  Breastfeeding fosters such a sweet closeness and peacefulness between mother and child.  And not only is it clean and convenient, it is also healthful for both baby and mother.   But nursing does not always get off to an easy start.  We've had problems each time, sometimes really tough problems, often because of mistakes on my part.  I want to share with you the troubles we've had and the mistakes I've made.  I especially want to encourage you to be persistent as you work on getting nursing established.  The vast majority of breastfeeding problems can be overcome, and it's well worth it to work through any pain or discomfort so that you can continue to nurse your baby.  For more detailed or individual advice, please consult the resources listed below.  In particular, you can email La Leche League (LLLI) with your question or problem, and you'll get a reply from an accredited La Leche League Leader.  

On to our story...  With my firstborn, undetected improper latch caused frequent plugged milk ducts for the entire two years she was nursing!   I always thought my painful plugged ducts were due to my not getting enough rest, or eating too many sweets.  It never occurred to me to check how my baby was latching on.   I advise that you closely study and follow the latching instructions in your breastfeeding handbook or at LLLI's site, and if you're still having any difficulty or discomfort, contact LLLI or your local lactation consultant.  If your newborn is latching on wrong, it's best to retrain him as soon as possible, before the poor latch becomes a set habit.

Here's a few tips for relieving plugged ducts.  Note, this is what works for me;  it may or may not work for you.  First I warm up the plugged area either by letting warm shower water run on it for a few minutes, or by resting in bed with a heating pad set to "medium" on the affected area.  After the plug is good and warm, I gently massage the plug (at the areola) and also the section that has gotten "backed up" and lumpy.  There is no need to press hard;  doing so is quite painful and may even damage the tissues.  Immediately after massaging, I place baby to breast (correctly latched on of course!)  ;-)   It helps if his or her lower jaw is attached at the affected section - this can help work the plug loose.  I let baby nurse as long as he or she wants, even if it seems like no milk is coming out, because often I'll find that suddenly the plug gives way and baby starts gulping down a lot of milk.  If still not unplugged, I'll just repeat these steps frequently (like, every hour or so) until I get relief.  I also make a point to take it easy when I have a plugged duct.  I rest a lot and make sure I'm getting plenty of fluids. Even after the plug is fixed, I may be sore for awhile. I continue to nurse fairly often for the next day or so, not only to help the soreness go away, but also to keep the plug from coming back.

With our second baby, I thought, "Hey, I'm a nursing veteran ... I don't need to review the book."  Was I wrong!  I forgot that just because a toddler can nurse sprawled all over your lap, in any crazy position or with her legs dangling down, doesn't mean your newborn can!  As LLLI points out in their book, it's important to keep your nursing newborn tummy-to-tummy with you, with his head, shoulders and body all in alignment.  This helps him to get latched on better without any straining on his part.

So anyway, I got sloppy with my second newborn.  I let him nurse at an angle to my body, or else lying on his back with his head turned toward me.  I let him chomp away even though I knew in the back of my mind that his latch was probably wrong.   When my nipples started cracking and bleeding, I knew something was badly amiss, and I finally started searching in my LLLI book for possible causes and solutions (including, correcting baby's latch).  While still trying to figure out what was going on, I got this red spot and spreading red lines in my right breast.  I had developed a breast infection, aka mastitis.  In addition to the breast pain, I felt awful, like I had the flu, with a fever and chills.   Fortunately, I felt much better in about 24 hours, thanks to my mom's watchful care and the antibiotic our CNM prescribed.  I can't stress enough how important it is for a mother with a breast infection to take baby to bed with her promptly, and stay there!  Let someone else take care of the children, change your baby's diapers, and wait on you hand and foot while you rest and recover.  Nurse baby frequently, especially on the affected side(s), and keep drinking plenty of fluids and eating wholesome, nourishing foods.  During recovery, continue to nurse frequently and rest.   This will help you to keep up the milk supply and get better, too.

By the time our third baby came along, I thought I had learned my lesson.  Month nine of pregnancy found me carefully studying the latch-on section of my LLLI book.  After baby arrived, I made sure his positioning and latch were always right.  He and I soon got into a good nursing pattern, and his first month or so, he thrived, gaining weight and getting lots of good, rich milk.

But when he was barely a month old, the holiday season arrived.  And foolishly, I felt obligated to do the whole nine yards of holiday preparations, just like I do every year.  I scrambled to get the holiday newsletter done, the cards mailed, gifts wrapped and shipped, house decorated, etc, etc.  My placid baby didn't mind as long as he was where he could watch me when he was awake.  He wasn't very demanding, and let me nurse him in haste.  Instead of the long, leisurely nursings we had been doing up to that point, I'd keep him on for about 5 minutes per side, then unlatch him, make sure he was safe, snug, and dry (and watching me), then bustle around doing my holiday routine.   And it wasn't long before his poops had gone from bright seedy yellow to watery green.  Not only that, but his rapid growth had slowed down markedly.  Now what was up?   I got online to a LLLI Leader, studied the LLLI book yet again, and asked other breastfeeding moms for advice.  I learned that our problem was most likely a foremilk-hindmilk imbalance.

What does that mean?  Well, during a feeding, what a baby gets first is the thin, watery foremilk.  He doesn't get to the richer hindmilk until some minutes into a feeding.  That's why it's important to nurse baby until he is finished on each breast, and not try to rush him or watch the clock.  If baby never gets any of the hindmilk, or more accurately, if mother and baby have gotten into a nursing pattern where mother produces - and baby gets - virtually all foremilk and no hindmilk, that is known as a foremilk-hindmilk imbalance.

For me, the first letdown of milk I feel is when the foremilk is coming down.  Five to ten minutes into a nursing, I will feel a second letdown as the hindmilk is released.  I learned to wait for this second letdown, so that I could be sure baby was getting the rich hindmilk he needed to grow and thrive.  I was forced to slow to our former relaxed pace for nursing, focusing more on baby and his cues, rather than on fussing over all the external .... and unimportant ... holiday preparations.  As the holidays ended, I was resting a lot, letting baby nurse as often and as long as he wanted.  His stools were soon back to normal (bright yellow), and he began to gain weight again.

My experiences with our first three babies (we've since had two more :0) have taught me that no matter how comfortable and knowledgeable I may feel about nursing, it's still a good idea to thoroughly review all breastfeeding basics before baby arrives.  Now that there are so many great websites and books available on the subject, this is easy to do.  Below are some of my favorite breastfeeding resources; I hope they will be as helpful to you as they have been to me.  And if you have chosen to breastfeed, may you and your baby enjoy many happy moments as a successful nursing team!