Breastfeeding: Why Is It So Hard To Breastfeed A Baby?

This is the first in a multi-part series Ask Moxie is going to run on breastfeeding. My guest expert is Jamie. She's a lactation consultant, mother of four, raconteur, and tireless supporter of all things boobular. She's the person you want to talk to when your tits are in a vise (literally or not). In addition to writing these articles for Ask Moxie, she's written an amazing series of posts on breastfeeding, breastfeeding support, and breastfeeding in U.S. culture on her own blog. You should check them out.

And now, on with the show:

Why Is It So Hard to Breastfeed a Baby?
 
One thing that complicates breastfeeding for new mothers is the abundance of myths steering her in the wrong direction (or at least in unhelpful directions) as she's getting started. 
 

Myth #1: It's so much easier to learn about breastfeeding these days. There is a ton of breastfeeding information floating around out there. Unfortunately, a lot of it is bad. My copy of the Sears & Sears Baby Book instructs mothers to center the nipple in baby's mouth and RAM the baby on. Some babies are fine with that. Others will respond with the same indignation I would feel if someone shoved my face into my plate and expected me to eat that way. So choose your sources carefully to find current, research-based recommendations. (I am partial to kellymom.com and LLL myself.)
      

Myths #2 and #3: It won't hurt if you're doing it right vs.  Early breastfeeding is painful and you just have to suck it up. If breastfeeding hurts a lot, something isn't right. It may be that a tiny adjustment in the baby's latch (usually helping him to latch more asymmetrically, taking a deeper bite with his lower jaw -- details on these pages) will make a vast difference. The problem may be an anatomical varation like a tongue-tied baby or a mother with larger-than-average nipples (technically known as "oro-boobular disproportion"). Significant pain should signal you to get help pronto, before your nipples turn into steak tartare.
 

On the other hand, a lot of women experience a little pain. Your nipples have never been stretched so far; your ducts have never been distended to such a degree. Sometimes, especially before the milk starts flowing, it makes a person say ouch. According to The Breastfeeding Atlas, this type of pain should last about 20-30 seconds per feeding and resolve within a week. But if you hear that you shouldn't be saying ouch, you may worry that you're doing it wrong. Motherhood presents many and varied opportunities to worry that you're doing it wrong. Whenever possible (this is just such an instance), decline them.

 

Myth #4: A lactation consultant is a lactation consultant. As far as I know, no state in this country regulates lactation consultants. You can get tired of your career in furnace repair one day and hang out your shingle as a lactation consultant the next. This is part of why lactation support in hospitals is so uneven. You can find some wonderful nurses and LCs with a magic touch -- and, more importantly, the ability to transmit same to you. You can also encounter nurses whose idea of evidence-based practice is "Good Enough For My Baby In 1982 Is Good Enough for Yours in 2006." If you need breastfeeding help, you can search here for an IBCLC. You might also call a local LLL Leader (start here).  If you need more assistance than she can provide, ask her whom she would call if she had a stubborn breastfeeding problem.
      

Perhaps most pernicious is myth #5: Breastfeeding has to get off to a good start or it won't work out. A good start is a big help, but here's what you do if you get a rocky start instead (courtesy of Linda Smith):

1. Feed the baby. If possible, your own expressed milk, given in whatever way works for your family. If you opt to use a bottle, this is a helpful article  on using bottles to transition a baby back to the breast.
2. Protect the milk supply. To bring in a milk supply, rent a hospital-grade pump. If your insurance company balks, an LC should be able to drop them a letter explaining why it's important.
3. Fix the breastfeeding. If you can keep something relaxed happening at the breast, offering the baby a chance to nurse when you're both calm and he's not too hungry, many babies will catch on all on their own. Most will figure it out in time, with assistance from an experienced LC.

One last note: many of the women who read and comment here are infertility veterans. Lactation consultants report, anecdotally, a higher rate of breastfeeding difficulties among women with a history of infertility. Sometimes the cause is physical (PCOS can be related to supply issues); sometimes the reason is unclear. I mention this not to alarm anyone, but because forewarned is forearmed. The same tenacity that brought you to motherhood can also help you, given good information and support, to get past most breastfeeding hurdles. Good luck!

Comments

[wix]

just for the record, here's quickie re PCOS and breastfeeding: http://www.luckyhazel.com/wish/archives/001172.shtml

i'm also happy to exchange email with any readers who are either having PCOS-related supply issues or want to be prepared for same.

[beaver girl]

figuring out the asymetrical thing saved us. it was the key for us.

[Carrie]

PCOS breastfeeder here...
I found that it took longer for the milk to come in. That meant my son lost more weight in the beginning (about 10 to 11% of birth weight). The flow of information from maternity nurses to nursery nurses is non-existent, so half of our care team didn't know I had PCOS and was working hard to bring in a milk supply. They were pushing formula and making veiled threats about having to leave the baby in the hospital and go home without him.

The two best pieces of advice I got:
1. Give it 2-3 weeks. It gets so much easier/less painful. I actually counted the days.
2. Mom and baby should be tummy-to-tummy for positioning (unless you're in football hold. Then it would be baby's tummy to mom's obliques). 8 months later, we're still tummy-to-tummy.

[Jody]

Karen Gromada, the La Leche go-to person for breastfeeding multiples, has her own website now at http://www.karengromada.com and she responds fairly regularly to queries at http://groups.yahoo.com/group/apmultiples/

I put that out there because Gromada's had experience with PCOS moms via ART-conceived multiples and has lots of good information about overcoming early obstacles. Frequent nursing/pumping is essential for PCOS moms, something that can get lost in the haze of "low production, try supplements" that often prevails when PCOS and breastfeeding come up. And because, when you're trying to breastfeed multiples in those early weeks, and it's 2am and you're sobbing, it's nice to have someplace to go where you can ask a question and get an actual answer.

Although it's still really important to phone a local person the next morning. Those early weeks can be tough.

[Cat, Galloping]

moxie, you were very helpful to me when i was having all my trouble but wow:

"it makes a person say ouch"

hahahahahahaha
boy is *that* putting it mildly
though in the end the latch was the least of my problems.

perhaps if would be useful to address complications like cracked and bleeding nipples, bacterial infections, yeast infections, blocked ducts, mastitis? and the fact that these can all occur... in the same person at the same time?

or how about the fact that not everyone feels some special bond when they breast feed?

[Jen P]

I guess I'm quite lucky in that breastfeeding has never been a struggle for us. Well, I say that in the breastfeeding way, not in the feeding way. Feeding Sophie has been hell in that she still associated it with pain until about 2 weeks ago. (Severe GERD) Her suck and scream still gives me nightmares thinking about it.

But the pcos/milk supply issue sort of intrigues me. I have 1 functional ovary and it is polycystic and I have had NO problems with supply. In fact, I have the reverse issue -- my milk overfloweth. But I base that on all the sucking Sophie has done for comfort.

My milk came in on the 2nd day, Sophie only lost 2% of her bodyweight and I have never had trouble latching her. Sophie was born to suck. It has to be her favourite hobby. But we nurse to sleep on all occasions and she must nurse 10 to 12 times a day so my nipples have become accustomed to it all.

I am, however, incredibly religious about my Lansinoh and apply it at least 5 times a day to both nipples and I let them air dry. I also let them see a bit of sunshine once a day.

For Cat, Galloping: It took 5 entire months before I felt any sort of bonding feeling while nursing Sophie. I think anyone who struggles with feeding be it something like GERD or breast issues will find it a longer journey to those feelings. I'm lucky to feel them now. It's lovely actually.

I feel quite lucky in that breastfeeding is the only thing has gone right for us. I had mastitis 10 times while pregnant (treated once with antibiotics and the other 9 times naturally) and have only had 1 blocked duct thus far.

This is the homoeopathic remedy I used to help when I had sore breasts/blocked ducts. You need to get it at the first sign of soreness to ensure it doesn’t develop into a full blown breast infection needing antibiotics.

4 drops Phytolacca 30 + 1000mg Vit C every 2 hours for 12 hours – ie 6 doses

Rest and feed self and baby regularly

I uses Ester C as the Vit C as my midwife had said that normal Vit C can upset milk in baby tummy – think it makes it more acidic.

I wish everyone a lot of success breastfeeding. In my first week I felt pinches of soreness for about 20 to 30 seconds at each feed but the Lansinoh definently helped and I think feeding more frequently really helps establish the nursing couple (ie -- screw the schedule, feed on demand!).

[Sherry]

Dear GOD, Jamie...between you, Moxie and Karen Gromada, it's possible to have solved my supply issues (PCOS'er here) and the childrens' (I have twins) sudden protest to my right breast. I wish I could've nursed for longer (did for 9 weeks), but honestly, after turning to my LC (who, BTW, sent me an article instead of actually giving me suggestions on increasing my supply...helpful? No.), my OB's office who directed me to my Ped's LC, who also "couldn't find it in her book" I was spent and decided to pump instead. I'm not sorry about my decision because, honestly, it was driving me batty, but praise y'all for introducing some extremely helpful information for those of us with issues AND multiples.

Go all things boobular!

[liz]

And if your baby really hates it (mine did. He hated facing away from the room, wanted to know what was going on around him) You can still pump for as long as you want (I kept it up for 9 months). But it's important to keep at it, or you'll lose your supply.

[Moxie]

Cat, I think you were sold a huuuuge bill of goods by someone. I think it's normal (IME and from what most people I know have said) not to feel bonding when nursing until at least 6-8 weeks. Until then it makes you feel confused, inadequate, and a little (or a lot) freaked out. Only once it all starts to come together (usually around 6 weeks or later) do most people feel any kind of bonding or satisfaction in nursing.

If anyone told you that it was going to make you feel this huge surge of love and bonding right away, I'd distrust whatever else they've told you on any topic.

I am still stunned at the amount of intense pain you had when nursing. I haven't heard of anyone else having such a truly shit time of it. I felt for you while you were in the middle of it, and am glad that you gave yourself permission to quit when it was causing you such constant miserable pain.

Jen P, thank you for posting the homeopathic remedy for mastitis.

Yeah, Sherry. Don't you just want to say "boobular" all day long?

[ValleyGal]

I wish someone had warned me that my PCOS could lead to low supply. It is so worth it to find a good LC -- mine had the "special scale" (the one sensitive enough to measure amount fed) for rent and that was the tool that (A) diagnosed my supply problem, (B) helped me to know how much pumped milk to supplement, and (C) saved my freaking sanity. I say a special prayer for her every night.

Also, FWIW, if you're scheduling an elective c-section and want to avail yourself of the hospital's LC help, don't schedule your c-section for a Friday. Because there won't be anyone on staff on the weekend and you could be discharged before they get to you on Monday...

[Jamie]

Jen P, it's not unusual at all for mothers with PCOS to have oversupply. When I saw Lisa Marasco speak in 2003 (she was the first LC to connect the dots on PCOS and undersupply), she said it seemed to break down into roughly a third of moms with oversupply, a third of moms with undersupply, and a third of moms with no supply problems. She and BFAR guru Diana West (oops, no HTML allowed in the comments but check out bfar.org) have a book on milk supply coming out soon -- I can't wait to see it.

Cat, I am always sorry to hear about wretched breastfeeding experiences. When it goes badly, it can be beyond awful. One of the reasons I strongly encourage mothers to get help immediately when breastfeeding pain goes beyond an initial ouch moment is that it can cause the kind of cascade you're describing: the bad latch quickly causes tissue breakdown (cracked nipples), which leaves the mother more reluctant to nurse frequently and more vulnerable to infections (hello, plugged ducts and mastitis), which are usually treated with antibiotics (thrush, anyone?), which is often the thing that makes a mother throw up her hands in disgust and say, "Why am I torturing myself like this?"

Hats off to Sherry and Liz and the other pumping moms -- that takes a lot of dedication.

[Jen P]

Jamie,

thanks for the comment on pcos and supply. I have another mom in my coffee group who has pcos and had very little milk despite pumping, drugs to increase supply who gave up trying after she was hit hard with ppd. I will email her and tell her to look into pcos and undersupply. I know it might help her come to peace, as it's been 6 months and she's still really sad about it. She's going to start stimming for her next ivf next year and maybe this time she can be more prepared for supply issues.

thanks again!

[surcie]

It amazed me how something something that is supposed to be so natural and beautiful could feel so unbelievably unnatural, uncomfortable, and awkward. I wish I had known that might be the case! I felt like a huge failure, and I'm sure that contributed to the supply issues I had.

[Chris S.]

I breastfed my son until 17 months. Am a pcos-er, and had oversupply issues. Crazy spraying milk. All over. Anywho, I also had a problem with plugged ducts, even though we nursed frequently. After researching, I started taking lecithin supplements and it worked wonders. I found the kellymom.com site to be very helpful. Oh, and I hated bf for the first 4 weeks or so. I told myself I had to go to six weeks minimum. Then it got easier and easier, and before I knew it I actually enjoyed it.

[Jennifer]

I had trouble breastfeeding. After a week I had no milk or not enough. I struggled with it and tried different things. The LLL I went to thought that it could be a gradular problem. Anyone know where to go to see if it is in fact a gradular problem? the Ob/GYn I went to see this month had no clue about it.

[Moxie]

Yes. Jennifer, I would call Dr. Mona Gabbay. She's (AFAIK) the only MD who specializes in breastfeeding. She's in Westchester, NY, but will certainly be able to tell you who to see in your area.

Mona Gabbay, MD, IBCLC
Breastfeeding Medical Consultants of Westchester
145 Seventh Avenue
Pelham, NY 10803

Tel: (914) 632-7999

The women I've known who've used her have found her to be unbelievably knowledgeable and compassionate.