Breastfeeding Is Not Always As Easy As ABC

Courtney Clark Bilodeau, MD

Dr. Courtney Bilodeau answers common questions and explains some challenges and concerns surrounding breastfeeding for Breastfeeding Awareness Week.

A – Should all women breastfeed?

Health care providers agree that breastfeeding is one of the healthiest choices a mother can make for herself and her child.  Your body provides the ideal way to give your child a perfect source of nutrition.

But many moms experience challenges with breastfeeding along the way. 

Breastfeeding takes time to learn and can be more difficult than anticipated. Not all babies latch on immediately and it’s not uncommon for new moms to feel disappointed or discouraged. 

B – Is breastfeeding an option for me?

For some women, breastfeeding may not be an option. This is true for women who:

  • Take certain medications or use illicit drugs.
  • Have been exposed to certain infections.
  • Have a chronic medical condition.
  • Have had an environmental exposure and are clinically ill from toxins such as lead or mercury.

Also, in rare cases, breastfeeding is not advisable if the infant has certain medical conditions such as galactosemia, a rare genetic metabolic disorder.

That said, I like to stress that breastfeeding doesn’t have to be all or nothing. If you decide to breastfeed exclusively, that’s great. If not, there are other ways you may choose to breastfeed.  Some women choose to partially breastfeed by combining breastfeeding with formula feeding. Some mothers only pump, or may transition to formula feeding.

You have options. Speak to your health care provider or lactation consultant. Ultimately, it’s about choosing what works best for you and your baby.

C – When should I be concerned and seek help?

Be sure to talk to your provider about any concerns you may have. You may experience some of these common uncomfortable or painful problems while breastfeeding:

Engorgement: Breast engorgement may occur when a mother makes more milk than her baby uses. More often, it’s associated with the baby, or breast pump, not effectively removing breastmilk at each feeding, or pumping. The breasts become firm and swollen, which can make it hard for the baby to latch and breastfeed, making the condition even worse!  Prolonged engorgement will eventually lead to an inadequate supply through a negative feedback on the milk making process.  The risk for infection (mastitis and abscess) also increases with engorgement. 

Soreness: It’s common for nipples to feel sore when moms first start to breastfeed. This is almost always a short-term problem, and can usually be corrected in a matter of days. The degree of soreness varies, with some mothers experiencing slight tenderness, and others noticing bleeding, cracked nipples. Cracked nipples can be caused by thrush, dry skin, pumping improperly, or latching problems. During the first week of breastfeeding, moms may have bloody discharge while the baby is learning to latch or when moms begin to pump. A little blood won’t harm the baby.

Thrush: Thrush is a yeast infection that develops in the baby’s mouth and can also spread to the breasts. It causes excessive itching, pain, and sometimes a rash. The nipples may look normal. You might also find them to be red, swollen, scaly, or have tiny blisters.  Yeast infections may also lead to plugged ducts and mastitis.

Plugged ducts: Some mothers nurse several babies and never experience plugged ducts or mastitis (breast infection), while others have recurrent episodes. A plugged, or clogged, duct is a sore, tender area in the breast. It occurs when a milk duct is not draining well and inflammation builds up. The area may be warm to the touch and red, and if it’s located in a duct close to the surface of the skin, you may be able to feel a distinct lump with your fingers. A plugged duct is not accompanied by fever.  If you develop a fever or feel body aches, this can be a sign of mastitis and you should see your health care provider.

Mastitis: Mastitis is a bacterial infection in your breasts that can develop within the first few weeks postpartum although it can occur at any time during breastfeeding.

Tips to remember:
  • When a baby is fussy or wants to nurse again shortly after eating, it’s natural to worry that you’re not producing enough milk. However, these can be normal behaviors. The baby gaining weight can reassure mom that breastfeeding is going well.
  • If the baby is losing excessive weight, needing less frequent diaper changes, becoming lethargic or jaundiced (yellowing of the skin), the baby needs to be evaluated by the pediatrician immediately. 
  • If you’re asked to supplement your baby with formula, don’t despair!  Once your baby is getting adequate nutrition, he or she is less likely to be fussy and may even be able to sleep for longer stretches of time.   When mom and baby are feeling more rested and satisfied, they’re more willing to work on the nursing process and more likely to achieve exclusive breastfeeding, if desired. 
  • Remember, you’ll need to continue a regular cycle (every 2-3 hours) of breastfeeding or pumping to maintain a supply even if you are supplementing with formula.  

Our breastfeeding medicine team is available to help you. Our program offers comprehensive, individualized treatment for women who are experiencing complicated breastfeeding issues or have a medical condition which can complicate the lactation process.  Learn more about our Breastfeeding Medicine Program here

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