Breastfeeding challenges: Common problems and discomforts

How can you manage problems and discomforts when breastfeeding?

Breast milk is the best food for babies during their first year. Although breastfeeding may seem natural, it isn’t always easy. If you have trouble, don’t let it get you down! Many moms face these same issues.

If breastfeeding hurts, especially in the beginning, talk to your your healthcare provider or lactation consultant. You may just need a little help to get it figured out, and if you’re able to get help at the start it can make a big difference. A lactation consultant is trained to help you find a comfortable latch and solve feeding problems.

You can get breastfeeding help from a lot of different people: 

• Your healthcare provider and your baby’s healthcare provider
• A lactation consultant. You can find one through your healthcare provider or your hospital. You can also look at the International Lactation Consultants Association.
• A breastfeeding peer counselor. These are moms who’ve breastfed their own children and have training to support you. You can find a peer counselor through your local WIC nutrition program. Or you can visit womenshealth.gov/breastfeeding or call the National Breastfeeding Helpline at (800) 994-9662.
• A breastfeeding support group. Groups like La Leche League connect you with others who share your experiences.
• Friends and family members who have breastfeeding experience.
• Your partner. They can support you by handling chores, bringing you water, fluids, and listening to your breastfeeding concerns.  

Breastfeeding after a Cesarean birth?

A Cesarean birth (commonly called a c-section) is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb). It's normal to feel sore and tired, but you can still breastfeed. Here’s what you can do:

• Find a comfortable hold: Ask a nurse or lactation consultant to show you how to hold your baby when you breastfeed to help protect your incision (cut).
• Keep your baby close: Having your baby stay in your room at the hospital (rooming-in) makes it easier to breastfeed without having to walk to a nursery. Ask for help getting your baby when you are ready to nurse. 
• Manage pain: Take pain medicine exactly as prescribed by your healthcare provider. They’ll make sure it’s safe for your baby during breastfeeding. If you feel drowsy because of the medicine, make sure someone is with you when you breastfeed your baby.
• Use pillows: Using nursing pillows to help support your baby’s weight while breastfeeding so they don’t press against your belly.

What is breast engorgement?

This is when your breasts become swollen and full of milk. They may feel hard, tender and sore. Most of the time the discomfort goes away once you start breastfeeding regularly. Here are some ways to help with engorgement: 

• Breastfeed often. Let your baby feed as long as they want. This helps empty the breast. Let your baby breastfeed on one breast until it is soft and then switch sides.  Switch which breast you start on first. 
• Don’t skip night feedings. Try not to miss or go a long time between feedings, including at night.
• Express (release) a small amount of milk with a breast pump or by manual expression before breastfeeding. Manual expression is when you massage your breasts with your hands to release breast milk. Ask your provider or lactation consultant to show you how to manually express your breast milk.
• If your breasts really hurt, put cold packs on them in between feedings. Tell your provider if you have a lot of pain.

What can you do about nipple pain?

Your nipples may be sensitive or feel sore the first few days of breastfeeding but this discomfort should only last 7 to 10 days. You may also feel discomfort at the very start of a nursing session that goes away in less than 1 minute. If your nipples are cracked and sore, you may need to change the position you use to breastfeed. If you have nipple pain: 

• Check the latch: If it hurts, gently interrupt the suction with a clean finger in the corner of the baby’s mouth and try again. If you need help with latching a lactation consultant or your baby’s provider can observe and give suggestions.
• Change positions each time you breastfeed.
• Put some fresh breast milk on your nipples after each feeding to help them heal. Just like breast milk is good for your baby, it can help you, too.
• Avoid things that may irritate your nipples. Don’t use strong soaps or body washes that may irritate your nipples and limit tight bras or clothes that put pressure on your nipples
• If you use nursing pads, change them once they get wet.
• If the pain doesn’t go away or your nipple itches, burns, cracks or has shooting pain tell your provider or lactation consultant. If you see a shiny white dot on your nipple, it may be a milk blister. Warm compresses, massaging and expressing milk may help give your milk blister relief. If they don’t help, tell your provider or lactation consultant.  

What are plugged ducts and mastitis?

A plugged duct feels like a small, hard, tender lump in the breast. If the milk stays blocked, it can lead to mastitis (a breast infection).  

• Symptoms of mastitis: You may have a red, warm area on your breast along with a fever, chills, or body aches.
• Keep nursing: It’s safe for your baby and helps clear the blockage.
• Heat and massage: Use a warm compress and gently massage the hard spot toward the nipple before nursing. 
• Change breastfeeding positions. Try to breastfeed regularly and not skip feedings. Apply ice or cold packs to reduce swelling between feedings. 
• Know when to talk to your healthcare provider: If the hard spot in your breast lasts for more than a few days or if you have a fever or severe pain, call your provider. 

If your provider prescribes an antibiotic to treat the infection, take it exactly as your provider tells you to. Take all the medicine until it’s gone. Your provider makes sure the antibiotic is safe for your baby. Don’t start or stop taking any medicine during breastfeeding without your provider’s OK.

What is nipple confusion?

Nipple confusion can happen if a baby is given a bottle or pacifier before they have gotten good at breastfeeding. This can make it harder for them to latch onto the breast later. Or they may not want to breastfeed at all. If this happens, your baby may struggle and cry and may not get all the breast milk they need. And your breasts may become engorged.

To help prevent nipple confusion:

• Try to wait 3 to 4 weeks until breastfeeding is going well before using bottles or pacifiers, if possible.

Tell your provider or lactation consultant if you think your baby has nipple confusion. You deserve support as you navigate your breastfeeding journey. Use these tools as you go through your postpartum journey:

• March of Dimes’ Compass app: Use this tool to stay connected and for additional information. Find support on the Compass App
• Visit the March of Dimes blog: Get tips on mom and baby health. Explore the blog.
• Talk to your team: Use the information in this article to ask your healthcare provider specific questions about your comfort and your baby’s latch. Remember, you’re your own best advocate!

More information

American Academy of Pediatrics

Problemas y malestares de la lactancia materna