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Troubleshooting: Breastfeeding

It isn't always easy but if you can get over a few hurdles, breastfeeding is great for baby and for you. Here are a few tips for common concerns


Posted: 1 December 2008
by Debra Stottor


On the face of it, it’s the most natural thing in the world, but in reality many women encounter problems along the way, not to mention conflicting advice. If you are having trouble but want to give breastfeeding a go, check out overcoming breastfeeding problems and read on here for answers to a few common questions.

My midwife says I should feed from one breast at each feed, but my mum says I should use both. Who’s right?
Both. There was a time when all mothers were advised to feed from both, then this changed to just feeding from one.
The theory behind this is to ensure that your baby empties the breast completely, and gets plenty of the calorie- and fat-laden hind milk (the foremilk, which comes out first, is thinner and more thirst-quenching). If your baby is settling well between feeds and is gaining weight as expected, he’s probably getting the right proportion of hind and fore milk from you, whether you feed from one or both breasts.
But if you’re feeding from one and he seems unsettled and isn’t gaining enough weight, you may find you need to top up from the second breast – and you should certainly try this before offering a top-up of formula milk.
The key to successfully feeding from both is to make sure your baby has emptied the first breast before offering the second. It’s a good idea to wind your baby between breasts. If he looks likely to settle after just one breast, put him down to sleep, otherwise offer the second and let him feed from this until he’s had his fill – it’s fine if he feeds for just a few minutes or as long as he stayed at the first breast.
To maintain an equal milk supply in each breast and prevent any blocked ducts, do alternate which breast is offered first.
For more on producing milk, click here.

How do I know when my baby’s had enough?
There’s no way of knowing exactly how much milk your baby’s had from your breast, so you have to look for clues as to whether he’s getting the right amount. As long as your baby is latching on well and seems content, chances are you’re doing fine, and you should have the confidence to follow your instincts. Here are a few key pointers to bear in mind.
  • How long does he last between feeds? Ideally, he should last 3-4 hours, you may need to feed him for longer or offer a second breast.
  • Is he gaining weight and generally well? If yes, don’t worry. If not, see if you can get him to take more at each feed or increase the frequency of feeds.
  • Is he draining your breasts of milk? Your breasts should feel firm before feeding and much softer afterwards. If this is the case, and he still seems awake after winding, offer the second breast. If he sucks eagerly, he’s still hungry and you should carry on until he’s comfort sucking rather than actually drinking.
  • If he starts to pause at the breast rather than sucking he is probably getting full. Try winding him and start feeding again to see if he wants any more.
  • If you’re in any doubt, speak to your midwife, health visitor or a breastfeeding counsellor for advice and reassurance.
For more about whether or not your baby is drinking enough, go to Is my Baby Sucking Enough Milk?.

I love breastfeeding but am finding it exhausting. Is it possible to mix breast and bottle?
It is possible, but is not generally advised as it affects your milk supply and if you want to revert to exclusive breastfeeding you may find this hard. That said, many mothers successfully combine the two and find it a good compromise.
Before introducing formula on a regular basis, it’s best to establish breastfeeding fully so that your milk supply is up and running, and will then respond to demand as needed. As with weaning off the breast completely, it’s best to introduce one bottle at a time, ideally at the same time each day, and to alternate between breast and bottle.
If your breasts are left too full at any time, you may end up suffering engorgement and possibly an infection.
And while you may be tempted to give up the night feeds, bear in mind that there’s evidence that night feeds give a greater boost to your milk supply than daytime ones – and breastfeeding has to be easier than making up and warming a bottle of formula in the dead of night, doesn’t it?
There is also a school of thought that introducing a bottle occasionally (once breastfeeding is fully established), ideally of expressed milk, is a good idea as it will avoid the chance of your baby rejecting the bottle when you want or need to wean him off the breast. There is little evidence that supposed ‘teat-nipple confusion’ really exists so your baby is most unlikely to then reject the breast.
If you’re feeling exhausted, do look at your diet and make sure you’re eating healthily and drinking plenty of fluids, and try to get more rest – give up housework for a bit and sleep when your baby sleeps. You may find that feeling less tired will change your feelings about breastfeeding.
Mixing breast and bottle is a popular compromise if you are returning to work but want to carry on feeding (this is often around the six or nine month mark), in which case you can ease off daytime feeds and move to formula gradually over the last two or three weeks before you are due to go back to work, then continue doing the early morning and nighttime feeds for as long as your child wants them (usually around the one year mark, but for some it is longer than this). By keeping on these feeds, you can maintain the closeness rather than giving up breastfeeding altogether at this point.

I love a hot curry but everyone says I should avoid spicy food when breastfeeding. Is this true?
To an extent, yes, although much depends on your baby.
Certain foods are thought to affect breast milk more than others, eg hot, spicy food, citrus fruit, garlic, but it’s worth giving them a try if they’re particular favourites as your baby may not mind, especially if you’ve been eating them throughout pregnancy anyway. We don’t know how long it takes for foods to pass into your milk, but it’s probably at least four hours.
If you eat any suspect food, see how your baby reacts after being fed at this stage. Does he seem unsettled while feeding? Is he suffering more wind than usual? Does he have diarrhoea? If the answer to the above is yes, the food may be the problem, so avoid it for a few days then try again and see if his reaction is the same. If it is the same, you might have to cut out these irritant foods until you finish breastfeeding.
For more on this, read Your Diet and Breastfeeding and Foods to Avoid when Breastfeeding.

My breasts feel full before each feed but my baby starts crying and pulling away from my breast during feeds. What’s the problem?
It may be that your milk is flowing too fast for your baby and he can’t drink quickly enough so is getting panicky and distressed.
You need to sort the problem out otherwise he may become ‘scared’ of breastfeeding. Breastfeeding expert Clare Byam-Cook recommends using a nipple shield in such cases as it acts a barrier between breast and baby. Your baby will only get what he wants through the shield, the rest will form a small pool behind the shield. If your flow tends to be fast only at the beginning of each feed, you may need to remove the shield partway through, otherwise it’s fine to leave it on throughout.
Also, as your baby gets older, he may become better able to cope with the fast flow, so it’s a good idea to try feeding without the shield occasionally just to see.
See also When Baby is Off His Milk.

Further reading:
You will find a wide range of articles about breastfeeding at the Breastfeeding Central section of ThinkBaby.

Good books include 'What to Expect When You’re Breastfeeding… and What if you Can’t?' by Clare Byam-Cook (Vermilion, £8.99) and 'Top Tips for Breastfeeding' by Clare Byam-Cook (Vermilion, £6.99). To buy, go to www.randomhouse.co.uk.

To find a breastfeeding counsellor, visit www.breastfeedingnetwork.org.uk or www.laleche.org.uk.


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