7 Common Breastfeeding Challenges & How to Overcome Them
According to the World Health Organization, UNICEF and Health Canada, it is recommended to breastfeed your baby exclusively for the first 6 months of life. This means that no other liquids or foods are given to the baby - not even water. Starting at 6 months, children should ideally continue to be breastfed until at least 2 years of age (and beyond), while also beginning to eat safe and nutritious complementary foods.
If these are the official recommendations, why are so many mothers who choose to breastfeed stop their breastfeeding journey earlier than they would like? What are the common breastfeeding challenges they are facing? And how can we tackle these challenges?
As a breastfeeding mother to a 20-month-old toddler and recently trained breastfeeding support godmother via Nourri-Source, I have learned about and experienced a fair share of challenges myself: Engorged breasts, oral ties, damaged and cracked nipples, a clogged milk duct, milk blisters and a strong let-down reflex.
Today, I’m building on this experience to share seven of the most frequently cited challenges when it comes to breastfeeding:
Not enough breast milk
Engorged breasts
Painful or damaged nipples
Clogged milk ducts
Mastitis
Milk ejection reflex (strong let-down reflex)
Not enough support
Disclaimer: As a breastfeeding godmother with Nourri-Source, I received basic training on breastfeeding and its associated challenges. However, please remember that each breastfeeding journey is unique. If you experience any challenges or severe pain, please reach out to your trusted medical provider or a certified lactation consultant (IBCLC).
1. Not enough breast milk
Sometimes breastfeeding mothers say that they don't have enough breast milk to offer to their babies. If the milk supply is indeed insufficient, the baby is not getting enough nutrients to grow well, doesn’t have enough wet diapers, shows signs of frequent hunger, appears to be dehydrated (dark urine/ dry mouth) and has difficulty following his/her individual growth curve.
Why does it happen?
At the very beginning, breastfeeding mamas are sometimes afraid of insufficient milk production because their milk hasn’t come in yet (which usually happens a few days after the baby is born). As opposed to premeasured formula, one cannot measure how much milk the baby has really ingested from the breast other than watching out for the quantity of wet diapers.
If this is not the case, it is likely that the breasts are not stimulated enough to produce enough milk or that the latch is not good enough. Rarely, there are other factors that impact milk production, such as health problems, not enough mammary glands, a new pregnancy, breast surgery etc.
Fact Sheet for Nursing Mothers (Source: From Tiny Tot to Toddler. Institut national de santé publique du Québec, Canada.)
What can be done?
First, verify your latch to make sure that the baby is drinking effectively.
The baby should latch on the breast with a wide-open mouth, lips that are slightly tilted outwards, and most of your areola should be covered by the baby’s mouth.
Deep Latch Technique (Source: The Pump Station & Nurtury, 2021)
If the latch is good enough, check if your baby has enough wet diapers and swallows the milk well during a feed (you should see and hear the swallowing). Then, the basic principle to increase milk production is to stimulate the breast more often, for example by offering the breast more frequently or by expressing milk (manually or with a breast pump).
Skin-to-skin contact between mother and baby can also help promote more frequent feedings.
We can also prioritize postpartum foods that are considered to promote lactation (oats, breastfeeding herbal teas, fenugreek, barley malt, almonds, brewer's yeast). Lastly, and always under the guidance of a medical practitioner or nutritionist, take supplements or medications to stimulate milk production.
Important: Consult your doctor or a certified lactation consultant (IBCLC) if your milk supply does not increase despite following some of the recommendations above.
2. Engorged breasts
One of the most common problems among breastfeeding mothers is engorgement. Engorged breasts are often heavy, tense, hard and very tender or painful. In some cases, the skin may also be hot and red.
Why does it happen?
There can be several reasons for engorgement.
Among the most common causes are when the milk comes in a few days after giving birth and the mother experiences large amounts of milk filling up her breasts – not very comfortable, but totally normal.
Engorgement can also happen when weaning the baby too suddenly, due to infrequent or interrupted feedings, milk production that is greater than the baby's needs or inadequate sucking/ latch (intake).
What can be done?
To relieve the discomfort, make sure that you have a good latch and breastfeed frequently. If the problem persists, you can compress your breasts and express milk (manually or with a breast pump) to soften the areola before a feed or express milk after a feed to increase your comfort level.
Massages can also help circulate fluids within your breasts. To reduce the inflammation from engorgement, you can apply cold compresses between feeds, put cold cabbage leaves on your breasts or take anti-inflammatory medication after consulting with your doctor.
Important: If the problems persist, please consult a certified lactation specialist (IBCLC) to avoid the risk of further complications (clogged ducts, mastitis).
3. Painful or damaged nipples
Some breastfeeding mothers experience pain in their nipples at the beginning of or during a feed. Apart from the sensation itself, the pain can also cause ineffective milk transfer as well as damaged, cracked or bleeding nipples.
Why does it happen?
The two main causes of nipple pain are a poor latch and engorgement.
If the latch is not deep enough, babies suck on the nipple rather than opening their mouth wide and putting the nipple deep in their mouths. Sometimes, restrictive oral ties (tongue/ lip ties) or musculoskeletal tension can cause pain as well. In this case, please reach out to a certified lactation consultant or pediatric dentist to diagnose oral ties and for an osteopath or chiropractor to examine your little one for possible tension.
Other reasons for damaged nipples include breast-pacifier confusion, improper use of the breast pump, a new pregnancy or other hormonal changes, infection or skin problems.
What can be done?
First, make sure that you have a deep and asymmetrical latch and start each feed with the less painful breast. Then, you can try compressing the affected breast and vary your breastfeeding positions to change the friction point.
If the pain is very severe, you can also break the suction before removing the nipple from the baby's mouth. Finally, if there is damage to the nipples, use the healing powers of breast milk by applying it directly to the affected area.
Important: If there is little or no improvement, consult a nurse or certified lactation consultant (IBCLC).
4. Clogged milk ducts
Sometimes, the nursing mother may experience localized pain (throbbing), redness of the breasts, lumps or hard lumps. Unlike mastitis (explained below), there is no fever with a single blocked milk duct, but care must be taken so that the clogged duct does not turn into mastitis.
Clogged milk duct (Source: How to prevent a clogged milk duct, Milkology)
Why does it happen?
The main reason for a clogged milk duct is that the breast has been left full for too long. This can happen with prolonged engorgement, a poor latch or positioning, skipped or spaced feeds, stress or blisters of milk.
Sometimes the milk ducts become blocked from prolonged pressure, for example from an overly tight bra, an ill-fitting baby carrier or a poor sleeping position.
What can be done?
The first thing to do is to ensure a good latch and to breastfeed frequently. Then, it is recommended to start with the painful side and express your milk as needed (manually or with a breast pump).
You can also vary the breastfeeding positions to ensure that all the ducts are emptied adequately, for example by bending over the baby and offering the breast from on top (‘dangle feed’) or by orienting the baby’s nose towards the lump.
Massages to the nipple during a feed can also relieve pain as well as a small massage in front of the lump. Lastly, you may consider anti-inflammatory drugs and cooling the affected region.
Dangle Feed Breastfeeding Position for Clogged Ducts (Source)
5. Mastitis
Mastitis is an inflammation and infection of the breast. We talk about mastitis if there is a specific area of the breast that is red, hard, hot and swollen AND if the nursing mother has severe pain AND if she has a fever.
Since mastitis can present as a blocked milk duct in its early stages, it is important to treat symptoms effectively as soon as they appear. The symptoms of mastitis are similar to the symptoms of the flu (chills, body ache, fatigue).
Why does it happen?
Often mastitis is caused by bacteria. The risk of mastitis is increased by the presence of nipple lesions, prolonged engorgement, fatigue or stress in the nursing mother.
What can be done?
The same recommendations should be followed as for clogged milk ducts (see above). In addition, please make sure to hydrate well and rest as much as possible. Anti-inflammatory drugs can help relieve symptoms, but care should be taken not to mask the fever either.
Important: If it really is mastitis and not a blocked duct, please reach out to your trusted medical provider.
6. Milk ejection reflex (strong let-down reflex)
We speak of a strong let-down reflex if breast milk comes out of the nipples with great speed and intensity.
The baby may choke on the feed, become restless and angry, or shorten the feeds but increase the frequency due to frustration. Sometimes, this milk ejection reflex can also cause a decrease in the baby's weight gain, colic or reflux. A breastfeeding mom with a strong let-down reflex may also experience nipple pain.
Why does it happen?
The risk of a strong let-down reflex is increased by overproduction or a very full breast due to the engorgement (see above).
What can be done?
First, you can breastfeed more often and use the anti-gravity position. Try offering only one breast per feed (and expressing milk from the other breast to relieve engorgement). Then, you can try breaking the latch at the beginning of the let-down and then manually expressing milk after.
Sometimes, it helps to let go of the first batch of milk and offer the breast to the baby afterwards. If the baby has a stomachache or reflux, it is very important to focus on proper burping (winding).
Important: If the baby is not gaining enough weight or not following its growth curve, it is important to get help and consult a certified lactation specialist (IBCLC).
7. Not enough support
Unfortunately, it still happens that mothers have the desire to breastfeed their babies but do not have enough support to continue their breastfeeding journey.
They may not be taught enough about breastfeeding and how to overcome challenges, must return to work earlier than expected, no longer have the time/ resources to breastfeed regularly or are judged by their environment (partner, family, colleagues, friends or the general public).
Why does it happen?
Even though breastfeeding is one of the most natural things in the world, it is still not sufficiently normalized or encouraged in our society. There is a lack of appropriate environments to be able to sit and breastfeed your baby in public, there are very few mothers who breastfeed young children after 12 months and there still is a stigma around openly breastfeeding your baby in public.
“Breastfeeding failure often reflects an inadequate support system and an overly fragile breastfeeding culture rather than the skills and abilities of the breastfeeding person itself." (translated from French from Beaudry, Chiasson and Lauzière, The Biology of Breastfeeding, University of Quebec Press, 2006, p. 435).
What can be done?
To ensure a positive breastfeeding experience, it is recommended to learn about the benefits of breastfeeding for the mother and for the baby from reliable sources (WHO, Health Canada, La Lèche League etc.) and talk about it to those around you.
Mothers who choose to breastfeed need as much support as possible, for example allowing her to breastfeed where she wants, when she wants and how she wants.
We can support breastfeeding mothers by preparing nutritious meals and snacks and giving her enough water, taking care of chores at home or medical appointments, listening to her when she is going through challenges, encouraging her when she feels exhausted, etc.
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