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Common Problems When You Begin Breastfeeding

Baby Takes One Side Only
Often, the baby latches on more readily to one breast than the other. Perhaps one nipple is easier to grasp, or the milk on that side flows more freely. It is important to keep working with the baby to take the less-preferred side as quickly as possible, to assure that both breasts receive adequate stimulation and emptying. You can start feedings on the "difficult" side and see if the baby cooperates more when he is hungry. If he starts to fuss too much, switch to the preferred breast and let him settle and nurse. Then, building on this success, resume your attempts on the other side. If your baby isn't taking both breasts well by the time your milk comes in abundantly you should start using a hospital-grade rental electric breast pump to regularly remove milk from the breast that isn't being suckled. (I actually recommend pumping both breasts simultaneously since it takes no longer than pumping one side and will help keep the overall milk production generous.) Breast preferences very quickly can cause a lopsided milk supply, which only aggravates the problem. The baby's preference for using one breast results in greater milk production on that side, which in turn makes the baby prefer the better-producing breast even more. Many mothers attest to the effectiveness of a simple maneuver to entice the baby to take the less-preferred breast. Start nursing on the favored side (a cross-cradle hold works well) and then slide the baby over to the second breast without changing his position. As one woman explained, "My baby just thinks I have two left breasts."

Nipple Pain
During the first couple of days of breastfeeding, women often will complain of slight nipple discomfort for the first minute after latch-on. Severe nipple pain that lasts throughout the feeding, or nipple discomfort that doesn't improve once your milk comes in, suggests that the baby is either attached incorrectly or is sucking improperly. You shouldn't need a high pain threshold in order to breastfeed. Severe pain means something is wrong, so don't ignore this important clue. Get help right away with your nursing technique. The most common problem is that the baby is not opening wide enough and is latching on to the tip of the nipple instead of taking a large mouthful of breast. Other strategies to improve sore nipples include patting the nipples dry after feeds and applying USP Modified Lanolin (medical grade); nursing for shorter periods at more frequent intervals; and starting feedings on the least-sore side, then moving the baby to the more pain-ful side once let-down has been triggered.

Baby Isn't Satisfied After Nursing. Some new mothers become frustrated because their baby nurses for prolonged periods but doesn't seem satisfied. Often these are larger babies, over eight or nine pounds, who act persistently hungry until the mother's milk increases around the third day. Sometimes the baby will settle when swaddled snugly, held by his mother or father, or allowed to sleep on a parent's chest. Despite what I said earlier about not using a pacifier, such a baby might need one for a day or so. As long as the baby nurses well and often, short-term use of a pacifier is not likely to interfere with subsequent breastfeeding. If supplemental milk is temporarily required until your milk increases in volume, it can be offered by SNS, cup, or bottle. (Ask about using a hypoallergenic formula if you have a family history of allergies, asthma, or other allergic disease.) If the baby is already a proficient nurser, he probably will continue to breastfeed just fine. Be sure to nurse as often as possible and try to discontinue any supplements as soon as your milk starts to increase. If the baby still isn't being satisfied by the fourth day, notify your baby's doctor and seek additional help with breastfeeding. It's possible the infant isn't nursing correctly and may not be obtaining the milk he needs.

Uncomfortable Breast Engorgement
Few mothers these days are still in the hospital when their milk starts coming in abundantly. More typically, postpartum breast engorgement occurs once a mother has gone home. Exceptions to this include some mothers with C-section deliveries and those with longer stays due to medical complications. Milk coming in abundantly typically causes noticeable breast swelling, tenderness, and firmness. Latch-on may become more difficult due to flattening of the nipple and firmness of the areola. The result can be improper attachment and nipple pain. For some women, engorgement can be a source of discomfort and frustration, especially when excessive pressure interferes with milk flow. When engorgement is unrelieved, the residual milk and pressure can cause the mother's milk supply to decline rapidly.

Early and frequent nursing (at least every two to three hours) is the best way to prevent excessive breast engorgement. Applying warm compresses before nursing often helps start milk flowing, while cool compresses between feedings help relieve pressure and discomfort. Express some milk before nursing, preferably using a hospital-grade electric breast pump, to soften your breasts and draw out your nipples. Pay careful attention to proper nursing technique to assure your baby latches on correctly and obtains the maximum amount of milk.

From Dr. Mom's Guide to Breastfeeding by Marianne R. Neifert. Copyright © 1998 by Marianne R. Neifert. Used by arrangement with Plume, a member of Penguin Group (USA) Inc.

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