Common Breastfeeding Challenges: Get Tips on Diet and Benefits

Common breastfeeding challenges facts*

Breastfeeding can be challenging at times, especially in the early days. But it is important to remember that you are not alone.

*Common breastfeeding challenge facts medical author: Melissa Conrad Stöppler, MD

Lactation consultants are trained to help women find ways to make breastfeeding work.
Many women have no problems breastfeeding, while others will experience some challenges. These challenges can often be overcome.
Developing a good latch is important to prevent sore nipples.
Checking a baby's weight and growth is the best way to make sure he or she is getting enough milk.
Engorgement refers to the feeling of pain or fullness in the lactating breasts.
Clogged or plugged ducts are relatively common and can be relieved by massage, warm compresses, and frequent breastfeeding.
A plugged duct feels like a tender, sore lump in the breast.
Mastitis is an inflammation or infection of the breasts that can be accompanied by fever.
Breast infections that do not heal within 24 to 48 hours may need treatment with antibiotics.
Most mothers are able to make enough milk for twins, and some fully breastfeed triplets or quadruplets.
Breastfeeding after breast surgery is usually possible; the extent depends upon the type of surgery and the reasons it was performed.
Some health problems in babies can make breastfeeding more difficult.

Common breastfeeding challenges overview

Breastfeeding can be challenging at times, especially in the early days. But
it is important to remember that you are not alone. Lactation consultants are
trained to help you find ways to make breastfeeding work for you. And while many
women are faced with one or more of the challenges listed here, many women do
not struggle at all! Also, many women may have certain problems with one baby
that they don't have with their second or third babies. Read on for ways to
troubleshoot problems.

Sore nipples

Many moms report that nipples can be tender at first. Breastfeeding should be
comfortable once you have found some positions that work and a good latch is
established. Yet it is possible to still have pain from an
abrasion you already
have. You may also have pain if your baby is sucking on only the
nipple.

Ask a lactation consultant for help to improve your baby's latch. Talk to
your doctor if your pain does not go away or if you suddenly get sore nipples
after several weeks of pain-free breastfeeding. Sore nipples may lead to a
breast infection, which needs to be treated by a doctor.

What you can do

A good latch is key, so visit the Bringing your baby to the breast to latch
section for detailed instructions. If your baby is sucking only on the nipple,
gently break your baby's suction to your breast by placing a clean finger in the
corner of your baby's mouth and try again. (Your nipple should not look flat or
compressed when it comes out of your baby's mouth. It should look round and
long, or the same shape as it was before the feeding.)
If you find yourself
wanting to delay feedings because of pain, get help from a lactation consultant.
Delaying feedings can cause more pain and harm your supply.
Try changing
positions each time you breastfeed. This puts the pressure on a different part
of the breast.
After breastfeeding, express a few drops of milk and gently rub
it on your nipples with clean hands. Human milk has natural healing properties
and emollients that soothe. Also try letting your nipples air-dry after feeding,
or wear a soft cotton shirt.
If you are thinking about using creams, hydrogel
pads, or a nipple shield, get help from a health care provider first.
Avoid
wearing bras or clothes that are too tight and put pressure on your nipples.
Change nursing pads often to avoid trapping in moisture.
Avoid using soap or
ointments that contain astringents or other chemicals on your nipples. Make sure
to avoid products that must be removed before breastfeeding. Washing with clean
water is all that is needed to keep your nipples and breasts clean.
If you have
very sore nipples, you can ask your doctor about using non-aspirin pain
relievers.

QUESTION

Nothing can relieve the symptoms of morning sickness.
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Low milk supply

Most mothers can make plenty of milk for their babies. But many mothers are
concerned about having enough.

Checking your baby's weight and growth is the best way to make sure he or she
is getting enough milk. Let the doctor know if you are concerned. For more ways
to tell if your baby is getting enough milk, visit the How to know your baby is
getting enough milk section.

There may be times when you think your supply is low, but it is actually just
fine:

When your baby is around 6 weeks to 2 months old, your breasts may no longer
feel full. This is normal. At the same time, your baby may nurse for only five
minutes at a time. This can mean that you and baby are just adjusting to the
breastfeeding process – and getting good at it!

Growth spurts can cause your
baby to want to nurse longer and more often. These growth spurts can happen
around 2 to 3 weeks, 6 weeks, and 3 months of age. They can also happen at any
time. Don't be alarmed that your supply is too low to satisfy your baby. Follow
your baby's lead – nursing more and more often will help build up your milk
supply. Once your supply increases, you will likely be back to your usual
routine.

What you can do

Make sure your baby is latched on and positioned well.
Breastfeed often and
let your baby decide when to end the feeding.
Offer both breasts at each
feeding. Have your baby stay at the first breast as long as he or she is still
sucking and swallowing. Offer the second breast when the baby slows down or
stops.
Try to avoid giving your baby formula or cereal as it may lead to less
interest in breast milk. This will decrease your milk supply. Your baby doesn't
need solid foods until he or she is at least 6 months old. If you need to
supplement the baby's feedings, try using a spoon, cup, or a dropper.
Limit or
stop pacifier use while trying the above tips at the same time.

Ask for help! Let your baby's doctor know if you think the baby is not
getting enough milk.

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Oversupply of milk

Some mothers are concerned about having an oversupply of milk. Having an
overfull breast can make feedings stressful and uncomfortable for both mother
and baby.

What you can do

Breastfeed on one side for each feeding. Continue to offer that same side for
at least two hours until the next full feeding, gradually increasing the length
of time per feeding.
If the other breast feels unbearably full before you are
ready to breastfeed on it, hand express for a few moments to relieve some of the
pressure. You can also use a cold compress or washcloth to reduce discomfort and
swelling.
Feed your baby before he or she becomes overly hungry to prevent
aggressive sucking. (Learn about hunger signs in the Tips for making it work
section.)
Try positions that don't allow the force of gravity to help as much with
milk ejection, such as the side-lying position or the football hold.
Burp your
baby frequently if he or she is gassy.

Some women have a strong milk ejection reflex or let-down. This can happen
along with an oversupply of milk. If you have a rush of milk, try the following:

Hold your nipple between your forefinger and middle finger or with the side
of your hand to lightly compress milk ducts to reduce the force of the milk
ejection.
If baby chokes or sputters, unlatch him or her and let the excess milk
spray into a towel or cloth.
Allow your baby to come on and off the breast at
will.

Ask for help! Ask a lactation consultant for help if you are unable to manage an oversupply of milk on your own.

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Engorgement

It is normal for your breasts to become larger, heavier, and a little tender
when they begin making more milk. Sometimes this fullness may turn into
engorgement, when your breasts feel very hard and painful. You also may have
breast swelling, tenderness, warmth, redness, throbbing, and flattening of the
nipple. Engorgement sometimes also causes a low-grade fever and can be confused
with a breast infection. Engorgement is the result of the milk building up. It
usually happens during the third to fifth day after birth, but it can happen at
any time.

Engorgement can lead to plugged ducts or a breast infection, so it is
important to try to prevent it before this happens. If treated properly,
engorgement should resolve.

What you can do

Breastfeed often after birth, allowing the baby to feed as long as he or she
likes, as long as he or she is latched on well and sucking effectively. In the
early weeks after birth, you should wake your baby to feed if four hours have
passed since the beginning of the last feeding.
Work with a lactation consultant
to improve the baby's latch.
Breastfeed often on the affected side to remove the
milk, keep it moving freely, and prevent the breast from becoming overly full.
Avoid overusing pacifiers and using bottles to supplement feedings.
Hand express
or pump a little milk to first soften the breast, areola, and nipple before
breastfeeding.
Massage the breast.
Use cold compresses in between feedings to
help ease pain.
If you are returning to work, try to pump your milk on the same
schedule that the baby breastfed at home. Or, you can pump at least every four
hours.
Get enough rest, proper nutrition, and fluids.
Wear a well-fitting,
supportive bra that is not too tight.

Ask for help! Ask your lactation consultant or doctor for help if the engorgement lasts for two days or more.

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Plugged ducts

It is common for many women to have a plugged duct at some point
breastfeeding. A plugged milk duct feels like a tender and sore lump in the
breast. It is not accompanied by a fever or other symptoms. It happens when a
milk duct does not properly drain and becomes inflamed. Then, pressure builds up
behind the plug, and surrounding tissue becomes inflamed. A plugged duct usually
only occurs in one breast at a time.

What you can do

Breastfeed often on the affected side, as often as every two hours. This
helps loosen the plug, and keeps the milk moving freely.
Massage the area,
starting behind the sore spot.
Use your fingers in a circular motion and massage
toward the nipple. Use a warm compress on the sore area.
Get extra
sleep or
relax with your feet up to help speed healing. Often a plugged duct is the first
sign that a mother is doing too much.
Wear a well-fitting supportive bra that is
not too tight, since this can constrict milk ducts. Consider trying a bra
without underwire.

Ask for help! If your plugged duct doesn’t loosen up, ask for help from a lactation consultant. Plugged ducts can lead to a breast infection.

Breast infection (mastitis)

Even if you are taking medicine, continue to breastfeed during treatment.
This is best for both you and your baby. Ask a lactation consultant for help if
needed.

Mastitis (mast-EYE-tiss) is soreness or a lump in the breast that can be
accompanied by a fever and/or flu-like symptoms, such as feeling run down or
very achy. Some women with a breast infection also have nausea and vomiting. You
also may have yellowish discharge from the nipple that looks like colostrum. Or,
the breasts may feel warm or hot to the touch and appear pink or red. A breast
infection can occur when other family members have a cold or the flu. It usually
only occurs in one breast. It is not always easy to tell the difference between
a breast infection and a plugged duct because both have similar symptoms and can
improve within 24 to 48 hours. Most breast infections that do not improve on
their own within this time period
need to be treated with medicine given by a doctor.

What you can do

Breastfeed often on the affected side, as often as every two hours. This
keeps the milk moving freely, and keeps the breast from becoming overly full.
Massage the area, starting behind the sore spot. Use your fingers in a circular
motion and massage toward the nipple.
Apply heat to the sore area with a warm
compress.
Get extra sleep or relax with your feet up to help speed healing.
Often a breast infection is the first sign that a mother is doing too much and
becoming overly tired.
Wear a well-fitting supportive bra that is not too tight,
since this can constrict milk ducts.

Ask for help! Ask your doctor for help if you do not feel better within 24 hours of trying
these tips, if you have a fever, or if your symptoms worsen. You might need
medicine. See your doctor right away if:

You have a breast infection in which both breasts look affected
There is pus
or blood in the milk
You have red streaks near the area
Your symptoms came on
severely and suddenly

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Fungal infections

A fungal infection, also called a yeast infection or thrush, can form on your
nipples or in your breast because it thrives on milk. The infection forms from
an overgrowth of the Candida organism. Candida exists in our bodies and is kept
at healthy levels by the natural bacteria in our bodies. When the natural
balance of bacteria is upset, Candida can overgrow, causing an infection.

A key sign of a fungal infection is if you develop sore nipples that last
more than a few days, even after you make sure your baby has a good latch. Or,
you may suddenly get sore nipples after several weeks of pain-free
breastfeeding. Some other signs of a fungal infection include pink, flaky,
shiny, itchy or cracked nipples, or deep pink and blistered nipples. You also
could have achy breasts or shooting pains deep in the breast during or after
feedings.

Causes of thrush include:

Thrush in your baby's mouth, which can pass to you
An overly moist
environment on your skin or nipples that are sore or cracked
Antibiotics or
steroids A chronic illness like HIV, diabetes, or anemia

Thrush in a baby's mouth appears as little white spots on the inside of the
cheeks, gums, or tongue. Many babies with thrush refuse to nurse, or are gassy
or cranky. A baby's fungal infection can also appear as a diaper rash that looks
like small red dots around a main rash. This rash will not go away by using
regular diaper rash creams.

What you can do

Fungal infections may take several weeks to cure, so it is important to
follow these tips to avoid spreading the infection:

Change disposable nursing pads often.
Wash any towels or clothing that comes
in contact with the yeast in very hot water (above 122°F). Wear a clean bra
every day.
Wash your hands often, and wash your baby's hands often – especially
if he or she sucks on his or her fingers.
Put pacifiers, bottle nipples, or toys
your baby puts in his or her mouth in a pot of water and bring it to a roaring
boil daily. After one week of treatment, discard pacifiers and nipples and buy
new ones.
Boil daily all breast pump parts that touch the milk.
Make sure other
family members are free of thrush or other fungal infections. If they have
symptoms, make sure they get treated.

Ask for help!

If you or your baby has symptoms of a fungal infection, call both your doctor
and your baby's doctor so you can be correctly diagnosed and treated at the same
time. This will help prevent passing the infection to each other.

Nursing strike

A nursing "strike" is when your baby has been breastfeeding well for months,
and then suddenly begins to refuse the breast. A nursing strike can mean that
your baby is trying to let you know that something is wrong. This does not
usually mean that the baby is ready to wean. Not all babies will react the same
to the different situations that can cause a nursing strike. Some babies will
continue to breastfeed without a problem. Others may just become fussy at the
breast, and others will refuse the breast entirely. Some of the major causes of
a nursing strike include:

Mouth pain from teething, a fungal infection like thrush, or a cold sore
An
ear infection, which causes pain while sucking
Pain from a certain breastfeeding
position, either from an injury on the baby's body or from soreness from an
immunization
Being upset about a long separation from the mother or a major
change in routine
Being distracted while breastfeeding – becoming interested in
other things around him or her
A cold or stuffy nose that makes breathing while
breastfeeding difficult
Reduced milk supply from supplementing with bottles or
overuse of a pacifier
Responding to the mother's strong reaction if the baby has
bitten her
Being upset about hearing arguing or people talking in a harsh voice
while breastfeeding
Reacting to stress, overstimulation, or having been
repeatedly put off when wanting to breastfeed

If your baby is on a nursing strike, it is normal to feel frustrated and
upset, especially if your baby is unhappy. It is important not to feel guilty or
think that you have done something wrong. Keep in mind that your breasts may
become uncomfortable as the milk builds up.

What you can do

Try to express your milk on the same schedule as the baby used to breastfeed
to avoid engorgement and plugged ducts.
Try another feeding method temporarily
to give your baby your milk, such as a cup, dropper, or spoon.
Keep track of your baby's wet diapers and dirty diapers to make sure he
or she is getting enough milk.
Keep offering your breast
to the baby. If the baby is frustrated, stop and try again later. You can also
try when the baby is sleeping or very sleepy.
Try various breastfeeding
positions, with your bare skin next to your baby's bare skin.
Focus on the baby
with all of your attention and comfort him or her with extra touching and
cuddling.
Try breastfeeding while rocking and in a quiet room free of
distractions.

Ask for help if your baby is having a nursing strike to ensure that your baby
gets enough milk. The doctor can check your baby's weight gain.

Inverted, flat, or very large nipples

Some women have nipples that turn inward instead of protruding, or that are
flat and do not protrude. Nipples can also sometimes be flattened temporarily
due to engorgement or swelling while breastfeeding. Inverted or flat nipples can
sometimes make it harder to breastfeed. But remember that for breastfeeding to
work, your baby has to latch on to both the nipple and the breast, so even
inverted nipples can work just fine. Often, flat and inverted nipples will
protrude more over time, as the baby sucks more.

Very large nipples can make it hard for the baby to get enough of the areola
into his or her mouth to compress the milk ducts and get enough milk.

What you
can do

Talk to your doctor or a lactation consultant if you are concerned about your
nipples.
You can use your fingers to try and pull your nipples out. There are
also special devices designed to pull out inverted or temporarily flattened
nipples.
The latch for babies of mothers with very large nipples will improve
with time as the baby grows. In some cases, it might take several weeks to get
the baby to latch well. But if a mother has a good milk supply, her baby will
get enough milk even with a poor latch.

Ask for help if you have questions about your nipple shape or type,
especially if your baby is having trouble latching well.

Breastfeeding a baby with health problems

There are some health problems in babies that can make it harder to
breastfeed. Yet breast milk and early breastfeeding are still best for the
health of both you and your baby – even more so if your baby is premature or
sick. Even if your baby cannot breastfeed directly from you, it's best to
express or pump your milk and give it to your baby with a cup or dropper.

Some common health problems in babies are listed below.

Jaundice

Jaundice is caused by an excess of bilirubin, a substance that is in the
blood usually in very small amounts. In the newborn period, bilirubin can build
up faster than it can be removed from the intestinal track. Jaundice can appear
as a yellowing of the skin and eyes. It affects most newborns to some degree,
appearing between the second and third day of life. The jaundice usually clears
up by two weeks of age and is not harmful.

Two types of jaundice can affect breastfed infants – breastfeeding jaundice
and breast milk jaundice.

Breastfeeding jaundice can occur when a breastfeeding baby is not getting
enough breast milk. This can happen either because of breastfeeding challenges
or because the mother's milk hasn't yet come in. This is not caused by a problem
with the breast milk itself.
Breast milk jaundice may be caused by substances in
the mother's milk that prevents bilirubin from being excreted from the body.
Such jaundice appears in some healthy, breastfed babies after about one week of
age. It may last for a month or more and it is usually not harmful.

Your baby's doctor may monitor your baby's bilirubin level with blood tests.
Jaundice is best treated by breastfeeding more frequently or for longer periods
of time. It is crucial to have a health care provider help you make sure the
baby is latching on and removing milk well. This is usually all that is needed
for the infant's body to rid itself of excess bilirubin.

Some babies will also need phototherapy – treatment with a special light.
This light helps break down bilirubin into a form that can be removed from the
body easily. If you are having trouble latching your baby to the breast, it is
important that you pump or hand express to ensure a good milk supply. The same
is true if the baby needs formula for a short time – pumping or hand expressing
will make sure the baby has enough milk when you return to breastfeeding.

It is important to keep in mind that breastfeeding is best for your baby.
Even if your baby experiences jaundice, this is not something that you caused.
Your health care providers can help you make sure that your baby is eating well
and that the jaundice goes away.

Ask for help! If your baby develops jaundice once at home, let your baby’s doctor know. Discuss treatment options and let the doctor know that you do not want to interrupt breastfeeding if at all possible.

Reflux disease

Some babies have a condition called gastroesophageal (GASS-troh-uh-SOF-uh-JEE-uhl)
reflux disease (GERD), which occurs when the muscle at the opening of the
stomach opens at the wrong times. This allows milk and food to come back up into
the esophagus, the tube in the throat. Some symptoms of GERD can include:

Severe spitting up, or spitting up after every feeding or hours after eating
Projectile vomiting, where the milk shoots out of the mouth
Inconsolable crying
as if in discomfort
Arching of the back as if in severe pain
Refusal to eat or
pulling away from the breast during feeding
Waking up often at night
Slow weight
gain
Gagging or choking, or problems swallowing

Many healthy babies might have some of these symptoms and not have GERD. But
there are babies who might only have a few of these symptoms and have a severe
case of GERD. Not all babies with GERD spit up or vomit. More severe cases of
GERD may need to be treated with medication if the baby refuses to nurse, gains
weight poorly or is losing weight, or has periods of gagging or choking.

Ask for help! See your baby's doctor if he or she spits up after every feeding and has any
of the other symptoms mentioned here. If your baby has GERD, it is important to
continue breastfeeding. Breast milk is more easily digested than infant formula.

Cleft palate and cleft lip

Cleft palate and cleft lip are some of the most common birth defects that
happen as a baby is developing in the womb. A cleft, or opening, in either the
palate or lip can happen together or separately and both can be corrected
through surgery. Both conditions can prevent babies from forming a good seal
around the nipple and areola with his or her mouth, or effectively remove milk
from the breast. A mother can try different breastfeeding positions and use her
thumb or breast to help fill in the opening left by the lip to form a seal
around the breast.

Right after birth, a mother whose baby has a cleft palate can try to
breastfeed her baby. She can also start expressing her milk right away to keep
up her supply. Even if her baby can't latch on well to her breast, the baby can
be fed breast milk by cup. In some hospitals, babies with cleft palate are
fitted with a mouthpiece called an obturator that fits into the cleft and seals
it for easier feeding. The baby should be able to exclusively breastfeed after
his or her surgery.

Ask for help! If your baby is born with a cleft palate or cleft lip, talk with a lactation
consultant in the hospital. Breast milk is still best for your baby's health.

Premature and/or low birth weight

Premature birth is when a baby is born before 37 weeks gestation. Prematurity
often will mean that the baby is born at a low birth weight, defined as less
than five and a half pounds. Low birth weight can also be caused by
malnourishment in the mother. Arriving early or being small can make for a tough
adjustment, especially if the baby has to stay in the hospital for extra care.
But keep in mind that breast milk has been shown to help premature babies grow
and ward off illness.

Most babies who are low birth weight but born after 37 weeks (full term) can
begin breastfeeding right away. They will need more skin-to-skin contact with
mom and dad to help keep them warm. These smaller babies may also need more
frequent feedings, and they may get sleepier during those feedings.

Many babies born prematurely are often not able to breastfeed at first, but
they do benefit from expressed milk. You can express colostrum by hand or pump
as soon as you can in the hospital. You can talk to the hospital staff about
renting a hospital grade electric pump. Call your insurance company or local WIC
Office to find out if you can get reimbursed for this type of pump. You will
need to express milk as often as you would have breastfed, so around 8 times per
a 24-hour period.

Once your baby is ready to breastfeed directly, skin-to-skin contact can be
very calming and a great start to your first feeding. Be sure to work with a
lactation consultant on proper latch and positioning. Many mothers of premature
babies find the cross cradle hold helpful. It may take some time for you and the baby to get into a
good routine.

Did you know? If you leave the hospital before your baby, you can express milk for the hospital staff to give the baby by feeding tube.

Breastfeeding and special situations

Twins or multiples

Did you
know? Many twin and multiple babies are smaller or born premature. Please see the
Premature and/or low birth weight section for other tips for caring for these
babies. Also, talk with a lactation consultant about more ways you can
successfully breastfeed.

The benefits of human milk to mothers of multiples and their babies are the
same as for all mothers and babies – possibly greater, since many multiples are
born early. But the idea may seem overwhelming! Yet many of these moms find
breastfeeding easier than other feeding methods because there is nothing to
prepare. Many mothers have overcome challenges to successfully breastfeed twins
and more even after going back to work.

Being prepared

It will help to learn as much as you can about breastfeeding during your
pregnancy. You can:

Take a breastfeeding class.
Find Internet and print resources for parents of
multiples.
Join a support group for parents of multiples through your health
care provider, hospital, local breastfeeding center, or La Leche League
International.
Let your health care provider and family members know that you
plan to breastfeed.
Keep in mind that even if your babies need to spend time in
the NICU (neonatal intensive care unit), breastfeeding is still possible, with
some adjustments.
Find a lactation consultant with multiples experience before
the babies are born so that you know where to turn for help. Ask her where you
can rent a breast pump if the babies are born early.

Did you know?

Many breastfeeding basics are the same for twins or multiples as they are for
one baby. Learn more about these important topics:

How to know your babies are getting enough milk
How to troubleshoot common
breastfeeding challenges
Ways to keep milk supply up

Making enough milk

Most mothers are able to make plenty of milk for twins. Many mothers fully
breastfeed or provide milk for triplets or quadruplets. Keep these tips in mind:

Breastfeeding soon after birth and often is helpful for multiples the same
way it is for one baby. The more milk that is effectively removed, the more milk
a mother's body will make.
If the babies are born early, double pumping often
will help the mother make more milk.
The doctor's weight checks can tell you if
your babies are getting enough breast milk. For other signs that your babies are
getting enough breast milk, see the How to know your baby is getting enough milk
section.
It helps to have each baby feed from both breasts. You can "assign" a
breast to each baby for a feeding and switch at the next feeding. Or, you can
assign a breast to each baby for a day and switch the next day. Switching
breasts helps keep milk production up if one baby isn't eating as well for a
bit. It also gives babies a different view to stimulate their eyes.

Breastfeeding positions

Breastfeeding twins and more may take practice, but you and your babies can
find your ideal positions and routine. Keep trying different positions until you
find ones that work for you. For some mothers and babies, breastfeeding twins at
the same time works well. Others find individual feedings to work better. Still
others find that it depends on the time – you may feed one baby at a time at
night and feed two babies at the same time during the day. Lastly, as your
babies grow, you may find that you need to change your feeding routine.

Below are some positions that may work for you:

Double clutch ("football") – Place both babies in the clutch hold. You will
need pillows at your side (and maybe one on your lap) and you will place the
babies on the pillows with their legs going toward the back of the chair or
couch. If you are placing the babies in front of you, try to keep their whole
bodies turned toward you, their chests against your chest. Their bodies must not
be facing up. This is very important to help prevent nipple pain and to make
sure that the babies are getting enough milk.
Cradle-clutch combination – Place
one baby (usually the easiest to latch or stay latched) in the cradle position
and then position the second baby in the clutch position.
Double cradle – Place
the babies in front of you with their legs overlapping, making an X across your
lap.

Partial breastfeeding

Even though full, direct breastfeeding is ideal, many mothers of multiples
feed their babies breast milk or some formula by bottles at times. It is
important to work with your doctor, your baby's doctor, and a lactation
consultant to figure out what works best for your family.

Breastfeeding during
pregnancy

Breastfeeding during your next pregnancy is not a risk to either the
breastfeeding toddler or to the new developing baby. If you are having some
problems in your pregnancy such as uterine pain or bleeding, a history of
preterm labor or problems gaining weight during pregnancy, your doctor may
advise you to wean. Some women also choose to wean at this time because they
have nipple soreness caused by pregnancy hormones, are nauseous, or find that
their growing bellies make breastfeeding uncomfortable. Your toddler also may
decide to wean on his own because of changes in the amount and flavor of your
milk. He or she will need additional food and drink because you will likely make
less milk during pregnancy.

If you keep nursing your toddler after your baby is born, you can feed your
newborn first to ensure he or she gets the colostrum. Once your milk production
increases a few days after birth you can decide how to best meet everyone's
needs, especially the new baby's needs for you and your milk. You may want to
ask your partner to help you by taking care of one child while you are
breastfeeding. Also, you will have a need for more fluids, healthy foods, and
rest because you are taking care of yourself and two small children.

Breastfeeding after breast surgery

How much milk you can produce depends on how your surgery was done and where
your incisions are, and the reasons for your surgery. Women who have had
incisions in the fold under the breasts are less likely to have problems making
milk than women who have had incisions around or across the areola, which can
cut into milk ducts and nerves. Women who have had breast implants usually
breastfeed successfully. If you ever had surgery on your breasts for any reason,
talk with a lactation consultant. If you are planning breast surgery, talk with
your surgeon about ways he or she can preserve as much of the breast tissue and
milk ducts as possible.

Adoption and inducing lactation

Many mothers who adopt want to breastfeed their babies and can do it
successfully with some help. Many will need to supplement their breast milk with
donated breast milk from a milk bank or infant formula, but some adoptive
mothers can breastfeed exclusively, especially if they have been pregnant
before. Lactation is a hormonal response to a physical action, and so the
stimulation of the baby nursing causes the body to see a need for and produce
milk. The more the baby nurses, the more a woman's body will produce milk.

If you are adopting and want to breastfeed, talk with both your doctor and a
lactation consultant. They can help you decide the best way to try to establish
a milk supply for your new baby. You might be able to prepare by pumping every
three hours around the clock for two to three weeks before your baby arrives, or
you can wait until the baby arrives and start to breastfeed then. Devices such
as a supplemental nursing system (SNS) or a lactation aid can help ensure that
your baby gets enough nutrition and that your breasts are stimulated to produce
milk at the same time.

Using milk from donor banks

If you can't breastfeed and still want to give your baby human milk, the best
and only safe place to go is to a human milk bank. You should never feed your
baby breast milk that you get directly from another woman or through the
Internet. A human milk bank can dispense donor human milk to you if you have a
prescription from your doctor. Many steps are taken to ensure the milk is safe.
Donor human milk provides the same precious nutrition and disease fighting
properties as your own breast milk.

If your baby was born premature or has other health problems, he or she may
need donated milk not only for health, but also for survival. Your baby may also
need donated milk if she or he:

Can't tolerate formula
Has severe allergies
Isn't thriving on formula

You can find a human milk bank through the Human Milk Banking Association of
North America External Website Policy (HMBANA). HMBANA is a multidisciplinary
group of health care providers that promotes, protects, and supports donor milk
banking. HMBANA is the only professional membership association for milk banks
in Canada, Mexico and the United States and as such sets the standards and
guidelines for donor milk banking for those areas. You can also contact HMBANA
if you would like to donate breast milk.

To find out if your insurance will cover the cost of the milk, call your
insurance company or ask your doctor. If your insurance company does not cover
the cost of the milk, talk with the milk bank to find out how payment can be
made later on, or how to get help with the payments. A milk bank will never deny
donor milk to a baby in need if they have the supply.

UrbanObserver

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