Ask the experts: Five nursing pitfalls

By Published On: February 27th, 2012

This week to continue our series of helpful information on […]

This week to continue our series of helpful information on breastfeeding, Diana West, BA, IBCLC and co-author of the La Leche League International book The Womanly Art of Breastfeeding discusses the most common problems women can face when attempting to feed their babies.

momandbabybedAs a pregnant or new mother, you might be concerned about making enough milk. The following five nursing pitfalls are among the most common reasons for milk supply difficulties. Knowing what they are and how to avoid them will help you lay a strong foundation for a successful breastfeeding experience.
Pitfall #1: Latch problems
One of the most common causes of low milk production in the early weeks is poor attachment to the breast. When baby latches too shallowly, he doesn’t have enough breast in his mouth to effectively draw out milk. Less milk is removed, and the breast responds by cutting back on production. The good news is that correcting the problem is often relatively easy. If you aren’t able to fix it on your own, the problem could be related to baby’s ability to suck effectively and may require the help of a lactation consultant.
Pitfall #2: Outside interferences
Some mothers facing a medical procedure, drugs, or hospitalization are told that they can’t nurse for a period of time. To make matters worse, little or no guidance is provided on how to maintain production, and by the time breastfeeding is “allowed” again, milk supply is damaged. Educating yourself on the facts is your best defense, and regular pumping your backup. Dr. Thomas Hale’s book, Medications and Mothers’ Milk (updated biannually), is an excellent safety reference.
Pitfall #3: The sleepy newborn
Excessive sleepiness has several possible causes. A newborn may be drowsy after delivery because of medications given to you during labor. The effects may be brief, or they can linger for several days. During this time, lots of skin-to-skin contact can help stimulate your baby and trigger his nursing instincts.
Simply not getting enough milk can also cause a baby to sleep too much. He may eventually rouse and show signs of hunger but fall asleep again within minutes at the breast. This in turn leads to needing longer periods of sleep to conserve precious energy. This can happen as a result of low milk supply, a problem with baby’s suck, or baby’s medical complications. Supplementation may be needed until milk production can be increased or baby is able to take more milk.
Another cause of infant drowsiness is jaundice, a temporary yellowing of the skin that often looks like a suntan and can make babies lethargic. Wake baby at least every two to three hours until he begins to rouse more on his own. Gentle methods such as holding him upright, massaging his body, talking to him, undressing him, or changing his diaper are most likely to result in willingness to feed.
Pitfall #4: Unnecessary supplementation
There are certainly times when baby isn’t getting enough milk and must be supplemented. But there are also times when unnecessary supplements sabotage milk production by reducing milk removal and stretching out feeding intervals. Problems usually start with “just one bottle a day” or “just a few bottles a week,” but the more supplements given, the more are needed because milk isn’t made when it isn’t removed. It becomes a slippery slope where bottle-feeding eventually seems more convenient or baby appears to like it better.
Pitfall #5: Clock-driven feeding durations and feeding schedules
Mothers are often urged to get baby on a schedule as quickly as possible to instill early discipline, fit him conveniently into family life, make life more predictable, or for “sleep training.” Whatever a parent’s fear or motivation, schedules are often regarded as an important parenting goal.
Schedules may seem helpful to parents, but they don’t always meet the needs of breastfeeding mothers and babies. Rather than allowing milk production to be driven by baby as nature designed, schedules artificially determine when feedings will take place. Mothers with abundant production and vigorously nursing babies may do well, but mothers with marginal supplies or babies with difficulties often do not. Even if all looks well in the beginning, a sudden drop-off in production can happen after a few months if an insufficient number of hormone receptors were established in the early weeks. Bottom line: advice that supersedes your instincts on when to feed your baby can undermine your milk supply.
Diana West is an IBCLC in private practice, co-author of the 8th edition of The Womanly Art of Breastfeeding, The Breastfeeding Mother’s Guide to Making More Milk, and Breastfeeding After Breast and Nipple Procedures. She is the author of the Clinician’s Breastfeeding Triage Tool and Defining Your Own Success: Breastfeeding After Breast Reduction Surgery.