Common breastfeeding issues

Many mums will at some time experience difficulties with breastfeeding.

Your midwife or a lactation consultant will help and you can always call 13 HEALTH (13 43 25 84) and ask to speak to a child health nurse for advice.

Qualified child health nurses are available to provide you with breastfeeding advice and support from 6:30am to 11:00pm, 7 days a week for the cost of a local call.

How often should I feed my baby?

The simple answer is whenever your baby is hungry or seeking comfort. It's normal for newborns to feed 8 to 12 times in 24 hours, including several times during the night. As your baby gets bigger, they will need fewer feeds. However, during your baby’s growth and development, there will be times when your baby will want to feed a lot more than usual.

How long does a feed take?

Your baby will determine this. Some will gulp a full feed down in just 10 minutes. Others may take 50 minutes to finish a feed. When your baby has had enough, they will stop sucking and come off the breast or simply fall asleep. If you notice that baby's jaw isn't really moving anymore, you can detach baby by inserting a finger into the side of the baby's mouth to break the seal.

How much should I feed my baby?

That depends on how hungry your baby is. It is important that you allow the baby to feed for as long as the baby wants on one side. If, after feeding well, the baby becomes fussy, then you may offer the other side. For some feeds, one breast may be enough.

Don't time the feed or swap sides unless the baby seems to have finished one side. This will ensure that your baby feeds well and helps with your breastmilk supply. If the baby takes only one breast, remember to offer the other breast at the next feed.

Signs your baby is getting enough milk.

I don’t think I’m producing enough milk

Your body is amazing and produces as much milk as your baby needs. It is very rare for a woman not to produce enough milk.

Your baby is getting enough milk if they:

• have 6 to 8 heavily wet nappies of pale, inoffensive-smelling wee a day
• are passing soft, mustard-coloured poo
• look bright-eyed, alert, healthy and have good skin colour
• are reasonably content for some time between feeds
• are feeding around 8 to 12 times a day, depending on baby’s age and storage capacity of your breasts
• are gaining weight over time. Your baby should be back to their birth weight by 2 weeks of age.

If you want to increase your milk supply:

• check the positioning and attachment of your baby on the breast is correct
• increase the frequency of feeds. The more the baby feeds, the more milk you will make
• allow your baby to finish the first breast before offering the second breast—always feed from each breast more than once each feed
• express milk between feeds
• eat a variety of healthy foods during the day and stay hydrated (water is best)
• avoid supplementing baby’s feeds with infant formula (unless there is a medical reason), as the less baby drinks from you, the less milk you will produce.
• try not to use a dummy, they can reduce breastfeeds and breastmilk production
• relax when you breastfeed. Find a quiet spot and turn the phone off
• get more sleep. Have a nap when baby naps, or just relax with a book or walk in the garden
• try frequent skin-to-skin contact, breast massage and nipple stimulation.

My breasts are swollen

In that first week when your milk comes in, your breasts can feel full and firm. This will usually go away in a day or two. In the meantime:

• breastfeed as often as baby cues (signals) to feed (usually 8 to 12 times in 24 hours) and if you are separated from your baby, express as often as your baby would breastfeed
• make sure that baby is positioned and attached well at the breast and feeding is comfortable
• wear a supportive, well-fitting bra (no underwire). If you want to wear an underwire bra, it is important that you at least sleep without it on
• apply cool packs as they help ease discomfort
• hand-express a small amount of milk before baby feeds to make the breast softer which will help the baby attach.

If your breasts remain hard and the baby cannot attach, you may need to seek help.

Contact your midwife or a lactation consultant, or call 13 HEALTH (13 43 25 84) and ask to speak to a child health nurse for advice.

My nipples are sore

See a midwife, lactation consultant, child health nurse or a doctor straight away. They will make sure baby is latching on correctly.

If your nipples are sore and you are afraid of breastfeeding, try gently hand expressing for a few feeds to allow your nipples to heal. Usually this is not needed as sore nipples can often be helped by changing the baby’s feeding position and checking the baby’s attachment.

If your nipples become shiny, very red and does not improve with checking of baby’s feeding position, you may have an infection; see your doctor.

To prevent sore nipples:

• Don’t pull the baby off your breast or you'll stretch your nipples. Insert your finger into the side of your baby’s mouth to break the suction seal.
• Try smearing expressed breastmilk on your nipples after each feed and allow to air dry. Your breastmilk contains healing properties that you can't buy in a shop.
• Avoid using shampoos and soaps on the nipples, because they can cause your skin to dry out. Generally avoid applying ointments, sprays, tinctures and powders to your nipples as they may cause irritation.
• Wear breathable, natural fabrics.
• Change your breast pads often and avoid plastic liners.
• Nipple shields are not advised to be used when you have sore nipples as they can make the nipples more painful. Before introducing a nipple shield seek the support of a midwife or lactation consultant to check that baby is getting enough breast milk with the nipple shield in place.

More about managing sore or cracked nipples.

I think I have mastitis

If your breast feels swollen, red, hot and painful, and you feel like you have flu-like symptoms (fever, chills or fast heart rate), you may have mastitis.

If you ignore the symptoms, it can lead to an abscess in your breast. It is safe and important to continue to feed your baby when you have mastitis. It will hurt, but it will help your breasts heal, and the milk is safe for baby.

It can also help to:

• Feed in response to your baby’s feeding cues (or express if baby is not breastfeeding)
• If unable to latch baby to the breast, begin by hand expressing the affected breast to soften the area around the nipple
• Avoid increased expressing or use of breast pump
• Avoid use of nipple shields where possible
• Avoid deep massage of the breast
• Cool packs may help ease discomfort
• Pain medication, such as paracetamol or ibuprofen can help.

If symptoms are not improving within 12-24 hours see your doctor immediately so they can check if you need antibiotics.

How can I avoid getting mastitis?

The more run-down you are, the more you become prone to infection. Being a new parent is exhausting, so try to get plenty of rest and eat healthy food to keep your body strong. Don’t be afraid to ask family and friends for help if you need it!

To avoid getting mastitis:

• Feed baby as often as they cue to feed – do not restrict how often and for how long baby feeds at the breast each time
• checking your baby’s positioning and attachment so that feeding is comfortable
• if baby is not feeding at the breast you may need to express milk to prevent mastitis and to keep your milk supply
• if baby is not feeding well at the breast or breastfeeding continues to be painful seek advice from a midwife, child health nurse or lactation consultant as soon as possible