Q. What are some basics I should know?

A. The main things to remember are that: almost any healthy woman should be able to make plenty of milk to fully nourish her baby until at least about the age of six months, assuming that the baby is latched on well, and she is feeding frequently.

After six months or so, when baby is sitting up and showing interest in table food, mom should start offering them to her baby! She can give her baby complementary, or weaning foods, while still continuing to breastfeed. But sometimes women think they don’t have enough milk and start adding supplements well before the six month period, before getting all the facts.

Yes, it is true that some women can’t breastfeed or will not be able to produce enough to adequately nourish their babies. These are very rare — physiological and mechanical issues, such as insufficient glandular tissue (IGT), or previous surgery or breast injury, or polycystic ovary syndrome (PCOS).

But even in many of these instances, moms can find compromises, such as feeding from only one breast, or taking prescribed medication (such as domperidone) to increase milk production, or using a supplementary feeding device that delivers the supplement (including possibly the mom’s own expressed milk) while baby sucks the breast. These are all special circumstances.

So is the situation when birth interventions affect the beginning of breastfeeding and milk production — but with good help and support, moms can be reassured that frequent breastfeeding with good latch on the breast, and maybe breast stimulation by breast massage, compression, and/or pumping if necessary, can make a big difference and help get breastfeeding well established, especially once the drugs, such as epidurals, synthetic oxytocin, and pain medications, (all of which do affect mom’s natural oxytocin production, which in turn affects milk production) wear off.

The wonderful truth is that almost all women can make enough milk! In fact, most women can make enough to feed twins. But there are things that can affect a woman’s ability to make milk, such as incorrect latching.

Which brings us to our next key point: it is NOT normal for breastfeeding to hurt, which can easily happen if the baby is not latched correctly. Pain usually indicates that the baby is not latched onto the nipple correctly, and that a change is needed — the baby needs to be correctly latched to stimulate a good supply of milk.

It is also important to keep the breast emptied as much as possible as this is what helps the body to produce more milk — this means a mom should breastfeed OFTEN — and that’s a wonderful opportunity to cuddle and have fun with your baby anyway — or just take a nice nap together! And that leads to another round of breastfeeding! And learning to breastfeed while lying down makes it so easy to relax and breastfeed or even to sleep while your baby breastfeeds!

Okay, back to the topic of pain. Pain can also signal a medical problem that can develop from an improper latch, such as mastitis. In really challenging situations like this, it is important to get direct help, learn how to get the baby latched properly, and KEEP breastfeeding — and this might help to prevent mastitis. But even if you are taking medicine that has been prescribed to correct the mastitis, it is important to keep breastfeeding! This should actually help to relieve the mastitis if you do have it.

Less than ideal latching is often associated with a lot of pain, and sometimes cracked, reddened, or bleeding nipples — or nipples that look flattened and blanched after the baby comes off the breast. Even though pain is the main signal that the baby’s latch should be improved, occasionally women do not use an effective latch — and yet they do NOT experience pain. But this situation should not be ignored. Here’s why:

The mom in this situation might discover, several weeks after the baby is born, that even though breastfeeding doesn’t hurt, she realizes she is breastfeeding ’round the clock — and that her baby isn’t gaining weight well, and seems fussy and unsatisfied after every breastfeeding, and doesn’t have many wet and soiled diapers. She seems to be running out of milk and doesn’t know why. The latching could very well be the main reason, and if this is happening and your baby is not gaining at the right rate, it is important to get help fast. The sooner a challenge is dealt with, the less work it tends to take to fix it. But even if it has on for a while, it’s still worth get help with, as babies are born to WANT to breastfeed and they are usually able to learn how to do it properly, even after months have gone by, if they are given qualified help.

Often, the problem is that the mother’s body COULD be making milk, but the baby is not latched on enough to remove milk adequately and properly signal the mother’s body to make more milk. In other words, the baby is not stimulating the mother’s breast to produce the milk that she could be producing, and a change in positioning and latching might make all the difference.

Latching problems can also be directly related to overfilled breasts, which is known as engorgement. This is also something that a lactation consultant can help with.

This is an ironic situation that arises quite often, in fact. Mom has trouble with latching, and baby doesn’t get enough milk. But instead of fixing the latching challenge and discovering she can now make tons of milk, she starts topping up breastfeeding with formula, which can make her own milk production decline because now the baby is less hungry and not breastfeeding as much as s/he would without the supplement.

Or maybe mom starts pumping her milk, resulting in even more overfilling and greater latching difficulty.

When all she needed to do was get help with latching.

NOTE: This is not to say that there aren’t situations where formula and/or pumping aren’t necessary, but these should be done with guidance from health professionals and only when mom’s milk production is at a lower-than-healthy level that is dangerously affecting baby’s weight and ability to gain. Again, let me stress that in serious situations like this, you should make sure to keep in close touch with your baby’s doctor or go to an emergency department if baby seems critically ill or you are not sure.

Let me share some good news now. In fact, the good news is that MOST breastfeeding challenges have breastfeeding solutions! In most cases, breastfeeding can continue even if supplementation really is necessary (which is only the case in a tiny percentage of mothers or babies who have medical issues that preclude full breastfeeding or when supplementation has already been started and should be tapered off — NOT stopped suddenly — once the breastfeeding challenge is resolved and the breastfeeding is going well). So, the fact is that the vast majority of moms can fully breastfeed with proper information and support.

In times past, when everyone knew their neighbours, and EVERYBODY breastfed, women helped each other learn how to do it, and how to prevent or fix problems. So it is normal to need help if you are not able to figure it all out yourself. One of the problems nowadays, though, is that there is a lot of misinformation out there. Such as info from formula companies. Or people who have had breastfeeding difficulties and who might give well-meaning but outdated advice.

Fortunately there is a growing body of people trained in helping moms who are now out there — you can learn from public health nurses who have clinical training in breastfeeding assistance, and from lactation consultants, who specialize in helping families resolve their breastfeeding challenges.

International Board Certified Lactation Consultants (IBCLCs) have lots of training in troubleshooting and assisting women who have difficulties with breastfeeding, including things described above, such as sore nipples, sore breasts, engorgement, low milk production, as well as breastfeeding after breast surgery and so on.

Another important point to remember is that breastfeeding is compatible with most health and living situations, including most medications that might be prescribed for you, as well as cigarette smoking, and a less-than-perfect diet. Your breastmilk provides nutrients, growth factors, and protection from infection better than any formula in the world! The exception is that a few drugs are not compatible with breastfeeding. If in doubt, Dr. Thomas Hale is probably your best authority on drugs and breastfeeding. Dr. Newman’s information is also reliable.

So if you are in serious doubt about how your breastfeeding is going, it is a good idea to ask for help right away. If you are in British Columbia you can ask your health unit or doctor for a referral if you want an IBCLC to visit you at home. If you are in the Greater Vancouver area, you can contact me for a home visit. Go to GET HELP NOW in the menu above.

Or you can look for a lactation consultant anywhere in the world, as there are IBCLCs in many locations globally.

In British Columbia, go to the BC Lactation Consultants Association to find an IBCLC in Vancouver and other areas around the province. Just click here and scroll down the page.

Or check the International Lactation Consultant Association website to Find a local IBCLC anywhere in the world. Just click here.