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Breastfeeding problems

‘My milk looks thin and is a different colour to bottle milk.’

There is a great variation in the colour and consistency of breast milk. Unlike bottled milk, the cream is at the bottom and not the top! The first part of the milk, the fore milk, is thirst-quenching and may look watery and bluish.

The second part, the hind milk, is thicker and can vary from creamy white to yellowish. Your baby doesn’t mind the colour. 

‘My nipples hurt when she feeds. What can I do?’

During the first week or two, some breastfeeding mothers feel some discomfort as their baby starts sucking at the beginning of a feed. As soon as the milk begins to flow this discomfort stops.

If feeding hurts, your baby’s position is probably wrong but if you can’t get the position right yourself, ask for help.

‘I’ve been feeding my baby for two weeks now, but my nipple is cracked and painful. Should I give up?’ 

If your baby is in the right position at your breast, feeding shouldn’t hurt.

  • Check that your baby is ‘fixing’ properly. Ask for help if you need it. Once
     your baby is positioned correctly cracks should heal rapidly.
  • Keep your nipples clean and dry, but avoid soap, which dries the skin
     too much.
  • Change breast pads frequently. Avoid pads with plastic backing.
  • Wear a cotton bra and let the air get to your nipples as much as possible.
  • Try sleeping topless, with a towel under you if you’re leaking milk.
  • A few drops of milk rubbed into the nipple at the end of a feed may help.
  • Thrush in your baby’s mouth can sometimes cause sore nipples. Thrush
    is an infection that results in small white patches in the baby’s mouth,
    which don’t wipe away. If you think your baby has thrush, both you and
    your baby will need medical treatment, so see your GP.
  • If your nipples remain sore, ask a health visitor or breastfeeding counsellor
    for advice.

‘He stops and starts and cries and just doesn’t seem to settle down.’

If your baby is restless at your breast and doesn’t seem satisfied by feeds, he or she may be sucking on the nipple alone and not getting enough milk. Check your baby is in the right position and fixed properly to your breast. Ask for help if you need to. Colic may also be a problem.

‘My breasts are very swollen and hard and painful. What’s wrong?’

Your breasts are ‘engorged’ which means that they are full of either blood or milk. The first type of engorgement can happen during the first few days before you start to produce milk. It is caused by the blood supply to your breasts increasing as your breasts get ready to make milk. Ask your midwife what to do. She might suggest relieving the discomfort by taking paracetamol.

The second type of engorgement is caused by milk and can happen at any time from about the third day after the birth of your baby, when you start to produce milk. This type of engorgement is common in the first few weeks or if your baby has gone a long time between feeds. The answer is to feed your baby. If feeding is difficult for some reason, ask for help. To ease the swelling, try a hot bath or bathe your breasts with some warm water. Smooth out some milk with your fingers, stroking gently downwards towards the nipple. Or try holding a face cloth wrung out in very cold water against your breast. Check your bra’s not too tight.

‘I have a hard, painful lump in my breast. What is it?’

It’s probably milk which has built up because the ducts are blocked and aren’t being emptied properly. Check that your bra isn’t too tight and that nothing is pressing into your breast as you feed (your bra or arm, for example).

A good feed on the blocked breast will help. As you feed, smooth the milk away from the blockage towards the nipple. If this doesn’t work, ask for help. If left untreated, blocked ducts can lead to mastitis (see following).

‘There is a red, hot, painful patch on my breast and I feel quite unwell. Why?’

You may have mastitis. Don’t stop feeding as you need to keep your milk moving. Try different positions to empty different parts of your breast. Try the suggestions for relieving engorged breasts and blocked ducts, get lots of rest, and try not to wear a bra, especially at night. A health visitor or breastfeeding counsellor can offer information, help and support.

You may also need antibiotics to clear the infection. Your doctor can prescribe one that is safe to take while breastfeeding.

Help with breastfeeding

You can get help and advice from:

  • your community midwife, health visitor or GP;
  • a breastfeeding counsellor or support group. Contact your local branch of the National Childbirth Trust, La Lèche League or the Association of Breastfeeding Mothers. These organisations can provide you with help and support from other mothers with experience of breastfeeding.

Making breastfeeding work for you

Some mothers are happy to feed anywhere and in front of anyone. That’s fine. Other mothers like being able to breastfeed, but are uncomfortable with the idea of exposing themselves in public. However, it is possible to breastfeed discreetly. You can choose clothes that make it easy, such as a loose top or T-shirt that you can pull upwards.

Practising in front of a mirror before you go out might help you to feel more confident.If you simply find the idea of breastfeeding in front of others awkward and embarrassing, you might prefer to live a very private life for the first few months with your baby. That’s fine too. Don’t feel under pressure to socialise if you don’t want to. When you do go out, ask if there is another room where you can feed your baby. Many shops and public places now provide mothers’ rooms. Do what feels best for you.

Expressing milk

If you want to express milk in the first few weeks (perhaps because your baby is in Special Care), ask your midwife about it. Hospitals often keep machines for people who need to express milk and you can be shown how to use one. Alternatively, the Association of Breastfeeding Mothers, La Lèche League and the National Childbirth Trust all have breast pumps for hire.

Unless there’s a special reason for expressing milk, it’s usually easier not to try it until you’ve got breastfeeding well established. After six weeks or so you may want to express milk for someone else to give to your baby. 

If you’ve plenty of milk you’ll probably find expressing quite easy, particularly if you do it in the morning. However, some mothers do find it quite difficult. Your midwife or health visitor will show you how to express milk either using an electric or hand pump or by hand.

You must express your milk into a sterilised bottle, which you can then cap and keep in the fridge. Don’t keep it for longer than 24 hours. You can also freeze breast milk if you want to keep it for a few weeks, but make sure you freeze it as soon as possible after expressing it, and certainly within a couple of hours (there are specially designed breast milk freezer bags). When you want to use it, put it in the fridge until completely defrosted but then treat it as you would bottled milk.

If the father wants to become involved in feeding, he can give your expressed milk to the baby.

Combining breast and bottle

In the early weeks
If you want to breastfeed it’s best to completely avoid giving bottles to your baby in the early weeks. This is especially true if you don’t think you’re producing enough milk – your baby needs to breastfeed frequently to make sure there is enough milk. However, if you are concerned that you’re not producing enough milk for your baby, contact your health visitor or a breastfeeding counsellor for help before you decide to give a bottle.

If you do eventually decide to give the occasional bottle, but then would like to go back to full breastfeeding, you can, but you will have to breastfeed your baby often and for longer to increase your milk supply. Feeds will space out again once your milk supply has increased. Of course, ‘weaning’ your baby off the breast might be the right answer for you, especially if breastfeeding is making you unhappy.

Once breastfeeding is well established
You’ve more flexibility for combining breast and bottle at this later stage. You can introduce a regular bottle feed of formula milk if, for example, you’re returning to work or simply want someone else involved in feeding. If you offer the bottle feed at the same time each day, your own supply will adjust quite quickly and you should be able to keep on breastfeeding at the other feeds. Mothers returning to work, for example, often breastfeed in the morning and evening and their babies have a cup or bottle of formula during the day.

Changing from breast to bottle
If you’re having difficulty breastfeeding and decide to change to bottle feeding, you’re unlikely to experience difficulty getting your baby to take a bottle and you’ll probably both feel more relaxed when feeding settles down. If you have been breastfeeding exclusively, but now need to get your baby to take a bottle, perhaps because you’re returning to work or for some other reason, then you may find it difficult at first.

It might be easier to change over to infant formula using a cup or egg cup. There is no reason why you have to use a bottle. Don’t stop breastfeeding suddenly as this can cause your breasts to become hard, swollen and uncomfortable. Give yourself time for the changeover and cut out one feed at a time, starting well before your return to work. It’s probably best not to give the first bottle feed at times when your baby is tired and it may help if someone other than you gives the first feeds. Your baby is not then near your breast, smelling and expecting breast milk. Don’t panic if you experience difficulties at first. Your baby will get used to the new arrangements in time.

We are indebted to Health Promotion England for their help in compiling this section.