111. Coping With Feeding Challenges

This section covers latching and milk supply challenges and offers some self help ideas. Your public health nurse, midwife or healthcare provider can offer you initial support with breast/chestfeeding. If you are experiencing challenges and need further help and support you may need to visit a lactation specialist. Lactation specialists can be nurses or doctors that have taken additional breast/chestfeeding training. There are also independent certified consultants that work in private practice. An appointment with a lactation specialist can:

• be arranged by a public health nurse and be at your nearest public health clinic
• be at a local breast/chestfeeding clinic with a doctor specializing in lactation (often you can call to make an appointment without needing a referral from your healthcare provider)
• sometimes be arranged through the low risk maternity clinic you attended for your prenatal care
• be with a private certified lactation consultant in your home (this option requires a fee to be paid)

During the first week or so, your nipples may feel tender but continued pain is not normal. Poor positioning or latch is the most common cause of sore nipples, and it is important to get help to correct this as soon as possible. When your nipples are very sore, you may feel discouraged. Breast/chestfeeding should not be painful.

• Position and latch your baby correctly. If your baby is not latched deeply enough, take baby off the breast by sliding your finger between your baby’s gums until the suction is released. Offer baby your breast again.
• Ask your healthcare provider to check for tongue tie, this condition may cause your baby to be unable to latch.
• Avoid bottle feeding until breast/chestfeeding is well established. This will ensure that the baby learns to latch properly at the breast.
• Use cotton breast pads. Avoid plastic liners.
• Avoid using soap on your nipples. It can be drying and remove the natural moisturizing and antibacterial properties of skin secretions.
• Milk expression and pumping should not hurt. If it does, check the directions on the pump, then get advice from a lactation consultant if this does not help.

• Feed your baby as soon as they wake and before they cry, as it is easier to get a good latch if your baby isn’t crying. You can wait until after your baby has fed before changing their diaper.
• Start feeding on your least sore nipple first.
• Massage your breast before and during the feeding to help your milk flow.
• Use different feeding positions to reduce the stress on one part of the nipple.
• Studies suggest that the healing of cracked nipples is helped by continuing to apply drops of expressed milk and/or applying modified lanolin (such as Purelan® or Lansinoh®) sparingly to the crack on the nipple after feeding.
• Check with your doctor or lactation consultant about taking a pain medication.
• Get help if your nipples are not improving in a day or two.
• Occasionally sore nipples are caused by a yeast infection. If you or your baby has a yeast infection, both of you usually need to be treated with medication.