Worst Breastfeeding Fears

by Amy Spangler
February 07, 2011

Moms were recently asked to share with us their “worst fear about breastfeeding” on facebook.com/babygooroo.

“Not enough milk,” “leaking,” “swelling,” “making others uncomfortable,” “latch” and “biting,” were among the offerings—all common concerns, but the number of mothers who cited “biting” as their worst fear was surprising. Given that moms are now encouraged to breastfeed for at least a year (introducing complementary foods around 6 months of age), one can always hope that the proportion of moms fearful of biting means that more moms are breastfeeding (or are planning to breastfeed) for longer periods of time.

We realize that breastfeeding isn’t always easy. But underlying fears can make breastfeeding even harder. So we’re delighted to have an opportunity to address those fears, and grateful to the moms who shared theirs.

1. Biting
I can honestly say that in 35 years of working with breastfeeding families, I have never known a mom to wean because of biting. That being said, it doesn’t mean that babies don’t bite. However, once a baby realizes what’s at stake—no breast, no milk, no mom, no way—the biting stops. Biting usually occurs at the end of a feeding when a baby is no longer suckling and swallowing. When babies are well-latched, their mouths are filled with breast tissue and biting is a physical impossibility. But once a baby nears the end of a feeding, she starts to relax, and what was once a deep latch, becomes a shallow latch, at which point, biting is a real possibility. You can prevent biting by watching your baby’s sucking pattern. As soon as she stops sucking and swallowing (and reverts to a pattern of short sucks), slide your finger along your breast into your baby’s mouth, protect your nipple, and take your baby off the breast. Some babies (especially those who are teething) bite or gum the breast not realizing that it is painful for mom. If biting occurs, simply press your baby’s face into the breast for a few seconds. This will cause her to release the breast in order to breathe. Firmly tell her, “No biting.” Wait several minutes before offering the breast again. Your baby will quickly learn that biting has unwanted consequences and the biting will stop. To hear what other moms have to say about biting, watch our breastfeeding video on YouTube.

2. Pain
It’s not surprising that pain is one of the most common fears. Studies show that 8 out of 10 mothers report that breastfeeding is painful: “I thought breastfeeding was supposed to be natural, instead it hurt;” “It was so painful I dreaded each feeding.” It’s important for mothers to know that pain and latch go hand in hand. When a baby is poorly latched, nipples get squished between the roof of the baby’s mouth above and the tongue below. Moms can usually tell if their baby has a poor latch by examining their nipples before and after they breastfeed. When babies have a good, deep latch, the nipple is at the back of the baby’s mouth, so other than being lengthened (stretched out) the shape of the nipple is the same before and after breastfeeding. When babies are poorly latched, the nipple looks flattened or creased after breastfeeding. While achieving a good latch is the secret to pain-free breastfeeding, even mothers of babies with a good latch find that breastfeeding can be painful at first. Fortunately, this tugging, pulling, or painful sensation that occurs at the start of a feeding lasts for only a few seconds, and stops after a couple of weeks. If the pain persists throughout a feeding, between feedings, or for more than two weeks, be sure to get help from someone trained to help breastfeeding families, such as an International Board Certified Lactation Consultant (IBCLC), La Leche League Leader, or WIC peer counselor.

3. Latch
Because a good latch is key to successful breastfeeding, fears about how to achieve a good latch are easy to understand. Begin by watching your baby for early signs of hunger such as wiggling, squirming, or sucking on fingers or fists and offering the breast at those times. If you wait for your baby to cry (a late sign of hunger), she is more likely to latch on poorly and less likely to breastfeed well. Positioning your baby correctly at the breast will help her achieve a good latch on the breast. Choose a position that is comfortable for you and your baby. Think about how you face the table to eat a meal and position your baby in the same way—chin, chest, and knees facing the breast. Tickle your baby’s nose (or lips) with your nipple and wait for her mouth to open wide, as if she is yawning. Then quickly but gently place her on the breast—leading with her chin and lower lip. Your nipple will point slightly upwards, toward the roof of her mouth. Your baby’s tongue should be over her lower gum, between her lower lip and the breast. Her lips should curl out, like the lips of a fish, and lie flat against the breast.

When your baby is positioned well, you may see little or none of the areola (the darker part of the breast around the nipple). How much areola you see will depend on the size of your areola and the size of your baby’s mouth. You will usually see more areola on the top, above your baby’s lip, than on the bottom. Your baby’s nose and cheeks may gently touch the breast, and her chin should press firmly into the breast. You will know that your baby has a good latch if you hear her suck, swallow, and breathe in a regular pattern and breastfeeding is comfortable for you. Watch our breastfeeding video on YouTube to hear what other moms have to say about latch.

4. Leaking
Many moms experience leaking, especially during the early weeks when babies are eating at all hours of the day and night. Leaking is caused by the let-down or milk ejection reflex, which is triggered when your baby breastfeeds. A let-down reflex can also occur when you hear your baby (or another baby) cry, see a picture of your baby, or simply think about your baby. (Having an orgasm can also trigger a let-down, so be sure to breastfeed before having sex.) Some moms feel a tingling sensation just before their milk starts to drip or spray, but some get no warning. Once your baby establishes a feeding schedule (generally after 4–6 weeks), and the breasts know how much milk to make and when to make it, leaking will be less of a concern. In the meantime, breast pads can provide short-term protection for your clothing. Avoid pads with waterproof liners that trap moisture against the skin. Wearing patterned clothing (small prints) can also cover up a multitude of mishaps.

5. Swelling
Engorgement occurs when the breasts become overly full and the tissue swells. Most mothers experience fullness the first 2–3 days after birth, when the blood carries nutrients to the breasts, so that larger amounts of milk can be made. As long as you breastfeed frequently and don’t delay or skip feedings, the fullness is relieved, otherwise engorgement can occur. Cold compresses are the key to relieving engorgement. While a warm shower or tub bath may be more appealing, heat makes the swelling worse, and should never be used unless the breasts are leaking freely. Bags of frozen vegetables wrapped in a wet washcloth make great cold packs. Packing the breasts in cold, raw cabbage leaves also relieves engorgement, although why cabbage leaves work is unclear. Once the swelling is down, you can hand express or pump to relieve the fullness. A baby is the best breast pump on the market, so pump only enough milk to allow your baby to latch on well.  Tips for preventing engorgement:

• Breastfeed as soon as possible after birth
• Breastfeed every 2–3 hours, day and night, during the early weeks
• Breastfeed well on the first breast before offering the second breast (always offer the second breast, but don’t be concerned if your baby is full after only one breast)
• Start your next breastfeeding on the breast that was offered last
• If necessary, hand express or pump to relieve fullness after feeding
• Avoid supplements and pacifiers

6. Not enough milk
Nearly every mother worries about whether their baby is getting enough to eat. It’s a fear rooted in the fact that you can’t measure the amount of milk a baby takes from the breast like you can from a bottle. But there are other ways to tell that your baby is getting enough to eat, including wet and dirty diapers and weight gain. It’s a proven fact that nothing comes out the bottom unless something goes in the top! As long as your baby is having a minimum number of wet and dirty diapers and gaining the right amount of weight, you can be sure she is getting enough to eat.

• Number of stools. After day 1, expect at least three stools a day the next three days and four stools a day the next four weeks.
• Color of stools. Your baby’s stool will be black and sticky on days 1 and 2, green and pasty on days 3 and 4, and yellow, seedy, and runny (normal) by day 5.
• Consistency of stools. Expect stools that are small, frequent, and runny. Breastfed babies’ stools look like a mix of water, yellow mustard, cottage cheese, and sesame seeds!
• Pattern changes. After 4–6 weeks, expect larger and fewer stools (every 1–5 days). Some babies will continue to have small, frequent stools for many months.
• Color of urine. Your baby’s urine should be clear or pale yellow in color (dark yellow or orange urine may be a sign of dehydration).
• Number of wet diapers. Expect six or more wet diapers a day by day 5. Although wet diapers are important, the earliest sign that your baby may not be getting enough to eat is a decrease in the number of stools.
• Weight loss/gain. Many babies lose weight (about 3–7 percent) during the first few days after birth. After day 5, your baby should begin to gain weight at the rate of 4–8 ounces a week.

If you would like to hear what other moms have to say about hunger cues and how to tell your baby is getting enough to eat watch our video series on YouTube.

7. Breastfeeding in public
Congratulations! You survived the early weeks. Now that you and your baby have learned to breastfeed at home, it’s time to go public. One of breastfeeding’s many benefits is being able to come and go with ease—no bottles, nipples, or coolers. All you need is a breast and a baby! Some moms are comfortable breastfeeding in front of others (including men), but some are not. Decide for yourself where your comfort level lies. But remember that experienced mothers can breastfeed discreetly and modestly anywhere, it just takes a bit of practice.

Breastfeeding in front of a mirror using different breastfeeding positions and different types of clothing will help you decide which positions and which clothing items give you the protection you seek. Some mothers prefer to cover up while breastfeeding, hence the popularity of items such as Hooter Hiders, while others refuse to hide the fact that they are breastfeeding. Most states have laws that protect a mother’s right to breastfeed in public places. But despite these laws, some mothers are fearful of disapproving stares or unkind remarks. Mothers nursing toddlers face even greater resistance. Many people accept the need to breastfeed a baby whenever and wherever mom and baby happen to be, but are less supportive of mothers nursing toddlers in public. Hear what other moms and dads have to say about breastfeeding in public in our breastfeeding video on YouTube.

The culture in the United States is changing, albeit slowly, and breastfeeding is regaining its place as the cultural norm. In the meantime, be aware of your own feelings. If you are uncomfortable breastfeeding in front of others, find a private place where you will not be disturbed. Turn off your cell phone. Put a small sign on the door, “Hungry baby, do not disturb.” Many retail stores now provide private spaces where mothers can breastfeed. If you are outdoors, a shady spot under a tree or a picnic table away from the crowds might be ideal. Mothers in church can always select a seat next to the aisle, while moms on airplanes can sit in a window seat in the first row of the cabin. It may take a bit of creative thinking to find a comfortable space, but once you are confident in your ability to breastfeed in front of others, you will be more attuned to your baby’s need to eat, and less concerned about where you are when the need arises, or the opinions of those around you. “Yes, thank you, I’m breastfeeding. And my baby loves it!”