Five Common Breastfeeding Challenges Mothers Face

Lim (left) shows first-time mother Amalina Zamry how to properly position her baby for breastfeeding using a doll. Holding their baby so that they can latch on properly to the breast is one of the most common problems breastfeeding mothers face.  

Along with giving birth, breastfeeding is often assumed to be one of the most natural and instinctive acts in the world. However, this is not always the case. In fact, Subang Jaya Medical Centre lactation nurse Lim Lay Lee shares that even mothers who have breastfed a few times before usually require a refresher on how to do so properly with their newest baby.

“They say it’s been too long, they forgot already,” she says with a laugh.

It’s also not unusual for the first-time mum to forget what they learnt in the hospital once they are at home on their own. Here are some of the common challenges mothers – whether experienced or first-timers – face when it comes to breastfeeding:

1. Positioning baby

According to Lim, the biggest challenge mothers encounter during breastfeeding is how to hold their baby and put them to the breast properly. She estimates that in her experience, only one out of 10 mothers will get it right straight away.

First-time mothers in particular, tend to think that their baby is very fragile, she shares, and fear to hold them firmly. Another common worry is that the baby will not be able to breathe when they are pressed to the breast to feed.

However, Lim assures that not only are babies more resilient than that, but that the correct position will ensure that the baby is able to breathe freely. More importantly, if the baby is not positioned properly, they will be unable to latch on well to the nipple.

This will eventually cause cracked and sore nipples for the mother, which will make it painful for her to breastfeed. There are various positions that mother and baby can adopt to ensure proper latching and breastfeeding.

These can usually be learnt from lactation nurses during antenatal classes or after childbirth. The nurse will also teach the signs of proper latching, so that the mother knows if their baby has latched on properly.

Lim notes that one common mistake many mothers make is that they don’t wait until their baby’s mouth is opened wide enough to feed, which affects the latching process. She also ensures that the father knows how to hold and position the baby correctly.

This is as mothers, who are often tired and overwhelmed from childbirth, can forget the breastfeeding techniques taught to them in the hospital after they are discharged.

“Support from the husband is very important. The wife, today you tell, tomorrow she would have forgotten, so the husband will remember usually,” she says.

However, Lim assures that mothers will usually get a hang of breastfeeding after a few days of practising and guidance.

“After a few days of practising holding and being taught how to do it properly, and being reassured that it is fine to hold their baby tighter and nearer to the breast and clamping the baby down, they will get used to it and they will know that they can do it to their baby without injuring them. It’s a lot of reassuring and a lot of re-education,” she says.

2. Unsolicited advice

Another challenge breastfeeding mothers can face is the well-meant, but unsolicited advice from family members, or “out-laws”, as Lim jokingly refers to them. She notes that relatives tend to offer plenty of views and criticisms on the mother’s breastfeeding technique. All this puts additional stress on the mother,” she says.

The volume of milk produced is another area frequently commented on, with worried grandparents often pouncing on what is perceived as insufficient milk being fed to their grandchild.

This then usually leads to the suggestion of supplementing the baby’s diet with either water or formula milk. Without doubt, breastmilk is the best and most nutritiously-complete choice for a baby. If a mother can breastfeed, formula milk should be avoided for at least the first six months of life.

Water is not advisable either for at least up to six months of age because it offers no nutritional value to an infant and takes up valuable space in their very small tummies, which should be solely allocated to the nutrient-dense breastmilk. And unlike adults, babies receive all the hydration they need from breastmilk.

3. Dealing with engorgement

It takes three to four days after childbirth before breastmilk production really kicks in. But when this happens, mothers will often feel their breasts becoming very full and lumpy (i.e. engorged), which is very painful.

And this, coupled with sore nipples from poor latching, can be very challenging for the mother to deal with. Lim notes that this problem is exacerbated by mothers and babies not adhering to regular feedings every few hours.

“If they don’t feed adequately, the breast will get full and become engorged – it is very painful,” she says. “I always tell them, please bring your breast pump along – if your baby cannot help you to empty it, then at least you have a breast pump to help empty your breast. And I also teach them how to do hand expression.”

4. Worry about lack of breastmilk

According to Lim, many mothers tend to worry that their breastmilk production is inadequate to feed their baby. This is usually a result of their breast remaining soft and/or doing hand expression in the wrong way so that no milk is coming out.

Lim does agree though that some mothers will initially produce little colostrum – the first form of nutrient- and antibody-rich breastmilk.

“You just have to reassure them that if they continue to feed their baby, their milk will come in,” she says.

It will “definitely come in”, she says, as long as the mother feeds their baby regularly, on demand, about eight to 12 times within 24 hours.

Even if their nipples are too sore to breastfeed, they should use a breast pump or their hand to express their milk in order to stimulate continuous production. Insufficient breastmilk is usually because the mother doesn’t feed their baby adequately.

“They delay six hours, eight hours, before putting baby to the breast – there’s not enough stimulation, not enough hormones, so the body thinks your baby only needs to feed once or twice a day, so it doesn’t need to produce so much,” she says.

Some babies also only “demand” very little breastmilk. For these, Lim says: “You have to wake up your baby; your breast will tell you – when your milk comes in, your breast will feel full.

“So I tell them, you listen to your breast, don’t listen to your baby – wake them up, no mercy. Put them to the breast, they will suck.”

She also adds that proper hand expression can help show the mother that she is indeed producing colostrum. “I will show them how to do hand expression.By th e time I help them to hand express the breast, they can see colostrum come out and they get very excited: ‘Wow, I have milk! I have milk! My baby is not starving!’” she says with a laugh.

“But what you need to tell them is as long as your baby pees once or twice a day, that means your baby is drinking normally.”

5. Unusual nipple shape

In Lim’s experience, around half of mothers will have a nipple shape that makes it difficult to breastfeed. This includes short/flat, long/big and inverted nipples. These normal anatomical variations affect how well the baby can latch onto the nipple to breastfeed. For mothers with short or flat nipples, Lim assures that the nipple will usually elongate sufficiently by itself with continuous breastfeeding.

“Mother just has to continue to put baby to the breast,” she says. “There will definitely be some soreness, so we will have to advise them what to do.”

There are various techniques and devices that can help elongate or evert short/flat and inverted nipples to make it easier for baby to breastfeed. Meanwhile, the problem with long/big nipples is that the baby may not be able encompass the areola (the circle of pigmented skin around the nipple) with their mouth.

Lim explains: “Your milk is produced in the breast tissue and will flow down to behind the areola where there is a reservoir. So the baby has to latch onto the reservoir to squeeze the milk out.”

She adds: “The nipple is just an outlet – there’s nothing there; the baby won’t get anything if they just suck the nipple.”

Her advice for mothers with long or big nipples is to use the breast pump first until their baby’s mouth has grown big enough to be able to latch properly onto the entire nipple and areola.

Source: The Star