Midwife & Breastfeeding Consultant

Breastfeeding problems – recognising and resolving them

Posted on November 30, 2012

We all know that breastfeeding is the best way to feed a baby.  Research studies have repeatedly demonstrated that babies who are breastfed are less likely to suffer from asthma, eczema, chest infections, urinary tract infections, diarrhoea, constipation, juvenile diabetes and childhood obesity.

We all know that breastfeeding is the best way to feed a baby.  Research studies have repeatedly demonstrated that babies who are breastfed are less likely to suffer from asthma, eczema, chest infections, urinary tract infections, diarrhoea, constipation, juvenile diabetes and childhood obesity.  These are just some of the fantastic benefits that are derived from breastfeeding and although more women in Ireland are choosing to breastfeed the uptake is still very low and in fact it is the lowest in Europe.  The World Health Organisation recommends that all babies are exclusively breastfed for the first six months so that they can achieve optimal growth, health and development.

A national study taken throughout Ireland in 2008 showed that 53% of Irish women start breastfeeding in hospital and that by two weeks the breastfeeding rate had dropped to 31%.  The research goes on to show that at one month 55% of the women who intended to breastfeed were fully formula feeding, this means that over half of the women who wanted to breastfeed had given up within the first four weeks. 


What is most telling about this study is that 81 % of the women surveyed said they would like to have breastfed for longer.  Why do so many women start with the best of intentions and then stop so early on? One of the main reasons is that when women encounter problems and they don’t know how to resolve them, they may not even realise that they can be solved and just assume that they have to give up.  However, this is not the case because with the appropriate support and advice most breastfeeding problems can be easily resolved.


There are many many women who don’t encounter any problems with breastfeeding and find it an enjoyable and wonderful experience but it is important to realise that breastfeeding problems can and do occur.  This article will cover two common problems that can happen within the first couple of weeks of breastfeeding; sore nipples and a sleepy baby.  Very often these are not recognised as problems and are just viewed as a normal part of the breastfeeding process, but if left unchecked they can cause many other difficulties so early recognition is vitally important.  If the problem is identified early and the mother receives skilled breastfeeding help then these issues are very easily resolved.  


Sore/Cracked  Nipples


 Recognising the problem:   Breastfeeding is painful and after the feed the nipples feel tender and sore.  If not dealt with promptly this can progress to the nipples becoming damaged (cracked) and over time it can also result in low milk supply, slow weight gain, blocked milk ducts, mastitis and or a fussy baby.


Resolving the problem:  Breastfeeding is meant to be a comfortable and pain free experience.  Pain with latch on indicates that the baby is latched onto the breast incorrectly.  To obtain a good latch the baby needs to take a big mouthful of nipple and areola with the nipple placed at the back of the baby’s mouth. Once latched on to the breast the baby’s mouth should be wide open and the upper and lower lips folded out.  Sometimes with the initial latch on there is a 30 to 50 second feeling of “ouch” as the nipple is stretched but after that it should not hurt


 The best way to learn about helping the baby latch on is to take a breastfeeding preparation class during pregnancy, a good class will teach latch on techniques in detail.  But if you already have sore nipples the treatment is as follows: apply pure lanolin cream (Lansinoh) to your nipples around the clock, reassess the latch, bring baby to the breast when the mouth is wide open, (View latches on websites provided). 


If these measures are not improving the situation the mother should either visit a breastfeeding clinic at the hospital or arrange a private Lactation Consultant (LC) visit as soon as possible.  Another alternative is to contact a breastfeeding support group such as La Leche League or Cuidu as they have trained breastfeeding counsellors who offer advice and support.   You can use a nipple shield over the sore nipple to protect it as an interim measure until help arrives. 


Lactation Consultants (LC) are skilled at assessing the latch and showing you how to improve it and usually this problem is easily resolved.  Sometimes there are other causes of sore nipples such as the baby having tongue tie or thrush being present, again the LC will assess for these problems and help you resolve them. 



Sleepy baby/ baby not wanting to feed


 Recognising the problem:  In this situation the baby will latch onto the breast take a few suckles and then fall fast asleep or another indication is that the baby doesn’t wake up often enough for a feed.  This usually occurs from birth and can continue for the first two to three weeks. 


A newborn should be actively looking to breastfeed at least every two to three hours and usually a feed will consist of 10 to 40 minutes of active sucking (eyes can be closed but the jaw is moving).  If a newborn is consistently not feeding like this then he or she will not get enough milk and problems such as low blood sugar, slow weight gain, low milk supply, engorgement can all result.


This problem most often occurs after the baby has had a difficult birth.   Procedures such as a forceps delivery, vacuum extraction, foetal distress during labour, labour medications, an induction of labour or emergency caesarean section, any one or a combination of these procedures can result in baby being sleepy.


Recognising the problem early on is crucial as often a new mother will think she has the best baby in the world because her darling is sleeping for hours at a time! She doesn’t realise that this is actually a problem, it is important to understand that newborns need to feed at least every two to three hours for the first few weeks of life.


Resolving the problem:   Measures need to be put in place to help the baby recover from the birth and provide breast milk.  The baby should be placed skin to skin between mothers’ breasts for as much time as possible for the first couple of days, dad can pitch in when mum is sleeping.  The baby needs to be offered a breastfeed every two hours; if the baby does not feed effectively at that time then the mother should express (pump) breast milk and feed the baby the expressed milk.  This continues until the baby starts waking up, looking for the breast independently and feeding for longer periods. 


Supplementing the baby with “top up’s” of formula does not fix the problem and can actually cause more breastfeeding problems and is not recommended.  The baby needs mother’s breast milk and that milk can be obtained easily by expressing and giving it to the baby until he/she becomes more alert and starts actively feeding.  Usually with the correct care the baby responds within 24 – 48 hours. The midwives and LC’s in the hospital will be able to help and support the mother with these measures.


It is important to remember that for the vast majority of women breastfeeding is straight forward and a joy.  However, if women are aware that there can be problems with breastfeeding, they are then empowered to do something about them.   By implementing these simple steps and accessing support these problems can be quickly resolved and breastfeeding can again continue with comfort, ease and joy.



Clare Boyle BSc, RM, IBCLC



Contributor info:  Midwife and lactation consultant Clare Boyle teaches the Breastfeeding Preparation Class in Dublin every month. The class teaches pregnant women about breastfeeding so they can approach it with confidence and knowledge.  Visit www.anulife.ie or ring 087 4198764 for more info.