Breastfeeding & Pumping

Breastfeeding and pumping breastmilk comes with many unspoken challenges. New mamas are expected to tough it out under the promise that it will eventually get easier (or even enjoyable) and that it has health benefits for the baby. The American Academy of Pediatrics recommends breastfeeding for at least 1 year and the World Health Organization recommends 2 years. But there is very little information about what exact benefits are derived in specific situations like if the baby is not in daycare during the first year and is generally healthy, if the baby gets breast milk only for the first few months, or gets a better quality formula. When I tried to research these and other questions, I found that breastfeeding recommendations appear to based on many reasons other than health like the cost and time savings of not having to buy and prepare formula and faster weight loss for the mom. Although breastfeeding and pumping can be incredibly hard particularly for mothers that try to go back to work, medical research does nothing to help them figure out the 80/20 for their breastfeeding situation. When is the pain and effort not worth it based on the benefits derived? When does it make more sense to spend that energy on other things for you and your baby?

Below are the top 12 breastfeeding problems that I’ve faced or heard about from friends. Hopefully, it’s a good resource for new mamas who are trying to determine the root cause of their discomfort and figure out how they can address it. There’s a lot of pressure on women to breastfeed both from themselves and others. It’s almost taboo to question whether all of this is worth it. But each mother needs to figure out what makes sense based on her own situation. And for some, breastfeeding can truly be a magical experience (or so I’ve been told!).

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1. Latching pain

You’d think that evolution would have made sure that there is only a right way a baby can latch onto a breast. You’d be wrong! The right way for latching is not very intuitive and requires the baby to get hold of a chunk of the breast significantly larger than you’d normally think of as the nipple. Every other type of latch will likely result in nipple pain while nursing and afterwards.

Flat or inverted nipples can make latching correctly even more difficult. Some babies are not able to latch right because of tongue tie and other physical issues. A lactation consultant can help figure out a good latch in difficult situations or recommend an incision for issues like tongue tie. A good nipple shield can also help, both in terms of getting the baby to latch correctly and to protect the nipple when the baby latches incorrectly. If nothing helps, there is still a way to feed the baby breast milk by exclusively pumping and feeding from a bottle.

2. Biting baby

As babies start teething, they are trying to itch their budding teeth with everything they can get hold off. At that time, it can be particularly scary to stick your nipple against those sharp little things. A good latch while feeding may protect the nipple from biting, but the baby could still bite when she is not actively feeding. The only thing to do is to remove the nipple and the baby will hopefully learn not to bite after a few times.

My baby managed to bite me way before he started teething. He would painfully bite the nipple with his gums and hold on until it turned white. His bite was so strong that I had a hard time removing him. That again was a sign of a bad latch and a nipple shield made it more difficult for him to bite me. I tried many different types and sizes of nipple shields before finding one that worked, despite having pretty regularly shaped nipples.

3. Painful letdown

One thing I found particularly surprising was how painful letdown can be when the milk ducts tighten to force milk from the glands to the nipple. I’ve read that letdowns can sometimes be as gentle as a pins-and-needles sensation, but for me it was always far more painful than that. In the first few weeks, this pain was accompanied by uterus contractions so it felt like my entire body was aching every time I started breastfeeding or pumping. When I was pumping, a lower pump setting helped reduce the pain a little.

I would also feel the same pain when my boobs decided to let down milk even though I wasn’t breastfeeding. This would happen every time a baby cried (not just my baby!) and made sleep training particularly challenging. My husband took on the task to sleep train our baby to save me from needless painful letdowns and I was mostly preoccupied with pumping every 2 hours anyway. More on that below.  

4. Not producing enough milk

Similar to how supply and demand works in economics, the body will generally supply more milk when it senses a greater demand for it. When a newborn starts nursing colostrum (the highly nutritious first milk that builds up during pregnancy), she signals to the mother’s body to produce more milk for the next feeding. This process ensures that the milk production increases as the baby’s stomach grows.

But sometimes this process doesn’t work as intended. If the newborn is not able to breastfeed after birth because of complications with the baby or mother, this cycle can be broken. Pumping can sometimes help kickstart the process. But some women have permanently reduced milk production due to things like postpartum depression. Not being able to nourish your newborn can be incredibly frustration and send new mamas down a downward spiral.

5. Producing too much milk & engorgement

I was undersupplying milk during the first few days after birth, but quickly turned it around to an oversupply with terrible engorgement. No, I’m no Goldilocks of breastfeeding. I can’t get it “just right.”

But producing too much milk can’t hurt, right? Guess again. Too much milk meant constantly having massive lumpy breast that got hard as rock if I didn’t empty them every two hours. They were ridiculously painful, making it difficult to sleep, walk, and even hold my baby. I could only wear a soft nursing bra, which provided minimal support. Putting on a pumping bra was very painful. And my baby couldn’t empty my breasts, so I would nurse on one side to give him a good mix of foremilk and hindmilk, and then pump the other breast.

6. Clogged ducts & mastitis

If I ever overslept and failed to empty my breasts every two hours, I was punished with the even more painful clogged ducts that would show up as lumps in my breast after I emptied them. Having a lump in your breast is very scary, even if you suspect what’s going on. It’s even scarier knowing that if you don’t take care of the clogged duct, it can turn into mastitis. I only got mastitis once, managing to avoid it by religiously pumping every two hours and heating up every clogged duct with a hot shower or compress and massaging it out before it had a chance to get worse.

7. Cracked nipples

As if the constantly swollen breasts weren’t painful enough, I also developed cracked nipples that made nursing really painful and hurt when my nipples were rubbing against the nursing pads in my bra. Sometimes, my nipples would even bleed.

The cracked nipples seemed to have been caused by my baby latching incorrectly and falling asleep at the breast making my nipples stay wet for too long. Using a nipple shield while nursing and cold gel pads after helped reduce my pain. I also used lanolin cream and nipple shells that created space around my nipples in the bra. That helped heal the cracks, but they would often come back.

Luckily, my cracked nipples were never caused by thrush, which would have come from little white patches of yeast found in a baby’s mouth (when the baby has thrush). Thrush may need to be treated with anti-fungal medicine for both mom and baby.

8. Vasospasm or nipple blanching

My nipples would sometimes turn white from my baby biting them with his gums. But in time, I started noticing that my nipples turned white and were throbbing after nursing even when he didn’t bite. Turns out this is a common condition too. It results from sudden temperature changes between the baby’s mouth and room temperature, which causes blood to quickly leave the nipple. I found that a hot compress helped with this issue too.  

9. Milk blisters

Sometimes I would have a painful white mark on a nipple that was clogging a milk duct on the surface. I could usually get it to open up by massaging the area while in a hot shower, though I’ve read that they sometimes need to be pierced with a needle to get the milk flowing.

10. Painful weaning process

At some point, I decided that I needed to focus on my baby’s development in other ways and would stop breastfeeding and pumping to make room for that. By then, I had a freezer full of milk that I had pumped and had consulted with our pediatrician that I would be able to space out the defrosted milk and supplement it with formula.

Because I was producing too much milk, I had a hard time weaning my breast from breastfeeding. My baby, on the other hand, weaned overnight. It took several months to get my breast to stop producing milk. And it was a really painful process that resulted in multiple clogged ducts as I tried to decrease the frequency of emptying my overfull breasts. Once, after not breastfeeding or pumping for over a month, my breast started squirting milk in the shower. It was so discouraging.

11. Mental health & career implications

My baby was incredibly slow at breastfeeding and could sometimes eat for over an hour. He would constantly be falling asleep at the breast, which stressed me out as I knew that I needed to empty my breast quickly to avoid clogged ducts. When I wasn’t breastfeeding, I was pumping or dealing with a clogged duct, cracked nipples, or blanching. I got up every 2 hours at night to pump and was constantly sleep deprived even when my baby started sleeping through the night early. It was stressful and frustrating and I felt guilty that I didn’t have the time or energy to bond with my baby. I also felt guilty that I couldn’t get breastfeeding to work smoothly. I felt guilty having to pump. And I felt guilty when I finally decided to stop my milk production. There was so much breastfeeding guilt going around!

For me, breastfeeding also meant continuing the hormone rollercoaster of pregnancy and taking longer time to recover child birth. It caused me to suffer things like postpartum sweats until I stop breastfeeding and pumping. While the act of breastfeeding releases oxytocin, which could make you feel better while breastfeeding, the constant ups and downs can be unhelpful for mamas struggling with postpartum depression. One friend told me “I just couldn’t feel like myself until I stopped breastfeeding.”

Breastfeeding and pumping is also a burden for mamas who go back to work. They will often have a shorter in-office workday than before because they need to pick up the baby from daycare. Imagine having to interrupt that already shorter workday to get into a room for 30+ minutes a few times a day, get undressed, and fiddle with pump equipment trying to avoid spilling milk all over yourself. You’ve just been out on maternity leave and had some less productive time before that while dealing with various pregnancy issues. You need to catch up, but you’re only falling behind. It’s no wonder women are less motivated to stay in the workforce after having a baby.

12. Public breastfeeding haters

As if the process of breastfeeding is not painful on its own, there are also people that harass mothers who breastfeed in public. Haters gonna hate, right? Well, these haters are essentially trying to force mothers to not make it out of their homes, given that babies feed with short intervals.

 

Further reading:

Dealing with clogged ducts or Mastitis.

Easy steps to handle sore nipples.