5 Common Nursing Issues and Solutions

1. Establishing milk supply or boosting supply

 Many women struggle to establish their supply, and some experience unexpected dips along the nursing journey for a variety of reasons (e.g., the menstrual cycle appears, new exercise program, stress, return to work, and mastitis to name a few). Here are some details about milk production to help you understand how it works and what you can do to help. 

Basics:

  • Start BEFORE the baby is born. How? Preparation: Read a book or take a class (I offer a virtual and in-person breastfeeding prep-class). Preparation through education will make you feel more confident, and studies show higher success rates and longer nursing duration for those who have. Do not expect to get all you need from a hospital staffed LC (Lactation Consultant) during your hospital stay. No way they can adequately prepare you in such a short interaction with you/baby. 
  • Establishing your milk supply takes a minimum of 3-5 days with your first child and sometimes up to a week with birth trauma, C-sections, baby admitted to the NICU, etc. Realistic expectations help calm your worries; the process may take longer than expected.
  • Nurse (or pump) early and often after birth. The baby is most alert in the first 2 hours after birth. Delay baby care and spend that time nursing, snuggling, and skin-to-skin to capitalize on those precious moments. 
  • Once the milk comes in, the hard work and diligence are not over. Your body will still be working for the first 6-8 weeks to establish the supply. Therefore, it is vital to empty your breasts regularly. See below for tips in establishing and maintaining your supply. 

Practical steps to establishing or boosting breastmilk supply:

  • Stimulation (nurse regularly and/or pump)
  • Empty breasts regularly. After milk comes in, remember “dinner and dessert.”  
  • Incorporate grains into your diet as often as possible. 
  • Mother’s Milk Tea (3-5 cups per day) 
  • Supplements like Legendary Milk and Mother’s Love 
  • Sleep (8 hours minimum)
  • Hydration-drink half your body weight in water daily; more if you drink caffeinated beverages.
  • Many believe dark beers (ambers and stouts) positively impact supply. Do so carefully; timing is key, and be smart-1 beer and eat, hydrate, etc.  

2. What does a good feeding look like?

Start by gathering information from several sources--not focusing on any one item individually. I like to say that we should put all the pieces together to build the puzzle then step back to look at the big picture. There are four assessment pillars that help us establish a “good feeding baseline”: Baby, Breast, Clock, and History. 

Baby

  • Good latch with lips flared outward
  • Long-jaw movement 
  • Audible swallows
  • The baby is satisfied after feedings and can make it 2-3 hours between feedings (sleeping well between them). 
  • Age-appropriate wet and dirty diapers. 

    Breasts

    Breasts are emptied of milk. How do you know? Breasts are soft, and hand expression will tell you. If you do not know how to hand express milk, reach out to an LC for training. 

    Clock

    Most feedings average 30 minutes minimum (there are some exceptions). Work hard to keep baby awake and nursing well (above), BUT this is just a guide. Remember, no one pillar should be the focus, but rather all 4 hold up the building!

    History

    Ask the question, “What is normal for my baby and me?”. The time it takes to nurse is unique to the mama/baby team. Track nursing sessions early on and spot-check throughout the nursing journey (it will change over time as the baby becomes more efficient). The history component is information that will be gathered over time and an assessment of the data. An LC can help make sense of it all for you if this process is daunting or overwhelming. 

    3. Latch:  

    A proper latch is probably one of the most important parts of breastfeeding success. Avoid nipple trauma and issues with milk supply (poor latch can equal poor emptying of the breast) by learning what a good latch looks like. Guide your baby to teach him/her to establish good latch habits early on. Seek out assistance from an LC if needed to assess for signs of a poor latch. 

    Signs of a poor latch:

    • The Baby’s mouth is not wide when latching
    • Feeling pain during feedings 
    • Sleepy baby
    • Inconsistent, flutter (weak) sucking 
    • Difficulty latching-on and staying on
    • Engorgement   
    • Misshapen nipple 
    • Chin isn’t touching breast/nose smushed into breast
    • Clicking or popping sounds in your baby’s mouth

    4. The first two weeks… 

    What many do not tell you is that nursing is TOUGH! The first 2-3 weeks of your nursing journey will not be a walk in the park. For most women, it will be trying and takes a huge commitment. KEY: If possible, stick with it for 10-14 days! Just when mom is ready to throw in the towel, has had all she can take, and feels defeated, many mama/baby teams turn a corner. Every mama I work with reports seeing the light at the end of the tunnel around 10-14 days--things magically fall into place or swiftly start moving in the right direction. Suggestions:

    • It is tiring. Sleep as often as possible. 
    • Let the house go or accept help (laundry, cleaning, etc.) if offered.
    • Accept meals if offered. Order out. But EAT and drink (I know; hard to think you will forget to eat, but it happens!).
    • The baby will fall asleep nursing. It’s hard work, and they tire easily. Learn how to keep the baby awake and nurse well. 
    • Keep expectations realistic. 
    • Bottles are OK when needed if no latching issues!  
    • Pacifiers are OK. 
    • Weigh all the options, but YOU decide what works best for YOUR family!

      5. When to call an LC?

      • You are experiencing pain during or after nursing sessions or pumping.
      • Baby isn’t latching 
      • The baby is fussy and wants to “nurse all of the time.” 
      • The baby has jaundice with concerning bilirubin levels. 
      • The baby has not returned to birth weight by two weeks of age.
      • Have sore nipples
      • Are engorged
      • Feel like your supply is low
      • Have flat or inverted nipples
      • You feel like you want to stop nursing, but it was your goal before the baby was born. 
      • Nipples are misshapen when the baby unlatches.

      Other reasons you might reach out to an LC:

      • Are ill or need to have surgery   
      • Are returning to work and need help with a pumping + nursing plan
      • Experience mastitis (breast infection) 
      • Wish to breastfeed an adopted baby 
      • Experience stress around feedings 
      • Need to take medications 
      • Need advice about selecting an appropriate breast pump 
      • Are receiving conflicting advice or discouragement to breastfeed
      • Things aren’t going poorly, but you just aren’t sure you are doing this right. Most LC’s offer check-in visits!
      • ANYTIME! Most LC’s desire more than anything to support breastfeeding families! Attend a nursing moms support group or meet privately (in-office or home visit). 

      Megan Tucker

      Megan Tucker is a Registered Nurse, certified Lactation Consultant, certified Moms On Call consultant x 13 years, and certified childbirth instructor x 14 years with two decades of experience in women’s health (particularly high risk perinatal and infertility), home health, lactation, and patient education. She believes that families benefit greatly from a more personal approach. All Baby Basics classes and support packages are private and conveniently located in the comfort of your own home (or virtually). Megan lives in the Metro Atlanta area with her husband. Together, they have four children and have welcomed numerous foster children into their home since 2012.

       

      Note: Guest blog posts are shared for informational and educational purposes and may not reflect the official policy or position of SlumberPod (parent company, Dovetail Essentials, LLC), our employees and/or contractors.


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