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  • Cleo Marchese, IBCLC, RLC

Breastfeeding Red Flags....when to get help


As a new mother, you are exposed to lots of conflicting advice about everything from which diapers are “best” to the “right way” to breastfeed a baby. In most cultures, a new mother can turn to her mother or other women in her family for helpful breastfeeding advice. Unfortunately in the US, very few women breastfed their baby longer than a few weeks or months and most were not breastfed themselves so they cannot ask their mother for help.

This cultural gap in infant care leaves a huge hole in knowledge about this very important subject. There are lots of breastfeeding classes or support groups out there, it is important you find a knowledgeable and reputable source. Some support groups or breastfeeding classes are taught by unqualified laymen or under-qualified health care professionals. Bad information can sometimes be unsafe and can potentially ruin your breastfeeding experience.

Breastfeeding is said to be a natural process. While it is natural for your baby, it is a learned behavior for you. A learned behavior is a cultural experience or behavior you are exposed to frequently when you are young. It becomes second nature or instinctive as an adult. This gap in cultural knowledge leaves many mothers anxious about breastfeeding with many unanswered questions. It can be a real challenge to determine when something is wrong or you are just experiencing 'new mom nerves'.

Basic red flags indicating breastfeeding is not going well

Pain during a feeding

  • Nipples are beveled, creased, or look white after a feeding.

  • Any visible physical damage to the nipple. Cracks, scabs or bruising to the nipple or areola.

  • Feeding is unbearable.

  • You were told the latch looks good but breastfeeding still hurts.

  • You feel intense deep breast pain during a feeding and when baby is not feeding.

  • Your breasts are sore all the time, and your nipples hurt even whenyour clothes brush against them.

Signs of a poor latch

  • Pain during a feeding.

  • Difficulty getting your baby to latch, and stay latched.

  • Clicking or popping sounds during a feeding.

  • Engorgement

  • Your baby only nurses on the nipple. Your baby constantly readjusts no matter how many times you try to latch him/her correctly.

Signs of a poor feeding

  • Baby nurses all the times, yet is gaining very little or not at all.

  • Weak flutter-sucks at the breast.

  • Infant only sucks strongly for a few minutes or not at all then pushes away.

  • Baby goes to sleep at the breast immediately without a period of active sucking and swallowing.

  • Baby has worried or anxious expression on face much of the time.

  • Healthy, full term baby that has not regained birth weight by three weeks of age.

  • Infant is at, or below, birth weight at three or four weeks of age.

  • Infant’s limbs are tightly drawn into the body all the time, even after a long feeding.

  • Infrequent wet or dirty diapers. Newborns should have multiple dirty diapers each day after your milk comes in. It is never normal for a newborn to go days without stooling.

  • Rapid weight loss the first few days of life, more than 12% of body weight.

When to call a lactation consultant

  • Your baby is premature or preterm.

  • Your baby is sleepy all the time or has jaundice.

  • Your baby cries all the time or is really fussy.

  • Refuses to latch, currently or since birth or has difficulty staying latched.

  • Poor weight gain. Feeds more than 12 times a day and still seems hungry.

  • Extreme pain when breastfeeding.

  • Severe engorgement, baby cannot latch.

  • Flat or inverted nipples, difficulty latching baby or cannot latch baby at all.

  • You feel you have too little or too much milk.

  • You were told you need to wean because you need to start a medication, have mastitis, need to be hospitalized, undergo surgery or because you are ill.

  • Anytime you feel breastfeeding is not going well.

Are there good breastfeeding support groups out there? Absolutely, look for non-profit groups like La Leche League or WIC Peer group meetings. La Leche League Leaders and WIC Peer group counselors are extensively trained to help mothers with basic breastfeeding questions. If you are taking a breastfeeding class, look for classes given by an IBCLC, a board certified lactation consultant. Your hospital may have a peer-support group or breastfeeding class as well. They should be staffed by board certified lactation consultants. Be wary of breastfeeding classes or support groups at baby stores, or retail outlets not using an accredited expert. While they may be fun, their primary goal is getting you in the door to purchase items.hospitals while others rely on lay persons to help new mothers. Remember, when your baby is ill or preterm, never take any advice that contradicts your pediatrician.

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