If your baby refuses to latch on, be ready to face these challenges

Breastfeeding is an integral part of motherhood, but can pose several challenges, if not done properly. Read on to know more.
importance of breast milk
The importance of direct breastfeeding cannot be discounted. Image courtesy: Shutterstock
Dr Sheetal Sabharwal Published: 6 Aug 2021, 08:00 am IST
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Ever since we learnt to drive hard the concept of ‘Breast is best’, we also discovered that so many problems stem from improper breastfeeding. Some of these problems trigger the majority of the complaints that constitute postnatal visits to the doctor, and are often the cause of much duress to the mother. These problems deserve due attention because they are often the reason why women give up on breastfeeding. 

Problems resulting from improper breastfeeding can be widely divided into:

A) Maternal problems and;
B) Infant problems. 

Let’s briefly gain insight into some of the common problems, and their simple prevention and cure.

A. Maternal problems:

1. Postural

Bad posture while feeding is one of the most common problems of improper breastfeeding. This often results in a persistent backache and nagging shoulder pain in new mothers. The patients often assume that this pain is a result of epidural/ spinal anesthesia and sadly fail to address it early.

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New mothers are usually anxious when they hear their baby cry and to calm the baby, they quickly latch the baby on for a feed. But, they fail to first adopt a comfortable feeding posture. They commonly lean forward, slouch or fail to adequately support the back, while holding the baby. Over a period of time, this leads to pain in the back, neck and shoulders.

This can be avoided by first taking a few minutes to properly position oneself. It is also recommended to keep a chair or sofa dedicated for feeding with few cushions to support the back and the baby. The mother can be comfortably seated and then latch the baby on. This may just take an additional two minutes but significantly reduces the strain on the muscles. It is not necessary that everyone must have feeding pillows. The pillows used at home or cushions with a good ergonomic chair with proper back support can also be helpful.

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2. Cracked or sore nipples

Every mother must have experienced varying degrees of sore or cracked nipples. Though common, it is quite an uncomfortable one. It is usually caused by a faulty latch between the baby and the nipples. The improper latch is when the baby either bites the nipples too tight or for a very long time, thereby causing minor cuts in the nipple, which are very painful. These tend to worsen with more feeds.

It is therefore imperative to teach the mother what a proper latch is. The nursing staff or doctors must take the trouble of supervising the initial feeds to ensure that the mother is inserting more than two-third of the nipple into the baby’s mouth. The angle of which must be wide so that the pressure is not on the nipple but the areola at large.

Once the nipples are cracked, they must be tended to by either expressing breast milk from the other side to give that nipple some rest, and also application of creams and moisturizers containing lanolin. It is interesting to know that the application of colostrum and breast milk itself is effective in reducing cracked nipples.

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Some tips to prevent cracked nipples-

  • Keep nipples dry
  • No harsh soaps and cleansers
  • Avoid overuse of breast pads
  • Keeping a finger between the nipple and baby’s mouth to guide the areola and ensure a proper latch

3. Thrush

It may be seen as a consequence of the cracked nipples associated with poor hygiene after breastfeeding. The cracks on the nipple can get infected with yeast, resulting in thrush, which is painful. It is characterized by pain and shiny red and flaky skin on the nipple.

Some tips to prevent thrush-

  • Keep nipple dry and clean 
  • Address cracked nipples early and effectively
  • Cleaning the nipple with warm water after every feed especially if prone to cracks
  • Once the thrush appears, the mother may require medication in the form of antifungal creams

During infection, it is important to express breast milk from the affected side and rest the nipple to heal. Persistent nipple pain with or without the rash must draw attention to the diagnosis of thrush.

4. Milk lumps or breast engorgement

Breast engorgement is usually common after three to five days of delivery, due to sudden letdown and increase in breast milk production. This causes the breasts to become large and hard, and very painful. It can be transitory but is best prevented by expressing breast milk and feeding frequently.

5. Clogged ducts

Frequently seen as a sequel to engorged breasts, it results from the blockage in breast milk ducts resulting in pain, redness and even causes fever. It may also happen as a consequence of breast compression while sleeping, wrong-sized bras or underwire bras. This can be best dealt with by expressing or feeding the baby from the affected side , whilst gently massaging the area of lump or redness. Frequent expression is more effective after a hot compress or a hot shower. But one should remember the best and most effective breast pump is the baby, so feed frequently.

6. Mastitis

If the clogged ducts and engorgement are not dealt with effectively, it results in mastitis. Mastitis is a superadded bacterial infection, which is caused by cracked nipples or blocked ducts. It is extremely painful and may turn into an abscess.

Some tips to prevent mastitis:

  • Stop feeding on the affected breast immediately
  • Seek medical help at the earliest appearance of fever, pain and redness
  • Early start of antibiotics and anti-inflammatory drugs

Now, talking about infant-related problems, there are broadly two problems arising from improper breastfeeding for the infant.

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B Infant problems:

1. Thrush

This is a consequence of maternal thrush from the nipple. It needs oral antifungal mouth paint. The baby may refuse to get fed and cry excessively.

2. Sudden death

One of the most dreaded complications of improper feeding is infant death. This may be seen in mothers who have large breasts or feed while sleeping and fall off to sleep and rarely smother the infant. It is deeply distressing and hence mothers must be discouraged from feeding in the sleeping position.

To conclude, breastfeeding is a challenging yet simple and rewarding act of motherhood that requires proper counselling, supervision and guidance to encourage every mother to feed happily and pain-free.

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About the Author

Dr Sheetal Sabharwal, M.D., D.G.O., Obstetrician & Gynecologist Consultant, P.D Hinduja Hospital and Medical Research Centre, Khar facility. ...Read More

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