Dealing with difficult times
Many of the women we spoke to breastfed without any difficulty at all but some did have problems and they usually sought help from a breastfeeding counsellor or a health professional. Once they had overcome the problem, most women went on to breastfeed happily. They said that breastfeeding was one of the most rewarding experiences of their life and they were extremely glad that they had persevered through the difficult times. Some women, however, were unable to solve their problem and reluctantly gave up breastfeeding, sometimes resulting in later regret, but felt that they'd done the best they could under the circumstances at the time.
Breastfeeding has been a fantastic experience for her and she has an incredible feeling of...
A doctor at her place of work noticed Jessy’s hands and asked her about breastfeeding. It was the first time Jessy heard about Raynaud’s phenomenon of the nipple.
And then I think it will be really, really helpful if future generations or, or the next generations of mums that go, who are suffering from the same as I do, can benefit from these information, or if the GPs know more about it. And then when a woman goes to see them they can say what it is, or if the midwives, the midwife are aware of these and they can help the mum if the choice, if the mum chooses to breastfeed.
Many women said that their birth experience was difficult or traumatic, sometimes resulting in an emergency caesarean section, and that it affected their later breastfeeding experience (see 'Sore nipples'). Some found that they were tired or medicated or too ill after the birth and unable to concentrate on breastfeeding in the beginning (see 'The first breastfeed' and 'When extra care is needed for mother and/or baby'). Some said that their baby was sleepy or uncomfortable after a difficult birth and not interested in feeding for several days. One baby took several weeks to learn to breastfeed (see 'Support from hospital staff'). Some were separated from their baby at birth and this caused them a great deal of anxiety, especially when they had expected to have skin-to-skin contact with their baby and breastfeed within the first hour.
She had two very different experiences of breastfeeding after a caesarean section. Positioning...
I think after the c-sections I had the positioning for feeding was important, 'cause physically I was quite weak, I think, first time probably more both physically and emotionally and the feeding lying down was so much easier, because I could rest and I didn't have to physically hold the baby which was really demanding on my body. I think breastfeeding is a very physical thing to do, not be, not only because you're producing milk but physically holding the baby who was getting heavier and heavier, there is quite a big physical element to it and with a c-section, you have to wait a little bit longer before you can be more active.
One of the most common difficulties that the women faced was breast pain caused by blocked ducts or infections such as mastitis, thrush (see 'Sore nipples') or, in one case, a superficial bacterial infection. They said that a blocked duct came on gradually, was mildly painful and localised. They said that the pain of mastitis came on quickly and was accompanied by heat, redness and swelling in their breast and sometimes they felt 'flu-like. They thought that the causes included poor attachment, engorgement, stress and tiredness, missed feeds, dropped feeds during hasty weaning, too much milk, and clothing or straps restricting the breast. A few women said that they thought expressing breastmilk had increased their supply and possibly caused their problems. To treat the problem, most went to bed with their baby and continued to breastfeed from the affected breast. One woman, who was tandem feeding, asked her older baby to feed from that breast to clear the blockage. Some used massage, expression, cabbage leaves*1, heat (compresses or a warm bath), painkillers, homeopathic remedies or antibiotics*2.
She had an abundant milk supply, frequent bouts of mastitis and occasional blocked ducts. She...
So can you describe mastitis for me?
It usually started with a little red patch on my breast that would be kind of hot and, and a bit painful to the touch and then quite quickly I would develop a sort of flu like feeling, a fever and shivery and really feeling quite ghastly actually. And it would usually be when I was very tired, run down, it would, always seem to happen on a Friday evening or so when I'd had the week with the baby on my own and [partner] had been at work and also it was, I suppose related to the breast not draining very well sometimes, I seemed to have a lot of milk and the baby wasn't very efficient at, at suckling even though we'd sort of managed to get by.
So what did you do when you noticed these symptoms?
I went to bed really, I felt so horrible that's all I could do and I think I took, ibuprofen or paracetamol or something to try and bring the fever thing down, and then just trying to get the baby to feed as much as possible off the breast which had the mastitis. And then when she wouldn't I would express or if, or if she'd already fed and was full I would express, I had a little hand pump and I remember sitting in the bath 'cause hot water was really helpful and putting a, a kind of hot flannel and, and it would sometimes come out that way, and sometimes I would see [pause] one of the things I found helpful was to sit in the bath and, and put a hot flannel on top of the breast and, and often just the warmth of the water would make the milk start to flow, and I remember kind of seeing it kind of swirling around in the water and knowing that it was coming out. And so, and oh, and sometimes I think I had a hot water bottle wrapped up in a cloth or something and put that on, and I did notice sometimes that I had like a little white blob on the nipple, which reading up about it seemed to be that that was sort of dried up milk that was blocking one of the, the holes, and sometimes if I could get that to kind of go then that would, that would relieve the blockage and then.
How did you get that to go?
Once, I'm sure this is probably not very good I popped it with a sterile needle that I'd burnt in a, in a flame, and then whoosh all this milk came out and it, and it went down. And I just think just a lot of expressing sometimes kind of helped them to, to pop as well. And I did also have antibiotics on occasions as well because sometimes it just wasn't going with the kind of measures I was using at home.
So you didn't always use the antibiotics?
The first, no I didn't, I sometimes did and I sometimes didn't.
How long did you leave it before you decided you needed antibiotics?
I usually left it about twenty-four hours or so I'd say.
So if you had no improvement within twenty-four hours'
'you knew you needed antibiotics?
I think that's what I was tending to do yeah. I mean I've actually had it with each baby in fact, all three of them, and for instance with the most recent baby I've had it three times in, about the space of, five or six weeks. And the first time I got through it with no antibiotics, the second time I did take the, some antibiotics because of, it wasn't going after twenty-four hours, and then I was still on the course of antibiotics when I got it the following weekend, in a different
She made sure that she fed her baby with his chin towards the area of the blocked duct in her...
All in a row, or?
I can't remember I think there were just odd ones here and there, I don't really remember, and it just made sense to me that this was swollen up because there was a blockage so I did the thing where you, I ended up in this ridiculous position because the baby's chin has to point to where the, the blockage is, and I ended up, he was lying flat on the bed and I had to go on all fours over him [laughs]. And I knew that I had got him in the right place because he fussed, and fussed, and fussed, he was obviously getting nothing out, but he kept at it and then he unblocked it and that night I took him and we co-slept, and I did feed him off both sides but I put him more on the side that had been blocked and it was fixed by the morning.
Did you know, was it sort of like an instant thing, ah that's been relieved or was it just because he'd fed so much you think that must have done it?
By the morning I knew that my breast was back to normal but there wasn't a moment where I went, 'Oh right that's it' I'm very lucky I can actually sleep when he's feeding, and once he got passed a certain age he was able to just pop on and off, on and off himself, so quite often I don't really have any idea how long he was feeding for or what he was doing [laughs] or anything so it helps me catch up on my sleep.
Okay, did you do anything else for that blocked duct like massage or heat compresses or feeding in the bath or anything like that?
No I didn't, I tried the chin positioning thing first and, I didn't notice the blockage until bedtime and then I thought, 'Well, you know, if this feeding all night doesn't help then I can move on and try some other things'.
Footnote' Changing the relationship of the baby to his mother's body will improve mastitis if it improves attachment and therefore milk removal.
Zainab’s nipple cracked badly but she continued breastfeeding from her less affected breast and expressed the milk from the other. She used cabbage leaves to help with the pain.
To rest yes and I, because of the breastfeeding classes that I went, it was quite helpful so I remember she said if you have cracked or sore nipples you can put cabbage which I did.
The cabbage leaves?
Yes the cabbage leaves and even my mum was like really cabbage, I said yes she, I was told it gives you a bit of relief and it doesn't dry up the, the nipples. I used the nipple cream but it was all in vain there was nothing, it wasn’t helping. I went to the GP they said because I’m breastfeeding they cannot give me any antibiotics I can only go on paracetamol that’s it. So I was pumping one breast and leaving the other one to rest which I could even say up to now it has an impact because one breast I have more milk than the other one because I think it’s psychology with the brain isn’t it that one needs it so let me give this one. Even now I can tell one has high milk and the other one has very little amount.
So I call the breastfeeding help group and they came, she tried helping me quite well, they were quite good but there was nothing she could do the nipple was so cracked it even like the nipple like split almost into two you could see the, it’s a horrendous experience I can’t even like. I was all in pain for two and a half months, I was in pain but I was so determined I wanted to carry on. My first child I gave him all through I didn’t even give no water until he was six months and then I put water and formula.
It is fairly common for babies to develop jaundice*3 a few days after birth as excess bilirubin (see Footnote 3) accumulates in their blood and makes them appear yellow. Of the few women whose baby did develop jaundice, some said that all they had to do was to be sure to wake their sleepy baby and breastfeed him/her frequently until the jaundice passed. Feeding near a window so that the sunlight could get onto the baby's skin was said to be helpful. One woman spoke about taking her sleepy baby to the hospital for daily blood tests. Eventually, the baby was covered with bruises at which point she decided to spend the whole night waking and feeding her baby to get breastmilk into her. Other women had babies under UV lights in the hospital and removed them from their crib for feeding, not always with the approval of medical staff. One woman said that her baby was:
“Stripped so she was totally naked, she was just lying there with little goggles and a little yellow body in the incubator with the lights on”.
Hospital staff tried to persuade her to give her jaundiced baby a bottle feed but she persisted...
Less light and the jaundice take time, I said, 'It doesn't I, I believe the more you breastfeed, breastfeed, the better he will get the quicker' and I ignored them, I honestly ignored them as I was doing what I had to do and after a few four days, four, five days we were out the hospital. And he was absolutely fine and he's a healthy wonderful baby boy running around now [laughs], and I love him to bits.
So that period in the hospital, you were taking him out of the incubator?
Whenever he wanted it to be honest because he was only a few, two or three days old he was on demand feeding and whenever he wanted the milk I took him out, breastfed him, and when I knew he was satisfied after half an hour or so I put him back in again, so it'd probably be half an hour, I tried to give him a good half an hour to forty five minutes on both sides, then I at least I know for an hour he'd be okay, then I'd take him out again same thing.
Did you sit there with him'
Yeah, yeah I was there basically they kept me in too, so I my bed was then his incubator was just next to me, he didn't go to Special Care or anything, he was just next to me, yeah.
And he had colostrum?
Oh yes definitely.
You didn't withhold breastfeeding'
'at any stage?
No, no, no, no straightaway he got all the colostrum then the milk came in, then the hind milk and everything he got everything from day one, yeah which I felt I had to do, it was my, I felt it was my responsibility to, as a mother, to give what he, it's for him 'cause in our religion it says it's a God-given thing otherwise we wouldn't be producing milk that's why it's important for the baby to have that.
A few women found that, for a variety of reasons, their breastmilk supply had dwindled and that they had to relactate (bring up their milk supply again), usually by frequent feeding and expressing using a breast pump.
Her milk supply went down because her baby with a cleft palate was unable to feed properly. It...
What did you do with that anger?
Channelled it into expressing [laughs]. It was a really, really hard time, there was a whole lot of milk that I had made at the hospital that was on it's way to the milk bank, we're talking litres, I had to haul it back here to the freezer and my job was to get my milk supply up again before that supply ran down. Now if I hadn't done what I'd already done for my first son, there's no way I would have known that you can exclusively express long time, long term. Fine one thing, but you can relactate, but by this time I'd already done a fair amount of reading, I'd set up Express Yourself Bras, I understood a fair amount about expressing and I was in touch with this fantastic breast, breastfeeding or infant feeding advisor and researcher up in the north of England, [name], who'd done all the research over the benefit of double pumping. She was like my saviour [laughs] because she was on the end of the 'phone to me, I knew in theory relactation was possible but I needed her help when milk didn't flow. I mean I was talking, oh ten days earlier I'd been making a hundred and eighty ml's in three minutes, I came
A few women talked about a period of real depression (not just the third or fourth day post-birth 'baby blues') sometime after the birth of their baby*4. At their lowest point, they felt that they had no love for their baby. They connected their depression to unrealised expectations, disappointment, frustration that things were not going according to plan and adjustment to motherhood. One woman was prescribed antidepressants but felt that they didn't work because the root cause of the problem had not been addressed (see 'Emotional and psychological aspects of breastfeeding').
She did not have the birth that she had planned and found breastfeeding difficult. She thinks...
Do you want to explore that idea of depression a little bit more at this stage?
Yeah, I didn't, I've only ever suffered once from depression and that was after my father died, with bereavement, but I think I didn't acknowledge that I was, I'd, I wouldn't say it was post natal depression as in the puerperal psychosis type thing, it wasn't, it was just down, feeling down, feeling overwhelmed and I also think that perhaps with it being your first child slightly later in life, you know, you're very in control of your career and suddenly life isn't in control anymore, you don't know what it's going to be like, nobody can tell you what it's going to be like to have a baby, suddenly you come home with this newborn, little thing, that just completely needs you and you sit there and you think, 'Well what am I going to do next? What do you do next?' so the overall, overwhelming feeling of responsibility and then coupled with the fact that the breastfeeding was just declining and it looked like, 'Oh my goodness don't say that (a) I haven't been able to have a normal delivery and now (b) I'm going to end up having to put him on the bottle', it just made me feel so low.
What about fatigue did that add to that as well?
I was tired a lot, and I think I remember being in the kitchen one night and I just said to my husband, 'Do you know I don't know if I love him' and that was the most dark I suppose it got, but I think I, my husband helped me realise, 'Look you're tired, you're, you know, you need to sit down, have something to eat, you know' and I was expressing at the time as well and that was the other problem that, you know, my nipples were so sore and they were cracked, they were bleeding, I was double expressing, I didn't seem to be able to get much off, so the worry of constantly thinking, 'He's hungry all the time I'm not getting enough off', it was just, you know, it was draining, draining, and when you're tired you can't think straight so, you know, it's a hard cycle to get out of really, you know, something has to change, for in order for you to get some rest, to be able to reassess the situation and continue.
You're looking back at it now; at the time did you think to yourself I might be depressed?
No not really I think I probably put it more down to being overwhelmed with having a newborn at home and the fact that things weren't going well with the breastfeeding, and I knew that I was going to be, while, whilst these problems were happening to me, I knew that I was the type of character that gets very, very disappointed if things don't go righ
Tongue tie is the term used to describe the condition where the frenulum - the ligament that joins the baby's tongue to the floor of the mouth - is short and tight. It may affect breastfeeding. Research has shown that most babies with tongue tie have their problems resolved by clipping of the frenulum, but it is controversial.
Her baby's tongue tie was cut at two days old but he still had problems attaching to the breast.
Can you tell me what you mean by tongue tied?
Tongue tie's where they have an extra the flap of skin goes to the end of the tongue preventing them to be able to suckle properly also in later life that can cause a lisp, and for him not to be able to lick, so he couldn't poke his tongue out, like that it was held back.
How long did it take you to pick that up?
I didn't, they picked that up in the hospital 'cause, the second, he was two days old, no he was, he was just over a day old and I was trying, having problems getting him latched on and the care assistant actually picked up that that was what was happening why I couldn't get him latched on, and then the next day they came and they cut that in the hospital.
So could you see that his, he couldn't poke his tongue out?
Once they'd pointed it out yes, his tongue rather than being pointed looked like a heart shape that was drawn in at the middle, so once they pointed it out it was quite obvious and he had quite a bad tongue tie as well, so yeah they cut that at two days old.
Can you explain what that meant?
They basically, they pulled his tongue and then there's this skin underneath, they snipped it, and the procedure took seconds, he cried but he was fine, I sort of held him and he was fine, he forgot about it after a minute if we'd not had it done so young as they get older it's more of a complicated procedure and I believe that if you wait until after they're six months they have to have general anaesthetic and all sorts so we felt it was better to have it done.
So no anaesthetic?
No anaesthetic they just snipped it.
It bled, I mean a miniscule amount, the doctor she held some padding to it, to the area and there was a little blood on it when she pulled it away, and then she gave it, him to me and I put him to my breast and he was fine and that was that. And then it looked like he just had a little ulcer there afterwards and it healed fine, so, you know [laughs].
So you put him to your breast?
It didn't, it still didn't come naturally even though he'd had his cut, his tongue tie cut very young it's, can still cause massive problems for babies breastfeeding and I assume maybe bottle fed babies but, so he, he never suckled right, he didn't latch on fully as well, there was always a gap, there was no proper seal made, if you know what I mean, around the, the nipple.
(Footnote' see Topic Summary 7' sore nipples).
Footnote' Minor brief pain at the beginning of a breastfeed in the first few days is fairly common. However, constant, long-lasting pain of the burning or itching kind or pain after or between breastfeeds is not normal and requires attention.
In the normal course of breastfeeding, teething is not a problem or a cause for weaning as the baby's teeth are covered by his/her tongue and not involved in sucking. If a baby is biting he/she is not actively breastfeeding. The women who spoke about biting said that it didn't usually last long. Several said that it was important not to jump, shout or otherwise react so that their baby did not get the idea that it was a game. One woman kept carefully and calmly taking her baby off the breast when she bit until she learned not to do it.
Dairy products, such as cow's milk and cheese, are common causes of allergies and, when included in a mother's diet, may pass to her breastfed baby and cause fussiness and colicky symptoms. A few women talked about their baby being dairy intolerant. After these women went on a diet free from all dairy products, their baby became more settled*5. One woman spoke of her baby being extremely constipated with painful bowel movements (see 'When mother and/or baby need extra care') while another said that her baby screamed every night and had loose infrequent stools. Diagnosis was always difficult and took a long time.
She had great difficulty in getting a diagnosis of dairy intolerance but noticed a dramatic...
Why was that?
Screaming, pure screaming, he just would not stop crying it was horrendous and horrendous to watch, he would scream for three hours at night, which is fine if you've got, if you're on your own and you've not got any other family then that's fine, but being that I've got two other little ones, you just can't physically give all your time to one person and that's what we were doing, and giving all our time to one little boy, person at night he was going to be up for two or three hours it was like taking the night shift so one of us would be up one night, the other one would be up the other night. It was just getting to the point where none of us were getting any sleep, we were just walking round, tired all the time. and I basically kept on going back to my doctor's saying, 'This isn't right, this isn't a normal child, there's something got to be wrong here', I took him to numerous places, homeopathy, cranial, all the places that you get told to take them and no one could say whether or not what was wrong with him, they just kept saying, 'Go back to your doctor's, go back to the consultant's'. We went to see a consultant in [hospital], and they said that there was nothing wrong with him because he was gaining weight, and I was neurotic being that I've had two children I was still neurotic and I should maybe, you know, look into other things that could be wrong with him, if I was that tired to put him on formula by this point I wasn't happy with what she said.
In fact I shut her off halfway through because I just couldn't be doing with what she was saying, but it just seemed every doctor we came to see it was either put him onto solids or give him formula, you know, and that's not something I want to do, you're meant to be given support, I wasn't given any.
How old was he at this stage?
He was four months.
Four months old. and I think it got to about, when he was about five months old and I got to the point where we just couldn't cope any more, the crying was just absolutely awful, and we kept taking him to all these different people and they weren't, none of them were helping, and I basically said to my husband, 'You've got to, we've got to do something' so I phoned the practice manager of our doctors surgery and we said that we've got a screaming child, no one can tell us what's wrong with him we need diagnosis, you know, we've been told to go on all these crash diets, I don't want to go and put myself onto a diet until I know what's wrong with him. I was given, he looked through my notes and there were the tests that had been done by the hospital, but it came back clear.
A test for what?
Didn't tell me, they wouldn't tell me what sort of test it was, I kept getting told from about five or six different people that it was, a test for this, a test for that, a test for this, and no one would give me any clear answers to what the test was, even the person when we rang up and asked didn't say what the test was, it was just, it didn't show nothing, and would just leave it as that. So there was no clear answers, so we had the practice manager ring us up and he said that there was obviously something wrong, and he would get someone to call us over it. In the meantime we got a letter from [hospital] saying that they had done a test on baby, but the test, they couldn't test it properly because there wasn't enough of it, and.
Nursing strike is the term used to describe times when a baby refuses to breastfeed for no 'apparent' reason. It is most unlikely that a baby under one year of age, who refuses to breastfeed, is weaning naturally. Some women talked about their babies going on a nursing strike, usually at holiday or Christmas time. The women were very worried and required counselling help to encourage their baby back to their breast. One woman received calming reassurance from a breastfeeding counsellor and lots of suggestions such as trying to latch her baby on while he was asleep, feeding him in the dark, using a dummy and then substituting it for the breast. One woman said that she was disappointed and frustrated when her babies refused the breast, one at four months and the other at ten months of age. She wondered what she had done wrong.
Her baby suddenly refused to breastfeed when they were on holiday. She received help from a...
That was once you were home?
Once I was back home from holiday yeah. And I went in there, and the lady in there said, 'Oh he looks like he's close to breast rejection' and I was quite panicked.
How did that make you feel?
Yeah quite panicky, particularly because he was refusing a bottle as well, and I'd tried expressing milk and giving him in a bottle and he wouldn't take that at all by that age, he did early on, he took some expressed milk early on, but by that age he was rejecting everything. So I was very nervous that, you know, I was going to have a real problem with feeding him at all.
How old was he by then?
He was about twelve weeks, fourteen weeks old maybe when I went to the clinic. And they were fantastic with me they said that, you know, there was a problem with the way he'd been latching on and in fact until that point he'd been almost sucking up the nipple by himself without really actively latching onto the, to the breast and he didn't have the same control of the milk flow, and they said that they thought it was really that, that he wasn't able to slow the milk down enough, and he needed to use his chin a bit more when I was feeding him, and it took a good two or three weeks of hard work to, to get it right again but from then on he was fine.
What sort of things did you do to entice him back to the breast?
I guess if he was reluctant I didn't push it I began to recognise that there were times when he'd been feeding before when it was really for comfort not for hunger, and so I let those times pass and, and really just waited till he was hungry, and I was very careful about the way I positioned myself, I probably used more cushions at that stage, 'cause you get a bit lazy with using cushions with one child I think and I used to just feed him anywhere and everywhere on my lap and, support him with my arms and, and by that stage my arms were quite tired as well so, I used to then be very careful about how I sat and used good support from the cushions. And was very careful about how I positioned his head, but even if I didn't think I was really latching him well, at least his chin was always on the breast then and, and he was, seemed much happier with it, within a week or two weeks he was fine.
Did you try feeding him in his sleep or anything like that to get him to latch on?
Not really no, he, I mean we kept the feeding patterns the same really and then he just took to it again, I think the help I had from the Breastfeeding Clinic was fantastic and, and it's run by two very, very knowledgeable ladies here, and they really tell you exactly what you're meant to try and do even if it doesn't always work. I went back two or three times and, an
*Footnote 1: Cabbage leaves, kept cool and applied to the breast, are sometimes recommended as a home treatment for engorgement. Their effectiveness has not been scientifically proven.
*Footnote 2: Antibiotics may be needed to treat mastitis if the woman's temperature has not gone down after 24 hours of home treatments or if it increases suddenly. The antibiotics used must be compatible with breastfeeding as the mother should continue to breastfeed, especially from the affected breast. Information on medications and breastfeeding can be obtained from LactMed – an online Drugs and Lactation Database geared to health professionals and lactating mothers. A resource that is part of the US National Library of Medicine (See Resources section).
*Footnote 3: Jaundice is the term used to describe the yellowish colour that some babies develop in the first week of life as bilirubin (the yellow pigment resulting from the breakdown of red blood cells) is deposited in their skin because their immature liver cannot yet deal with it. It is very common, is considered normal and resolves itself. Normal newborn jaundice in a breastfed baby is usually associated with inadequate feeding in the first few days and usually requires no treatment other than to sort out the breastfeeding problem. However, high or rapidly rising levels of bilirubin, especially in the first two days of life, may indicate an underlying disease or condition that needs investigating. High bilirubin levels may require treatment (UV light or blood transfusion) as they can cause brain damage.
*Footnote 4: It is important that postnatal depression is recognised and appropriately treated as it can affect the baby. Breastfeeding is not a physiological contributor to postnatal depression but a lactation consultant or breastfeeding counsellor may be able to help and will know when to refer to another specialist.
*Footnote 5: It is recommended that exclusion of a whole food group from your diet be done in consultation with a dietician.
Last reviewed November 2018.
Last updated September 2015