Breastfeeding Problems: Finding the right approach

I got an interesting email from genuinely fearless lactation consultant Valerie this morning, posing the question: when helping new mothers who are attempting to breastfeed, where should the line be drawn between encouraging positivity and realistic practicality?

She writes:

Occasionally in the hospital setting I will run across a situation when maternal anatomy makes clear that breastfeeding will not be easily accomplished. (To a lesser degree, there are situations such as “late pre-term” babies, tongue tie, or just uncoordinated suckle on the part of the baby – all of which make the startup a bit more complex.)

I find myself struggling between wanting to give a realistic picture of what may be required to give breastfeeding a chance vs. sounding too discouraging.

The most recent situation encountered yesterday that inspires my question: A mom I was trying to help has the type of nipples that do not easily compress for a baby to latch onto. The best way for me to describe them is that they are “fibrous” or feel almost like scar tissue. Little to no flexibility and a wide diameter so not easy for a baby to learn to latch onto. She had attempted with her first child briefly. Interestingly, there was even a charted feed with this child post delivery. (I highly doubt this child was latched at all based on my assessment of her nipples!) The primary nurses rarely touch a mom’s breasts or nipples so seem largely unaware that this type of nipple is not going to be easy to latch onto or that they even exist!

This mom had come in intending to do “both” (bottle/breast). This can certainly complicate a one or two day old baby’s willingness to feed in the average situation – depending on ease of latch and volume of formula given. (I know that some people call it nipple confusion – I think the baby is not confused at all – – bring on the milk!) 🙂 But her prior experience had her knowing that things were unlikely to be simply “latch and feed” so she knew what she would likely need.

Once the baby was awake and interested enough, it becomes easier to assess whether the baby was capable of latching – at least at this feed. In this case, as soon as I touched mom’s nipples (with permission granted 🙂 I saw that this would be no quick fix or a “just wait for the baby to wake up” fix. We tried a nipple shield for a few minutes without much success. I offered some suggestions to the mom about what options would be available in the short term – such as pumping – since the milk was coming – latch or no latch. With no milk removal, the supply would go. She affirmed that with her first child, she did experience engorgement.

I left the decision up to her as to whether she would like to begin pumping and / or continue to try on her own or with my help at successive feeds. (She had already given two bottle feeds since she’d been unable to latch baby on her own.) She had gone to the WIC breastfeeding class and seemed to want to try again with this child. I encouraged her to think about what she’d like to do if the baby continues to be unsuccessful in latching, and I would be happy to help her when she called. (Did not want to have her feel pressured at that moment – and wanted her to have time to think about it.) I don’t think she’d thought about pumping for bottles – even short-term – so I mentioned that some women do this for as long as they felt it was working for them. (Again – my personal opinion on this is to educate moms about how to do it, and acknowledge that it is often cumbersome and tiring – but possible for some moms who want to.) But even my suggesting this at this point made me wonder if I am indicating that I don’t think latch looks promising….

So – bottom line question. Do most moms want a realistic picture of what may complicate the breastfeeding success curve in the early days? Or that it may actually be impossible to latch a baby until the baby is possibly weeks old? As an LC, I certainly cannot predict what will happen, but sometimes it is obvious that success is not going to be quick or easy. I struggle between wondering if I should be realistic about what will likely happen without ending up being too discouraging in case the baby makes a liar out of me.

Besides making me wish I’d had a lactation consultant like Valerie in the hospital where I gave birth, this email made me think. If you had some physical condition which **might** make breastfeeding challenging, would you want to know beforehand?

Now, I think it’s pretty obvious where I stand on this; I believe forewarned is forearmed, and it is one of the reasons I write this blog, and encourage you all to share your stories every Friday. I’ve learned so much about lactation problems in the past 2 years, and as any regular reader of FFF can tell you, these issues are real, relatively plentiful and seldom talked about by medical professionals. In many cases, the problems aren’t insurmountable, but when a woman is a few hours postpartum or a newborn is losing precious ounces by the hour, it’s hard to find a calm resolution. Going in with knowledge of what you might be facing could help you be in the right state of mind, with the right folks on your team; you could do your research and not be at the mercy of whoever is on call from the LC team that morning (because god knows, it probably won’t be Valerie).

On the other hand, there’s that whole power-of-positive-thinking thing. Maybe ignorance really is bliss? If it’s a problem that may not even turn out to be a problem, could worrying about it do more harm than good?

Considering how many of us had physical impediments to lactation, I think we’re a perfect sounding board for any professional pondering these issues. So I’m asking you, FFFs – what do you think? If you were the woman in Valerie’s story, how would you prefer she handle the situation? Harsh realism, blind positivity, or something in between?

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.

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34 thoughts on “Breastfeeding Problems: Finding the right approach

  1. I almost could be the woman that Valerie was talking about, add inverted nipples to the mix. It would've felt much better for someone to acknowledge that fact that my anatomy would more than likely make breastfeeding impossible, instead of saying they truly believed I could make it work.

  2. I love that you tell your new moms that some problems get sorted out and some don't and that the length of the struggle is for them to decide. That is actually really reassuring information and I do wish more LCs treated women as adults – however intimidated, sleep-deprived and anxious – who can make decisions for themselves. Would have loved a set of alternatives from the LC/ped when baby lost weight at first – if you do this, here's what might happen, if you supplement, here are the costs and benefits, and so on.

  3. One other thing I was thinking is that honesty in breastfeeding an prenatal classes would also be beneficial. I know, I know. A lot of activists will say that talking about problems will scare moms away from trying to breastfeed. But digging a hole in the sand and burying our heads is a disservice to moms and babies who do have problems. Plus, I think talking about the real problems some women face, even just briefly, can help to avoid one of the big “booby traps” that gets mentioned — the friends or relatives who “couldn't breastfeed” or “didn't make enough milk” or whose baby “just wouldn't latch.” We hear that those thugs aren't true, that most women make plenty of milk and it's probably just a growth spurt and that colostrum is all the baby needs at first and that most babies latch just fine. But talking about the real problems — and how a lot can be fixed if you catch them early and get good medical care — can do a lot to get rid of those misstatements. When I see someone say she couldn't make enough milk and it doesn't surprise her because her mom and sister couldn't either, I wonder if something like hypothyroidism runs in the family. I wonder how many of those complaints of low supply or pain or other issues were because physical problems like IGT, PCOS, hypothyroidism, tongue-tie, nipple problems etc. but weren't properly diagnosed because nobody knew about them or because they were just told to use formula.

  4. First, you're absolutely right that a lot of women never imagine they will have problems breastfeeding. IMO it's not that the “breast is best” message hasn't been put out there enough, it's that people don't get enough support when things aren't working out. And I'm not talking from family members, the rest of society, coworkers–I'm talking about the very people who are trumpeted as being able to help get breastfeeding going: lactation consultants. So, so many of the FFF Friday posts I've read talk about consulting a LC–and BFing still didn't work out. We're doing all we can, we're doing what lactivists recommend we do, and yet we're still held up to be bad mothers.

    I think a large part of the reason why so many women see lactation consultants and it still doesn't work out is because of the unrealistic attitude and unwillingness to disclose potential problems by so many lactation consultants. Part of the reason I think Valerie's question has resonated so much with FFF readers, and why all of us are basically advocating the same answer to her questions, is because so many of us have experienced lactation consultants who were practicing medicine for the masses and not the individual. I have no problem with a LC who says overall, breastfeeding is best. But where so many fail is in not individualizing their treatment–and that's why Valerie's approach is so refreshing. We get “breast is best.” What we don't have is the HOW.

    Second, I can't say enough how much I agree with you that we need feeding consultants–infant and child nutritionists. They should be accessible for every parent, not just those with a serious condition and a prescription. The stats are now that 1 in 13 children has food allergies. has great resources for babies who have food allergies seeming from birth–obviously breastfeeding is not the solution it's trumpeted to be. Obesity is being touted as a crisis. Many parents are working and strapped for time, and don't have the knowledge to make homecooked meals like we did in prior generations, when one parent was at home. Some folks talk about the lost art of breastfeeding–how about the lost art of cooking?! Instead of passing off a simplistic one-size-fits-all solution, why aren't we giving more guidance to people for ALL the food they feed their kids? You might spend 6 months or a year or two breastfeeding, but you eat solids the rest of your life.

  5. One issue is that there are early problems which do get ironed out within a day or two – and some that don't. Can't predict everything and I hesitate to be too discouraging too early. I do, though, reassure the mom that the length of her struggle will be hers to decide. I try to encourage her to try for a couple of weeks if she's up to it – since you can't really go back and try again easily. Sometimes, it's nice to remind her that ultimately, it will either work out better or she will know when it's time for her to stop. It's not a forever struggle.

    As I read here the description of various encounters with LCs – it makes me think that for struggles in the first week or two, it would be probably helpful to see a hospital employed LC – as they are dealing with the early struggles most often and have more experience with how to deal with these issues (vs. tweaking later problems months down the road).

    Yes, I have also educated on FF – if that's what a mom would like to do (changing or supplementing) – suggesting small amounts in the first day or two, increasing as baby tolerates. How to get a baby to open a mouth to accept the nipple vs. jamming it in. That different nipples than the hospital supplied may be preferred by the baby, and to use slow flow nipples early on for most babies. Lastly, that the 60 mls in the bottles are most often way too much in those first couple of days – but parents do not always know that. (Am I a feeding consultant? Sometimes!)

    Enjoying all of the responses, ladies!

  6. I really wish the LCs that I saw could have been more forthcoming with the realities of breastfeeding. I saw three LCs. The final LC was probably more than a week after my son was born. At that point, I was pumping and hoping to establish a supply. While I felt she was a good LC, she at no point informed me that I might never get a supply, that I wasn't getting engorged (which may have been a problem) and she encouraged me to keep trying. I understand her position, but some truth at that point would have helped me to finally put the pump away and go to formula feeding exclusively. I never got engorged and now, 5 months after the birth, I'm realizing that should have been a sign to the LCs. I also had a nipple issue (possibly the fibrous issue described in the post), but again, none of them said that it may not work out and to prepare for formula feeding.

    I sincerely wish that instead of Lactation Consultants that we could have Feeding Consultants who would look at both options (formula feeding and breast feeding). Because then, once breast feeding is out, new moms and dads have to run to the store and purchase bottles and formulas with absolutely no knowledge of what's best because they had never dreamed they'd be in that situation. We were completely clueless about bottles and formula and were basically left to guess on our own until our next visit with the pediatrician. Feeding Consultants could look at what's best for mom, dad, and baby and make recommendations based on what the parents want to do for their child, but then also be realistic about what they CAN do for their child.

    I also took a child birth class where breastfeeding was championed and made to seem like the easiest, most natural thing in the world. So, I never dreamed I would have the problems that I did.

  7. This is one of those things that's hard to give a general answer to. For me, I would have wanted to know. I had a similar semi-difficult situation – baby uninterested in nursing until 6-7 hours after birth, large flat nipples, no breast changes at all during pregnancy, history of unexplained infertility, and so on. None of the nurses in the hospital (billed as the next best thing to an LC) told me anything more than “Oh, you're doing great!” They mentioned that I'd need to pinch my nipples in a “sandwich” to get my son to latch on, but that was pretty much it.

    I ended up spending the first two weeks in a haze of pain and jaundice and sleeplessness and guilt that we weren't doing very well with breastfeeding. After switching to formula, I held my newborn niece and saw her lean into my breast and open her mouth wider than my son had ever, ever opened his. It made me tear up a little bit, but it was such a relief to realize that maybe there was more going on than just me being a failure.

  8. I think you need to be honest because entirely too often postpartum women are told in one way or another that they are just selfish, lazy and the things that they are experiencing aren't legitimate drawbacks. Honesty and encouragement are the best policies

  9. On another hand… I have PCOS, I knew it could cause supply issues, and I spent all my pregnancy fretting over it. Turned out, my supply was adequate. What I did NOT know was that I had overly soft breasts with flat nipples which would be extremely difficult to latch on (and that my baby would be tongue-tie). I ended up breastfeeding, but God were the beginnings rocky. It's not always obvious what is relevant to know and what isn't.
    (PS, I absolutely love this blog).

  10. If I may add another point to consider, Valerie – in addition to physical and health-related challenges in BFing, it's a good idea IMO to prepare women for the transition back to the workplace and/or for the child to daycare and what that might mean for BFing. Some babies refuse the bottle even if it contains pumped milk if they were not given a bit of bottle early on (experience of a friend); sometimes supply goes down a fair bit without regular nursing and pumping doesn't always work (my experience – low pump yield though excellent growth with direct nursing) and so on. If someone is making a big personal commitment and sacrifices to BF they should be aware of how some life changes that may not be in their control will affect their BFing. I don't agree that it will discourage women – the most disheartened disempowered BFing women I know were those who knew nobody who did not BF or had faced challenges and felt like major failures.

  11. I am also singing with this collective choir. Please be honest from the outset that sometimes things don't work. I, personally, wouldn't have found that discouraging at all, and it would have kept me from building up such false expectations. Incidentally, I found out much later that the educator at the BF class I attended at my hospital was “not allowed” to discuss certain topics because they were worried about scaring people. I was angry about that for months because I really felt that I would have been able to come up with a combo feeding method that worked for me, or at least have a little more time to give up BF on my own terms. As it was, when I was struggling with a newborn who was literally starving, functioning on little sleep, and struggling with postpartum anxiety, I wasn't able to make nuanced decisions, like how to combo feed or what my long-term BF goals were. I was overwhelmed and thinking from a very all-or-nothing perspective. I think if mothers have ALL the information it allows us to come up with Plans A, B & C when we are in a better place to think through those options.
    P.S. Thank you for asking this question and engaging in this discussion! If you ever want to speak with someone in more depth, I would be happy to volunteer, and I'm guessing others would as well.

  12. Long-time reader, first-time commenter. I'm a breastfeeding mom (I know, not the opinion you asked for), and I've been reading this blog since I was pregnant, or maybe even before that, I forget exactly how long. This is where I've gotten my education on a lot of common breastfeeding problems and the lengths that people go to when combating them, and also where I learned to give myself psychic permission to switch to formula without guilt if it got to a point where establishing breastfeeding was driving me bonkers. (It didn't get to that point.) My daughter and I had comparatively minor problems establishing breastfeeding (minor enough, in fact, that I'd never learned to expect them, which actually was a detriment–persistent pain when latching, slightly jaundiced newborns who are too sleepy to eat, and overactive letdown are apparently so common that nobody bothers talking about them.) Even so it was pretty nervewracking the first few days while we got the hang of things on 2 hours of sleep. I wanted very much to know what was going on and what I could expect, and luckily I had enough helpful people in my corner to be able to get this information. It would have sucked royally to have dealt with somebody who knew I was likely going to have a problem and didn't level with me about it. So I agree with you, with regards to the question posed by Valerie. Of course she should be as kind and supportive as possible, but she should give it to her patients straight–if you want to breastfeed, you're likely to have this problem, and here are your options for dealing with it. The more knowledge they have, the better equipped they are to go for the outcome they want. They're then able to make an informed decision about continuing with breastfeeding or switching to formula.

  13. To echo the sentiments of other commenters, yes! A million times yes! I sometimes wonder if the rote repetition of “breast is best,” “anyone can breastfeed,” and, as was the mantra for all of my albeit wonderful and supportive helpers, “that is normal, it will pass” means that we are not speaking frankly as a parenting community about the real issues women face. While I feel fortunate that my progression to formula feeding happened while surrounded by a fabulous team of caring support people, I do feel a bit “let down” (pardon the terrible pun) by the fact that no one ever sucked it up and said “this may not be a sure thing for you.” Not all issues are just “booby traps,” not all issues can be overcome and maybe some issues are not worth working against. Until we have some truthful evaluation of all this, women can't can't make informed choices.

  14. Having information, however discouraging, is a hell of a lot more reassuring and better for a mother's self-esteem and confidence than the panic she might feel when her child is not gaining or eating enough and she doesn't know why. I will be much better prepared for BFing baby #2 as a result of the difficulties I had – the blithe “it's natural and will go on just fine” rhetoric that doesn't prepare you for latch, sleepy baby, reflux/overactive letdown/milk protein intolerance challenges and of course the 3-4 month distractability challenge (all I got from BFIng sites was “you can get through it if you stay up all night to feed!”) actually makes you give up on BFing faster.

  15. I had literally no clue that I have flat nipples, nobody EVER told me until I figured it out on my own that I wasn't the norm. Would have been really nice if one of the LCs at the hospital told me that, and tried to help me figure out how to get around it. And who knows, maybe there were other problems too that made it difficult (for instance I think I had a low supply as well).

  16. I can't tell you how much I wish we could clone you, Valerie.

    The problem I see with most breastfeeding promotion is that it either devolves into “everyone can breastfeed, and those who can't are in such a minority they're not worth mentioning,” or “breastfeeding is hard but if you have the willpower you will overcome any difficulty.” Even most moderate lactivists seem reluctant to even talk about breastfeeding difficulties beyond the usual (bad latch, bad latch, bad latch, and MAYBE reference to pumping for preemies or going back to work), I suspect because the last thing they want is to lose their readership or street cred by putting “booby traps” out there.

    What it amounts to is more of the same: one-size-fits-all medicine. People pushing one medical choice without considering the mother, child, or their charts. It's basically seeing women and children as feathers to add to the breastfeeding cap, or numbers to be added to some statistical goal.

    What a low assessment of women's intelligence! Some folks seem to think that hiding the truth about our own bodies from us empowers us, helps us make better health care decisions, and makes us better mothers. What a low assessment of breastfeeding! Making breastfeeding out to be something that only happens when you're sneaky about it harms all women because it demeans the beauty of breastfeeding, diminishes the power of the CHOICE to breastfeed, and makes those who cannot/should not/don't want to suspicious and more closed to considering trying again with future children.

    What we really need is to treat breastfeeding like any other medical decision–by weighing the pros and cons. We do this in every other aspect of medicine; we certainly do it for men, so why can't we do this for breastfeeding, too? We don't tell prostate cancer patients that chemo is 100% effective. We don't tell IVF patients that every treatment will take. We don't tell rheumatoid arthritis patients that their meds will surely put them into remission. We don't tell people with allergies that if they just have enough willpower, they can stop anaphylaxis, or if they just eat peanuts a certain way, their throats won't close. Why in the world would we treat new moms this way?

    If a woman or baby has an issue that precludes her from breastfeeding, far from wondering if she should know, perhaps there should be some dialog in the medical arena about a patient's/parent's RIGHT to know. If I had IGT, and no one told me, I'd be extremely upset. If I had a breast/nipple shape that made it noticeably tougher to breastfeed and no one told me, I'd be furious. If I had a baby who had a mouth shape that's non-ideal for breastfeeding, and no one informed me, I would be livid. As it was, I remain livid at the LCs who completely missed my issues, and doubly livid at the pediatricians who made me out to be either a child-abuser or a mindless sheeple for giving formula, when it turns out it was the absolute best decision for my family.

    Formula meant that I could care for my child. The third LC I saw (fourth one I talked to; I'd talked to one other on the phone) finally had the openness to see me as a patient and not a statistic, and actually figured out that I was not a good candidate for pumping OR breastfeeding “from the tap.” If I'd had someone like her, or like you Valerie, from the start, giving it to me straight, perhaps I would have enjoyed my baby's first few months of life instead of wasting that precious time panicked and loathing myself.

  17. Yes please be honest. Sketch out what a day might look like and lay out the options. I think a lot of the feelings of grief, guilt and regret come from not knowing what continuing was going to be like. I think a certain number of people who stop out of distress have feelings of what-if and if-only as they gain knowledge after the fact. Which makes gathering knowledge after the fact potentially painful because then the little mental voice wonders what would have happened if you'd just done X instead of Y. What needs ended up doing may sound daunting but emphasize that it isn't forever. Limits are really helpful. And alternate goals. I know I was given directions to pump after every feed and left to it with no end in sight. I finally decided to stop around 6 weeks because I had no guidance (and it was breaking me), and for a long time I felt really guilty about stopping because I had no idea if I should have stuck with it or what.

  18. Hi Milwaukee Mom-
    I just want to say that as the mother of a formula/pumped milk baby who is 6 months, who also saw 3 lc's before figuring out what was wrong, I feel your pain. I want to say to you, you should and I hope are proud of all the time effort and possibly agony you put into both the physical and emotional effort to try and get bfeeding going! Only my 3rd LC discovered the dome-like shape of the roof of my little one's mouth which was kinking my nipple at a 45 degree angle in her mouth–reducing the efficiency of her suck (which all others said looked good-and did from the outside) and caused me agonizing pain. I was VERY happy to hear the realistic advice of the 3rd LC, that while it MIGHT work out after a few more months, it was unlikely, and she supported me if I wanted to switch to pumping. At least my second LC who I saw many times said to me how hard I was trying and how impressed she was at my commitment and things like “I know many other women would have given up by now” things that recognized my effort, while not saying “and you need to keep trying harder”. I want to tell you, because you deserve it, you did a fantastic job Milwaukee Mom!!! Very good point about how just recognizing the effort the mom is putting in, keeps it positive, without putting MORE pressure on the mom, or having to be fakely positive about the situation overall! I for one was glad to be told the real root of the problem. I was really sad to learn that it wasn't anything that could easily be fixed, but I would have been far worse off if I had kept at it at my physical and emotional distress, or if I had quit and no one had ever had the guts to tell me there was a reason behind our struggle…i would have ALWAYS wondered “was it me?” “Did I not try hard enough?” “did I not deal with the pain as well as others”. I still tortured myself when the nursing ended, but it would have been far worse without the real information from a professional about the realistic picture has helped me down the road to emotional recovery…

  19. Bring on the harsh reality! My daughter was born at 32 weeks and our NICU nurses were constantly rotating, so every day that we came in, I was handing my miniscule bottles of breastmilk to a different nurse. I had nurses assume each bottle was a single side, that I couldn't possibly be getting 10ml from both breasts. The LC didn't believe I was pumping 10 times a day. I had multiple nurses tell me that my success breastfeeding was entirely up to me. I would have loved someone telling me I might not make enough milk to feed her, that it just happens sometimes.

    Even better if they could have followed that up with an action plan. Someone saying 'You have low supply, so you're going to need to supplement. We're going to do everything we can to make sure you have a good latch when she goes home. Nurse her at every feeding, top her off with a bottle.' And then given me details on sterilizing bottles, using bottled or boiled water, what kind of formula to use…I got NONE of that information. I would have LOVED for someone to tell me that I could have a good nursing relationship with her and still give her formula. I didn't get that at all. I just got speeches about breastfeeding success being entirely up to me, and then when I continued to get no more than an ounce in a pumping, I felt like a failure.

  20. Lynn– your disclosure is so powerful. Thanks for putting this out there. There are too many sexual assault and abuse survivors (even one is too many, but there are so many more… 1 in 4 to 1 in 10 women depending on whose stats you accept) and of course this can impact experiences of BF'ing. I work with sexual assault survivors every day, and had never thought of this, so thank you for making it part of the discussion and good luck.

  21. I went to a pediatrician who also specialized in lactation problems. They did a bunch of work up and found that I truly had low milk supply. I did the Reglan, Fenugreek, hospital grade extra pumping, and still could not increase my supply. The doctor was very up front with me and said that at best I might be able to breastfeed 50% of her daily needs and even that wasn't a guarantee. After 6 weeks of trying and having my supply go down even more, I gave up the fight and switched exclusively to formula.

    I really appreciated the doctors honesty up front. I didn't feel as bad giving up knowing that I had done my best. I feel that I would want to know what kind of a struggle I was in for.

  22. Hi Elaine, I just want you to know I appreciated reading your response and opinion. It is a great perspective. I also wish I had found this site before baby was born, what a great way to educate yourself on all sides of an issue!

  23. Thanks for all of the encouraging comments helping me to trust my instincts in how to assist a mom. Sometimes when I (or my fellow LCs) are evaluating a specific situation, we are trying to think of what to say as we are processing what we are seeing (or feeling!). Sometimes the baby is just not quite ready to prove what they're capable of — but the clock is ticking and there are pediatricians and neonatologists looking at numbers of pees/stools and ounces.
    Not every woman will be devastated if breastfeeding does NOT work out so it is her choice to continue the struggle or not. I just strive to ensure that a decision is not based on thinking that the “normal” struggle is abnormal.

    It is so helpful for me to hear about the collective stories here and on Bottle Babies so that I can more effectively support the moms I help each week – so thanks for your comments and keep on supporting each other.

  24. Val, you're awesome 🙂

    Asides from telling the mom what you're seeing, some informative pamphlets on the suspected condition and options. I would also do a separate pamphlets on the pros and cons of pumping, ppd and supplementing. I say this because I had one nurse obliquely tell me I may have problems bfing due to my breast shape.. It was something I had never worried about before. I also had no name to look things up. I stumbled on breasthypoplasia quite accidentally when trying to figure out what was wrong.

  25. Wow, if all LCs were like you the world would be a happier place!

    “Do most moms want a realistic picture of what may complicate the breastfeeding success curve in the early days? Or that it may actually be impossible to latch a baby until the baby is possibly weeks old?”


    I think your post is a good place to start. Explain things like you do here. You can be truthful about what you are seeing without being discouraging. This will hopefully open the door between you and the mom for future discussions. She may seek out your help more readily if she knows you will be honest with her and help her figure out what to do.

    I know a lot of moms here would have LOVED to hear things like “ I know you have the desire to breastfeed and I want to support you in meeting your goals, but this isn’t going to be a smooth ride and here is why….” Not giving a mom realistic expectations doesn’t help anyone. This is where moms get so frustrated. Why shouldn’t we be told things about our body and our children that we don’t know?! Knowing what lies ahead of you, helps you prepare yourself for the battle ahead or keeps a mom from feeling so helpless and depressed. THIS is what = informed choice.

    She needs to know that you have her in mind as much as the baby’s well-being. Let her know you will not judge her for whatever decision she will make and that you know it’s not an easy decision.

  26. Please, please, please be realistic! Knowledge is power. I wish someone would have just told me that for some moms & babies bf can be really, difficult and it's probably NOT YOUR FAULT. If I'd have only known that, I wouldn't have beat myself up so much when we had problem after problem. Think about other situations that involve risk. Just because we know the risks of home birth, or getting an epidural, or having a c-section, etc. doesn't mean we won't choose to do those things. We'll just be more prepared (at least psychologically) if complications arrive! Same with breastfeeding. Honesty is always the best policy!

    p.s. I want Valerie as my LC next time! 🙂

  27. Speaking from experience, I can say that I would much rather have had someone sit me down and say, “Listen, I know your goal is to 100% straight-from-the-tap exclusively breastfeed. But that isn't happening now, and if it does happen, it might take a while to get there. In the meantime, here are your options, they are all valid, legitimate options for feeding your child. Let's talk about the pros and cons of each. And let's get to what is driving your goal. What do you hope to get from breastfeeding exclusively so that I can help you get as much of those benefits as possible.”

  28. I would have LOVED a realistic assessment early on with my first child. The positive spin only made me feel bad or as if I was a failure. I have IGT and would have been far less discouraged and taken different measures with my first child had I known about it then. It amounted to lying to me to say “positive” things about how sometimes milk is delayed. And oh, my, how I hated the implication that pumping was a cure all. I like that you present pumping as a more neutral option.

  29. My friend with PCOS who had to use IVF to conceive did not know she may have a had a potential problem BFing because of PCOS until I'd mentioned that I'd read it in a comment here. She was lucky and did not have problems, but I think knowing before helped her to be prepared in case something came up. 🙂

  30. I agree with Suzie – forewarned is forearmed. In my case, it wasn't a potential physical complication, it was a psychological one. Namely, many years of childhood sexual abuse. A lot of which focused on my chest area. The midwifes I saw antenatally all knew this. It was right there in my notes. When it comes to my health (and that of my child) I am not shy about speaking up about my history, so I made sure to talk about it at my very first antenatal appointment.

    Not one midwife ever raised it as a potential breastfeeding barrier. Not one. I couldn't even contemplate that it would be a problem, in terms of BF'ing. (The reason I'd mentioned it at all was that I was aware that my history of PTSD put me at higher risk of pre and post natal depression). I NEEDED someone else to say it to me. Sure, there is the risk that it might've made me go “Oh hell, in that case no!” but you only had to talk to me for a few minutes to know how set I was on BF'ing. I'd have maybe had a chance to prepare myself for how my history of abuse would affect not just my breastfeeding relationship, but also the birth itself! Either way, I'd be going into it eyes wide open. I know it's all “hindsight is 20/20” but I like to think that I'd have been a lot more willing to be vocal about needing better support, if I'd known ahead of time that I had a genuine issue which may cause me problems.

    With any future babies, I like to think that I'd give it another shot. But this time, I'm not going in blind.

  31. My combo formula/pumped milk baby is now 6-months-old, so memories of the 3 LCs I saw in the first month are really sharp. I really wish they had been more forthcoming with me at the outset. It really would have helped me feel more positive about the breastfeeding I was able to do, particularly as I felt very vulnerable caught up in the hormonal monsoon that is those first couple of months. When things went south, I took it so personally because I just didn't know how damned hard breastfeeding can be. May be telling the mother she is doing a fantastic job and being really patient and focused, and then letting her know about the particularities of her own body so she is informed? I might frame the discussion as “I want to tell you what I am observing here so that you are empowered and informed and can come up with what works best for you and your baby….” would veer away from sounding discouraging. But you know what they say about hindsight…

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