Written by Wendy, IBCLC
Breastfeeding—especially at first—can be overwhelming and stressful. It’s totally common and normal for breastfeeding challenges to come up (I promise!).
Wondering how to solve a breastfeeding problem can be a stressor in and of itself. Let’s say your baby isn’t latching, or you’re wondering if their diapers look okay, or they keep slipping off the breast, or your breasts are sore … the list goes on.
Should you text a friend, do a web search, ask an online breastfeeding group, or call a lactation professional? How to decide which breastfeeding problems are serious enough for professional help, and which can be solved in another way?
What to Know About Different Kinds of Breastfeeding Support
Here’s the good news. There are many different ways to get support as a breastfeeding mom. Often, moms just need a little reassurance. Or they need to hear other mother’s stories to know they are not alone. That’s where calling a friend or engaging in a breastfeeding support group can be helpful.
But there are certain cases where reaching out for professional help is best. This might be in the form of an IBCLC, or board certified lactation consultant—the most highly trained lactation professional. Talking to a breastfeeding peer counselor or other credentialed lactation professional is also an option, as long as they’ve been trained to triage breastfeeding questions. Connecting with your pediatrician, OB-GYN, or midwife are also great options.
Here’s how to know when contacting a lactation professional is the right choice.
Your Baby Isn’t Gaining Weight
It’s completely normal for breastfed babies to lose weight right after birth. This is because of normal fluid loss and the passing of meconium (your baby’s first poop). It’s also because your breastmilk volume is low at first, and then increases when your milk comes in, about two to five days after birth.
However, once your milk starts flowing more abundantly, your baby should start to gain weight. Most experts say they would return to their birth weight by two weeks, but really, if your baby continues to lose weight after their first week, it’s usually a sign that something is amiss. This could be a milk supply issue, a latching/suckling issue, or several factors at once.
When it comes to baby weight gain and milk supply, it’s always better to be proactive. A baby who doesn’t have enough calories or strength won’t be able to breastfeed well. So if you’ve been told that your baby isn’t gaining weight at the rate that’s expected of them, please reach out to a lactation professional. There is almost always a solution here!
Also keep in mind that weight loss at any age is a red flag. Although weight gain slows in babies after the first few months, it should continue at a steady rate. Anytime your pediatrician mentions weight concerns and you are still breastfeeding, it’s always good to connect with a breastfeeding professional to sort things out. It might be nothing, but it might be a problem worth exploring.
Your Milk Hasn’t Come In After Five Days
Everyone is different in terms of how quickly their milk comes in. For most moms, it comes in around two to five days after birth. So if your milk hasn’t come in five days after you’ve given birth, this is a red flag.
How might you know that your milk has come in? Most moms begin to feel more full or even engorged. They may also notice that their babies are gulping milk while nursing and that their suckling is more slow and steady. You should also see more pee in your baby’s diaper, and their poops should start changing from black to brownish/green and to yellow.
If you have any concerns about your milk coming in, reach out to a lactation professional.
Your Nipples Are Damaged or In Pain
When you first start breastfeeding, your nipples may feel tender or slightly sore, and this can be normal. You and your baby are working out latching and sometimes certain angles and positions don’t work out so great for a second. A little tenderness—especially when it subsides within a few seconds of latching on and suckling—can be normal.
However, when there is real pain that makes it hard for you to focus or that just really doesn’t feel right, it’s time to reach out for help. Importantly, if you notice that your nipples or areolas have any damage, it’s usually best to get some professional help. Damage might look like cracks, fissures, cuts, bruising, or bleeding. Other issues include compressed or misshapen nipples when your baby unlatches. Usually sore or damaged nipples can be fixed with better latching and positioning, but other issues might be contributing. That’s why it’s good to reach out. Sometimes you’ll need some nipple cream or other remedies to heal your nipple or areola damage.
Your Baby Is Having Trouble Latching
There are many different latch issues that a baby can have. Maybe they aren’t latching at all—this is one where you need help right away, for sure. Or maybe they latch on and then seem to slip off the breast. Maybe the latch is hurting. Maybe they latch but it feels like they aren’t really suckling much, or they fall asleep soon after latching.
Latch issues can be caused by medical issues, milk supply issues, or just issues with how you are positioning your little one. The sooner you get help, the better. There are so many effective ways to manage this issue.
You Are Seriously Engorged
It’s totally normal to feel very full once your milk comes in. But when you are in pain from the fullness, or when breasts are so full that your nipples have completely flattened out, it’s time to get help. Sometimes the fullness makes it impossible for a baby to latch, and even pumping can be hard. There are methods that lactation professionals can use to help decrease the fullness and also to soften the nipple so that latching or pumping is possible.
Although engorgement usually happens soon after birth, when milk is coming in, it can happen at other times too, like when your baby is having a nursing strike, or sleeping longer at night. Engorgement is a risk factor for mastitis and breast infections, so if you are super engorged and it’s not resolving, it’s always good to reach out for support.
Your Breasts Are Engorged, You Might Have a Sore Spot on the Breast, and Your Feel Like You’re Getting the Flu
Overfull breasts or breasts that aren’t emptied regularly can lead to a condition called mastitis. Mastitis can make you feel awful, like you are getting flu or like you’ve completely depleted and exhausted. In addition to feeling overfull, you might have a particular sore spot on your breast, and you might see red streaks along the breast.
Sometimes during mastitis, the breast can become infected (bacterial mastitis) and you’ll need antibiotics to treat the infection. Other times, supportive care is what’s needed, including continuing to breastfeed on demand, trying cold compresses, and taking autoinflammatory painkillers like ibuprofen. Either way, if you have signs of mastitis, you should connect with a lactation professional or healthcare provider right away for advice and support.
Where to Go From Here
These are the most common scenarios where it’s best to reach out for professional lactation help. But there are other situations where professional help may be best. Trust your instincts here. If something isn’t working for you or you feeling desperate, please reach out. Reach out even if you’re not sure, and a lactation professional can help you understand if your situation requires professional care.
It’s also important to be discerning about informal breastfeeding advice you may get. Other parents and online groups can be great, but there’s a lot of potential for misinformation or bad advice. Most breastfeeding problems are solvable, but you want to make sure solutions are evidence-based, meaning they are based on research and studies from reputable sources. If you are given advice that doesn’t sound right to you, chances are, it isn’t.
Again, always go with your instincts here. They are usually right.
If you need breastfeeding support, here are some reliable places to get it:
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International Lactation Consultant Association, to find an IBCLC
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The Office on Women's Health helpline (800-994-9662), for free breastfeeding support from breastfeeding peer counselor
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WIC breastfeeding peer counseling, for WIC participants
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La Leche League International, for breastfeeding peer support and referral to IBCLCs
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Your baby’s pediatrician or your OB-GYN or midwife—they may be able to provide support or refer you to a lactation specialist for care.
