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Breastfeeding isn't always easy: Here are answers to commonly asked questions

TODAY logo TODAY 8/10/2018 Jordana Horn

A newborn breastfeedingA newborn breastfeeding © Getty Images stock A newborn breastfeedingA newborn breastfeeding For some mothers, breastfeeding comes easily; for others, it's a struggle. Some enjoy and savor it, while others don't. And most new mothers may have questions about breastfeeding that aren't so easily answered in books or quick sessions in a maternity ward.

TODAY Parents has created the following guide, with the help of Meredith Fein Lichtenberg, an International Board Certified Lactation Consultant and parenting coach, who answered some of the most common breastfeeding questions.

Should it hurt this much to breastfeed?

Breastfeeding babyFrom latching to pain to milk quantity, there are lots of areas where breastfeeding mothers have questions. © Uvarov Stanislav Breastfeeding babyFrom latching to pain to milk quantity, there are lots of areas where breastfeeding mothers have questions. While the baseline answer is no, breastfeeding shouldn't hurt, Lichtenberg points out that discussing pain is somewhat complicated, since breastfeeding taps into physical sensations that first-time moms have never experienced: "You do have nerve endings in the nipple and areola, and it will feel like tugging. It won't feel like nothing." Lichtenberg adds that if you're also in pain elsewhere from your birth experience, "your tolerance for anything else will be minimal." So the first step is to make sure that pain elsewhere is being treated, and that your breastfeeding position is a comfortable one. (For example, if you have hemorrhoids, you may need to adjust your seated breastfeeding position.)

But are you experiencing bleeding nipples and sobbing through every latch? Lichtenberg says that's not normal. "That is not the kind of tugging I mean. Visible skin damage or anything that makes you wince is not OK. When I work with a client I ask her to take her shoes off so that I can see if she is scrunching her feet when the baby latches, which tells me she is in too much pain."

What if the baby won't latch right? How can I tell if she is latched correctly?

Lichtenberg says rather than worry about the latch, just worry about pain. "If it hurts, he/she is not latched well. If it doesn't hurt, then the latch must be OK." What if the latch "looks OK" to a doctor, but a mom is in pain? "If the latch hurts, it's by definition not OK," Lichtenberg says. "If it doesn't hurt, then don't overthink it."

How can I tell if my baby is getting enough milk?

Wouldn't it be nice if a nursing mother's breasts had markers on them, like fuel gauges, showing clearly when they were "full" and "empty"? It does take a while for a new mother to reconcile herself to the fact that there is no exact measurement of how much a baby is taking from the breast in a given feed. Lichtenberg points out that even knowing the exact amount doesn't always help a mother feel relaxed, because sometimes the baby still seems hungry after taking a bottle, or doesn't finish a bottle, giving no clear reason why.

Ultimately, the simplest measure is weight gain. "A baby over five days old should be gaining about an ounce a day/half a pound per week," Lichtenberg says. She recommends going to the doctor or a breastfeeding clinic with a scale to check your child's weight if you are concerned.

She also recommends the FOAL List: Frequency, Output, Activity and Latch.

Frequency: A baby should be feeding 8-12 times per 24 hour period, with some shorter and some longer intervals, self-waking after day 8.

Output: After day eight, a breastfed baby should have six to eight wet diapers a day and at least three yellow mustard poops.

Activity: A baby should take both breasts and have several minutes worth of active, rhythmic sucking and swallows on both sides, interspersed with some sleepier minutes. Lichtenberg says it's not about how many minutes per side, but rather, it's about what the baby is doing during those minutes.

Latch: It shouldn't hurt.

If a mother continues to be concerned about making enough or too much milk, Lichtenberg says, work with an international board-certified lactation consultant who can take a full medical history and work to come up with a plan that makes breastfeeding a better experience.

Is it terrible if I give my baby some formula?

This is an emotionally fraught issue for many mothers of newborns, and many moms are ashamed even to ask the question. "We are talking about feeding well-cared-for babies, and it saddens me that the stakes feel that high," Lichtenberg says. She notes that it's a "complicated issue" because people begin with different goals: "I have had so many clients whose babies needed milk beyond what they could provide, and I sat with them while they sobbed over the baby needing even one bottle. Not because they felt pressure, or like it made them bad moms, but because they had a vision of how breastfeeding would go, and they were heartbroken and disappointed that it didn't."

At the same time, Lichtenberg says, "I've worked with many, many moms who did not feel that way at all, and giving a little formula was no big deal."

The top priority is to look at the big picture. "My job is to, first and foremost, feed the baby," Lichtenberg says. "And priority two through one thousand is to figure out what mom needs and how to get her as close to whatever her goals are as I can, in a way that is safe and respectful, and helps her grow into her role, and to help her manage changes of plan if they come up."

There are many online resources to help you with breastfeeding.

Find a lactation consultant near you through the International Lactation Consultant Association.

Find information about parenting and breastfeeding at KellyMom.com.

Mothers can find local breastfeeding support groups at La Leche League USA.

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