This advice is specifically designed for mothers who would like to breastfeed their baby on the way, or who are having trouble breastfeeding their child. It is not designed to make mothers who have already chosen to formula feed feel guilty for doing so. If you have given up breastfeeding 
and turned to formula because this information wasn't available to you at the time you made that decision, do not feel bad about it. You made the best decision you could with the information available to you at the time. Ultimately what is most important is that you and your baby are happy, well fed, healthy and comfortable with each other.
Breastfeeding may be natural, but it doesn't come naturally. It is a skill that needs to be taught. There are many hurdles to overcome, and if you don't have someone with experience and understanding on hand to show you how to get over them, breastfeeding can become a very difficult, stressful and upsetting chore. I'm going to do my best to explain the most common problems and ways to get past them to make it easier for those mothers who don't have easy access to adequate support and information. This is not about why you should persist, but how to do it without getting stressed or uncomfortable about it.
Sore nipples
Please note: I have used the term 'nipple' to describe the nipple and the areola as one thing. Most people just know the pink bit in its entirety as a nipple anyway, and I'm just trying to keep it simple and save confusing anyone that doesn't understand the difference.
The most common cause of sore nipples early during breastfeeding is the baby not being able to latch onto the breast properly. This can also have the side effect of the baby not being able to express enough milk and that can also lead to blocked milk ducts and eventually mastisis. See below for how to deal with the milk supply and mastisis. For the moment I'll just describe how to make sure your baby is indeed latching onto the breast properly.
Firstly pay attention to the terminology. It's not called nipple feeding, it's called breastfeeding. Your nipple may seem huge in comparison to the baby's mouth, but it will fit properly. Not all of the nipple has to be in the baby's mouth, but the right amount of it in the right way.
Firstly, sit comfortably and relaxed. Breastmilk will always flow best when the mother is relaxed. Rest your arm on the arm of the chair or a pillow so that is doesn't get tired holding the baby in the same position for an extended period. With your elbow bent, cradle the baby's head in the crook of your arm, with him slighty tilted towards your body. Depending on the size of your baby, your arm will run down the baby's back and under his bottom. Rest your hand on your lap so that you are not straining your arm to hold his weight. If your baby is large, rest his bottom on your lap and support your baby with your hand on his back.
To get your breast properly into his mouth, with your free hand, gently place one finger under your nipple and one above, with your fingers not touching the nipple itself. Press the top of your breast towards you with your top finger to point the nipple upwards. Place the very bottom edge of the nipple to the baby's bottom lip and roll the nipple into his mouth from the bottom up until the tip of the nipple is well into his mouth. He should latch on naturally, but it may take some practise at first. His first one or two sucks should pull the nipple properly into his mouth. By the third or fourth suckle it shouldn't cause any pain or discomfort - unless your breasts are a bit over-engorged. If this is the case, there are two solutions. 1. Put up with it for a few minutes and let the baby drain it for you, or 2. Express the excess milk to ease the discomfort first.
The top part of your nipple may very well not be fully in the baby's mouth and this doesn't matter. The important thing is that the bottom of the nipple is and that the tip of the nipple is deep in the baby's mouth. After a few minutes or so, if your breasts feel like they are engorging rather than draining, it may be that the baby isn't quite latched on properly and not getting sufficient milk. If this happens, remove your breast from the baby's mouth, squeeze a small amount of milk from the nipple to make sure it is in fact coming out, and try again.
A baby's mouth when feeding is like a little suction device and it can be quite powerful. The baby will create a seal around your breast as he feeds. As he feeds there should not be any wet sucking or slurping noises. If for any reason you need to remove your breast from the baby's mouth, be aware of this suction effect. Unless you want to experience pain and see how far you can stretch your breast across the room, you will need to break the baby's mouth seal. The easiest way to do this is to gently stick a clean finger in the corner of the baby's mouth to make him let go.
If you have a persistant problem with trying to get your baby to properly latch onto your breast, it may pay to take a quick visit to your child health nurse, or in a fix, call into the maternity ward of the local hospital, and get someone to give some practical assistance and check that you are indeed doing it right. It takes practise. My eldest son and I took a few feeds to finally get it right, and even then we'd have to make a few attempts to get him latched on to my breast properly at each feed for a couple of weeks. Like all things, practise makes perfect.
The next most common problem causing sore nipples is the baby biting. Most babies will first start to bite when they first start teething, hopefully before their teeth break through the gums. I say hopefully because this is the best time to teach them not to do it, and being bitten by gums doesn't hurt quite as much as being bitten by a mouth full of teeth. The most effective way of getting the message through to a baby that they are not to bite, that I found worked, was to promptly remove him from the breast when he bites and put him down for a moment. Let him have a little cry for a minute and then put him back to the breast. Everytime he bites, put him down again. He will quickly figure out that if he bites, he doesn't get fed and it won't take long for him to stop doing it. Some people might feel this is a little cruel, but a baby so young doesn't understand that what they are doing is cruel to you, and it's not like you can explain it to them. A hungry baby will understand that biting equates to being put down and having to wait a little longer for a feed. The minute of crying will not be as painful for you or the baby as having bleeding teeth marks on your breasts that stop you from being able to breastfeed completely!
If you are expressing breastmilk with a breastpump this can cause sore nipples if the nipple funnel is not the right size for you. There are many different breastpumps available and many come with attachments to suit your breast size. Make sure you have one that is the right size for you. See this advice for further information on breastpumps.
Not enough milk supply
This seems to be the most common reason for giving up breastfeeding. So long as your baby is content, growing well, and gaining weight, he is getting enough milk. Breasts don't come with a measuring gauge to tell you how much your baby is consuming in each feed, and despite some book telling you that a baby should be consuming a certain amount of milk each feed, your baby did not come from a book. There is also the fact that babies won't always consume the same amount in each feed. Some feeds they will want more and some they will want less.
Generally speaking, your supply of milk will keep up with what your baby demands. As the baby grows and needs more milk, your breasts will supply more. I was stunned to have breastfed my youngest son for a few months, to one day give him a bottle and find that he was consuming twice as much as what I expected him to! Make sure you are always well hydrated. Always drink plenty of fluid while breastfeeding and you shouldn't have too many problems. However, there are a few times in the baby's little life when he will suddenly go through a growth spurt and his milk needs will increase so much and so fast that your supply may not be able to keep up. Don't panic, there are two ways around this problem.
Firstly, be aware that babies hit their growth spurts at different times depending on the baby. Some will be a little bit earlier than others, some are late starters. It doesn't matter when your baby goes through his growth spurts, so long as you are aware that it is likely to happen. Generally speaking, the two major growth spurts that are likely to cause the most trouble are around 4 to 7 weeks, and again at 4 to 7 months. Regardless of when the growth spurt starts and the milk demand increases, it usually only lasts a short time, maybe a few weeks at the worst.
If you are aware that your baby is about to enter a growth spurt and you suspect that you will need to increase your milk supply for when this time comes, you can start expressing extra milk at the end of each feed about a week or so before. That way, when your baby starts wanting more, there is more available. If however, you are reading this because your baby has already reached that point and you are desperate to try and find a way to deal with being unable to keep up, here's the second option...
After - and only after - your baby has had as much milk from you as he can get, and he is still hungry and grizzly and wanting more, give him a bottle. If you have breastmilk stored, great, use it. If not, formula will not hurt. The worst it will do is make your baby's nappy smell a little bit worse for a short time and give you some peace and quiet. While your baby is topping up his feed from the bottle, express as much milk as you can. Even if it seems you are getting nothing, keep trying. The act of stimulating the breast to produce more milk is what is important, not whether you are getting any more milk out. Keep what you get to use for your baby's top up after the next feed if you have enough. If you don't, stick with the formula top ups until you get past this tiresome stage. Do this for every feed. After a few days to a week or so, your baby will suddenly start drinking less and less from the bottle. This is because he is finally starting to consume more from the breast. Your baby will eventually stop being grouchy about not getting enough milk from the breast because your supply will have finally caught up, and you can just go back to breastfeeding normally.
These growth spurt times can seem to drag on forever. They are tiring, frustrating, and draining; physically, mentally, and emotionally. The good news is, they don't actually last as long as they seem to. Two weeks can easily seem like 2 months at times like this. Keep track of your progress with a calendar. Bare in mind that it should only take, at most, a few weeks to get through and it will all get easier again. In fact, breastfeeding will suddenly seem like a breeze in comparison if you can just get past this harrowing time. If the calendar is telling you that it is dragging on a bit too long, check in with your child health nurse to see what is going on.
Mastitis
This is a nasty painful condition to which some women are very prone. I'm one of them. Mastitis is a bacterial infection that occurs most commonly in breastfeeding mothers, but can in fact happen to any man, woman or child. The first signs of it are very similar to having a blocked milk duct and if a blocked duct occurs and is not relieved, it can quickly lead to mastitis. The symptoms of a severely blocked duct and mastitis are so similar they are often confused. Hotness of the breast, especially near the site of the blocked duct, a firm tender lump in the breast, and sometimes redness of the skin near the blockage are all signs of these conditions. When a fever also sets in, it is quite likely to be mastitis.
I found the best way to combat it was simply to relax in a warm shower or bath and express the milk until all the ducts are clear and the pain has eased, massaging the lumps out of the breast from the back of the breast towards the nipple as I expressed the milk. The sooner you get to doing this the better. Leave it too long, and it can become full-blown mastitis, which is unbarable and may need medical intervention, such as anti-biotics, to solve the problem. The milk going down the drain in the shower was not really going to waste, as the breast just produced more anyway, and I only needed to get rid of enough to ease the symptoms, which still left plenty of milk for my baby.
Alternatively, if you only have one breast effected and it's only mild, allow your baby to drain it for you. Again, massage the lump out of the breast as your baby feeds and make sure to put the baby on the blocked breast first. This didn't work so well for me because I rarely had only one breast effected and I often had multiple blockages at once when it happened. Each blockage can slow down the milk extraction which can frustrate a hungry baby, so I just preferred to get the blockages out first.
For more information about mastitis, see this advice.
Social embarassment
The first and most obvious social embarassment with breastfeeding is leaky breasts. There are various breastpads on the market to help minimise the embarassment, some more effective than others. In a fix, cut a sanitary pad in half and tuck that in your bra. In fact, many mothers will recommend you just go with the sanitary pad right from the start as they do absorb more and are a lot more effective. I couldn't wear bras at all whilst breastfeeding without ending up with blocked milk ducts very quickly, so I just had to hang lose and deal. Dark black shiny shirts are good for this sort of situation. Just drip some water on a shirt and if it is very obvious, don't wear it. If you can hardly see that it is wet, put it on.
The most common social problem with breastfeeding is public opinion. Some mothers are as tough as nails and nothing anyone says will deter them from feeding their child anywhere. Not all women are like that. Some are very self-conscious and very sensitive about the opinions of other people. Be aware that no matter what you do, you are going to have people tell you it is the wrong thing. If you breastfeed your child for longer than a few months, you will start having people try to tell you that the child is too old for it. If you feed your baby from a bottle - even if it is breastmilk - you will have people tell you you should be breastfeeding. You can't win, so don't fight it, just ignore it.
Some mothers are not comfortable about breastfeeding in public, just as some people are not comfortable about nudity or making the baby in the first place with the light on. If this is you, many places have parent rooms where you can go to feed your child with more discretion. When breastfeeding in public, be aware that not everyone is comfortable seeing a mother breastfeeding a child either. You will always be treated with a little more respect if you do what you can to cover up a little bit. Put a towel, baby blanket or shawl over your shoulder to sheild your breast from public view when you can.
If someone asks you to move to a more suitable location, you need to consider the reasonableness of their request and how much it will put you out to do so. If you are at an event with friends or family, especially if you are paying to be there and you have been discrete about it, you have a very good ground upon with to simply refuse to move. What are they going to do - call the cops to remove you for feeding your child? That would make for an interesting court case and chances are they would lose. Hello compensation payout and more rights for breastfeeding mothers! However, if you are just sitting in a shopping centre mall and you are failing miserably at every attempt to be discrete, and you're not waiting to meet up with someone, you just happen to be between getting your grocerices and paying the bills, it won't hurt to go to the parent room - if it is indeed a clean modern suitable room. Sure, you might not be embarassed by it, but evidently someone is, and do you really need the stress of arguing the point and having other people pass negative judgement on you and make derogatory comments? Of course it's your choice, and I applaud any mother that is willing to tell someone that has suggested she go somewhere more appropriate where she thinks it would be more appropriate for them to stick their request. I do it myself. However, if you are a bit more timid than me and you do feel compelled to comply to such request, don't go feeling guilty or bad about breastfeeding because of it. Blame the narrow-minded people that took offence to you doing it. Its not breastfeeding that is bad and it certainly isn't you, it's public opinion that needs a kick in the butt.
Of course if you are simply to shy to breastfeed in the company of others, by all means, express the milk and put it in a bottle for those times you can't get some privacy.
Psychological problems
A lot of people rave on about breastfeeding and mother-child bonding. I say codswallop to that. There are plenty of exclusively bottle feeding mothers who are just as closely bonded with their children as breastfeeding mothers, and there are plenty of breastfeeding mothers who just don't feel that bond with their child. Sure, breastfeeding does help many mothers with the bonding process, but it's not the be all and end all solution to the problem.
Breastfeeding is called that because it is about feeding. If you are finding that you are not bonding the way you expected to with your child, it doesn't mean that you are failing in breastfeeding. If you are feeding your child adequately you are succeeding. If you are not bonding with your child there are others reasons for it.
Post Natal Depression (PND) is probably the most common cause of a lack of bonding, but it isn't the only one. A traumatic birth can create an unintentional resentment towards the baby. So can an unplanned pregnancy and being ill-prepared to have a child. If you have since seperated from your partner bitterly and people are telling you your child looks just like daddy, that can be a problem too, especially if you start seeing your child the same way. These problems have nothing to do with breastfeeding and giving up breastfeeding will not solve these problems. If this is you, some good professional counselling is probably the best help you can receive.
Some mothers are just uncomfortable about breastfeeding. The idea of a child suckling milk from their breast just doesn't feel right to them. Being uncomfortable about it in this way does not make it easy. For some women counselling can help, but for some there is just no two ways about it. It just doesn't feel right for them no matter what. I start feeling the same way once my children get older. I was lucky, both of my boys gave up on breastfeeding of their own accord when they were about year old, and I was quite grateful that they did. The idea of a child being able to walk up to me and say "Mum, I want a drink of milk" and wanting my breast just makes me feeling really weirded out. I applaud mothers who can breastfeed their child until they are 2 or 3 years or older. It's just not me. If I was put in that situation I'd be inclined to express the milk and hand it to them in a bottle or cup.
If you are feeling very uncomfortable about breastfeeding your child for this reason, and no amount of counselling or getting used to it is going to change that, you are probably better off not doing it. If you are genuinely uncomfortable about it, being forced to do it may well breed resentment for your child, and that is not a good thing. If you can, express the milk and bottle feed your baby. If you can't even do that much, buy formula. It doesn't mean you are a bad mother. So long as you do what you believe is best for you and your baby, you are doing the right thing, and that makes you a good mother.
Being away from baby
Be it because of work, hospitalisation, or shared custody issues, there may be times when you won't be able to be with your baby, or at least won't be able to breastfeed your baby. Just because you can't breastfeed during these times, it doesn't mean the baby can't have breastmilk and you can return to breastfeeding afterwards in most cases. You can always keep expressing milk and baby can drink it from a bottle until you can breastfeed normally again. Keep expressing the milk during the time your baby is away from you at his normal feed times to keep your milk supply going in his absense, regardless of whether or not the baby is having the expressed milk.
When my youngest son was in hospital I was with him the whole time, but he simply couldn't feed for 5 days. So I expressed the milk at his feed times, and because he couldn't drink it I donated it to the hospital for other babies that needed it. As soon as he was able to feed again he went back to the breast. I had a bit of a problem convincing him to take it at first but it didn't take him long to figure out that if he wanted to get fed he had to take it, and he did.
A friend of mine had to share custody of her child with her ex partner, and of course her ex partner obviously can't breastfeed, so when her baby was with him she would express the milk at her feed times and store it. When the baby went with her father the stored milk went with her in bottles. When her baby was with her, she breastfed normally. If her partner ran out of breastmilk he would just use formula for a little while until she was able to get more breastmilk to him. For situations where the other parent refuses to use the breastmilk, they can just use formula and the baby can go back to the breast afterwards so long as mum has been expressing adequate milk in the baby's absense. If the baby gets fussy and will only take a bottle and all else has failed, breastmilk in a bottle is an alternative option.
Drugs, alcohol, and illnessness
Many - but not all - drugs and other such chemicals can leach into breastmilk. This includes alcohol and nicotine. Some drugs and chemicals can harm the baby, some won't. If you are taking any kind of drug - prescription or not - or if you have been exposed to a potentially harmfull chemical, you should be checking with a doctor or pharmasist as to whether it is safe for the baby. Can the chemical or drug go through to the breastmilk and if so, are the levels of it in the breastmilk safe for the baby? Some diseases can also be harmful to a baby and can be transmitted via breastmilk as well. Better to ask a doctor and be safe than sorry. Though I wouldn't worry too much about catching a cold as your baby is more likely to catch it from you sneezing or coughing on him.
If you are going to a party and you are wanting to have a few drinks, planning ahead might be a good idea. Express a sufficient supply of breastmilk so that you can safely bottle feed your baby for a couple of days afterwards so that the alcohol in your system doesn't effect the baby. The same can be done if you know you are going to have to take a temporary course of medication. Keep expressing the milk during the baby's normal feed times and just tip it down the sink. The important thing is that your baby is safely fed and you can still go back to breastfeeding afterwards. If you are caught by surprise by having to take a medication you weren't prepared for or some similar situation, and you didn't have time to express sufficient breastmilk to keep your baby fed while you can't breastfeed, then by all means, do the same and just use formula for that time.
There may come a time when you find that you can not breastfeed for an extended period due to illness or a medication that you have to take. If given a choice between taking a life saving medication for a long period or breastfeeding your baby, you have to make a choice. Is being able to breastfeed your baby for a few months longer worth leaving your child motherless if you died? I can't see many mothers chosing to refuse to give up breastfeeding in this situation. If you find that you have to give up breastfeeding for an extended period, don't feel guilty about giving up all together. It's not your fault, it couldn't be helped, and you made the best decision to keep you and your baby safe and healthy.
One breast only
Be it as a result of accident, breast cancer, or numerous other things, there are some women that only have one functioning breast. This doesn't mean they can't breastfeed. A baby will stimulate a breast to produce as much milk as necessary. Swapping sides while feeding is good because the baby encourages both breasts to supply evenly, and it keeps them well balanced, but it isn't necessary. In the very early stages of a baby's life, getting that think colostrum rich milk from both breasts is a good thing for them and feeding from both gives them more of it at first, but only feeding from one breast still gives them plenty. Some mothers prefer to feed from one breast only as it is more comfortable for them. I did for a while.
My youngest boy was huge as a baby. By the time he was six weeks old he was the size of a 6 month old baby and he just kept getting larger and larger. By the time he was about 6 months old, I simply couldn't hold him to my left breast for very long as he was just too heavy. My right side was stronger than my left, so I reduced his time on the left breast and increased his time on the right, where I found it easier to hold him. I eventually gave up on the idea of feeding off the left breast entirely and fed exclusively from the right breast. Sure, one breast was bigger than the other and it looked a little odd, but given that my boy was so large and heavy and I just couldn't hold him to my left breast for any length of time, I didn't have a lot of choice. My left breast dried up and so I was able to stop worrying about blocked ducts and mastitis on that side at least, and my boy was still able to get as much milk as he needed when he needed it, from the right breast.
Wet Nurses
Before formula was invented, babies didn't always have to starve and die if the mother couldn't breastfeed. Problems with breastfeeding aren't just a modern phenomenon, they have been around ever since the dawn of mankind. In most societies, if a mother couldn't breastfeed her child for some reason, a wet nurse would be hired - some did this voluntarily - to feed the baby.
A wet nurse is simply a lactating woman who supplies breastmilk for another woman's child. In modern society, they still exist, they just aren't as common. They rarely directly breastfeed the baby themselves nowdays, more often opting to express milk for the child to be fed in a bottle by someone else.
If you are having problems with supplying your child with breastmilk and you prefer to not use formula, this is an alternative option you may find useful. Wet nurses sometimes donate breastmilk to hospitals, so some hospitals that accept such donations may have contact details for anyone they have doing this for them. Breastfeeding and Nursing Mothers associations may have contact details for some of these women as well. Some have to be found by advertising your need for one. I strongly advise that you have a sample of the woman's breastmilk sent off to be checked by a pathology laboratory to make sure there are no harmful chemicals, drugs, or diseases in the milk. This can be also useful to single fathers who wish their child to receive breastmilk when the mother is no longer with them.
When to throw in the towel and give up
Most babies will eventually wean themselves. There is not set time for weaning. Some decide they don't want it anymore when they are about a year old, others keep it up - mother permitting - until they are 3 or 4 years old, and some go even longer than that. The world health organisation recommends that babies be exclusively breastfed for at least the first 6 months of life and suggests that it continue until at least 2 years of age. This isn't always possible however. Personally, I say do the best you can for as long as you can.
If you find that nothing has worked for you and you choose to go with formula feeding, don't think you have failed as a mother or failed to breastfeed. You succeeded in doing the best you could for you and your baby, and that is all anyone can rightly expect of you. The world is not a perfect place. There are many reasons for giving up breastfeeding. Some mothers choose by personal preferance, some simply have no choice in the matter. Many mothers that turn to formula feeding are made to feel guilty by people who haven't had to walk in their shoes. The only way anyone can make you feel guilty is if you let them. Sure, breastmilk is considered better and healthier than formula, but when breastmilk is not available, formula is the best thing.
The best mothers are the ones that do all they can to make well informed decisions about what they believe is best for their child at the time. Nothing else matters.
(September 2007) (
