It is difficult when breastfeeding does not work, and if this applies to you, you should know that you are not alone! Here we go through the most common situations and what you can do.

When breastfeeding doesn't work

Parents typically worry whether the amount of breast milk will be enough for the baby. Baby may want to nurse often, and you feel uncertain if baby is getting enough milk. Not knowing exactly how much your baby is eating creates a sense of unease. You may even feel like you want a pair of transparent breasts with clearly marked measurements. But nature did not design us that way.

## Signs that breastfeeding is going fine 
Signs that breastfeeding is going fine and that your baby is eating enough are that your baby:

-	Has a large portion of the breast in his or her mouth when sucking
-	Sucks actively and strongly with a normal suck pattern that includes small breaks in between
-	Lies with his or her chin touching the breast and the nose unobstructed
-	Works the jaw and swallows
-	Lies close to you
-	Is content and active after feeding (but may want to eat soon again)
-	Urinates at least eight times per day and has stools
-	You feel positive while nursing and after, and your nipple looks the same as before.

## What you can do for you
How you care for yourself also has an impact on the amount of breast milk that your body produces. Consider the following:

-	Hold your baby skin-to-skin with baby’s nose unobstructed and always nurse on baby’s signals, which is often in the beginning. Doing so signals to/informs your body that it needs to produce more milk and promotes breastfeeding. The more you nurse, the more milk you produce. Supply and demand. Offer two to four breasts per session. Switch back to the previous breast.
-	Drink plenty of fluids. Fill the fridge with freshly squeezed juice and smoothies so that you can drink nutritious beverages when you produce milk. Always have something to drink next to you when you nurse.
-	Rest a lot. You need to crawl into bed, pull the curtains and turn off your phone even during the day. Take the chance when your baby sleeps. This makes a big difference in how you cope with breastfeeding in the evening/night and your milk supply later. 
You’re probably sleep deprived from the end of your pregnancy, labor and the days following.
-	Try breast compressions–squeezing the breast gently and carefully while your baby sucks.
-	Get support from the maternity ward, child health center, or breastfeeding clinic if the above doesn’t work.

## Support from your healthcare provider
Your healthcare provider will look at your breastfeeding status and your baby’s behavior at the breast. If none of the above helps, then you can try a supplemental nursing set. This involves hanging a bottle around the mother’s neck that contains pumped breast milk or baby formula, and a thin tube attached at the nipple. When the baby sucks the breast and the tube, the baby gets breast milk from the breast and breast milk/formula from the bottle. Baby will get enough milk and be satisfied, while the breast will be stimulated to produce more breast milk for later. Usually, milk supply will increase and supplemental nursing can be reduced gradually. 

The supplemental nursing set is available in pharmacies (complete with instructions) if you want to try it yourself.

*Tips! *If you feel that the tubes are in the way, that it feels complicated and you’re getting frustrated, put the supplemental nursing set aside. Do what you usually do and then try the set next time you nurse.

*Note!* If baby’s skin is yellow (newborn jaundice), and if baby is sleepy and quickly falls asleep at the breast, call the maternity ward.

Parents typically worry whether the amount of breast milk will be enough for the baby. Baby may want...

I don’t have enough breast milk

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It is important to distinguish between engorgement and clogged milk ducts, two completely different conditions. 

## Engorgement
Milk production in your breasts increases during days 3 to 5 after baby’s birth. As the milk comes in, a condition called engorgement occurs. The lymph nodes and lymph tissues swell, and both blood supply and the amount of milk increases, causing your breasts to tighten. They may become hard and lumpy. When the milk comes in, you can feel the milk ducts all the way up to your armpits. This is a normal condition—a good normal condition—that occurs when mature milk comes in. Not all women experience engorgement, and it is possible for milk to come in without feeling any tightness in your breasts.
Engorgement means that you feel a tightness in both breasts which become hard, sensitive and reddish.  It is difficult for baby to latch on your breast. You may also develop a fever.

__What to do__
To help baby latch on correctly, try a technique called reverse pressure softening (RPS) or gently hand express before your baby nurses in order to relieve some of the pressure.

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## How to alleviate the symptoms
-	Use heat or cold on your breasts (in the shower, for instance)—whichever feels best.
-	Rest, crawl into bed.
-	Drink plenty of fluids, ideally juice, warm beverages and nutritious smoothies.
-	Take Ipren (ibuprofen) for the pain, or Alvedon (paracetamol). Follow the instructions on the package.

Breastfeed often during these days. Frequently hold your baby skin-to-skin with his or her airways free. This helps to increase oxytocin levels in your blood, which stimulates the let-down reflex (milk ejection reflex). Gently hand express standing in a warm shower. You cannot pump out engorgement, but pumping can alleviate some of the pressure.

## Hormones that make you weepy
Hormones are raging in your body when your milk comes in, which might make you weepy and emotional. This is because oxytocin and prolactin (the two breastfeeding hormones) are at their highest levels. Baby wants to nurse often. Breastfeed as often as baby wants. Imagine that by nursing, baby is placing an order for more milk within a few days. Take extra good care of yourself at this time. Take one day at a time.

## This will pass
It will not be like this the entire time. Engorgement usually passes after one or two days. Your breasts will get soft again, indicating that you have only breastmilk in your breasts. 

## Rule out infections
Infections such as urinary tract infections, uterus infections and other such infections should be ruled out. If you feel that your general wellbeing is affected or you feel ill, contact your healthcare provider.

## Clogged milk ducts
Clogged milk ducts can be divided into bacterial and inflammatory clogged milk ducts.

Clogged milk ducts caused by bacteria start with a wound on the nipple, thereby enabling bacteria to sneak into the milk ducts (where they should not be). A bacterial infection develops in the breast.

Inflammation of the clogged milk duct is an inflammation that occurs when one or more of the milk ducts are obstructed due to swelling around the ducts, preventing the flow of milk. It usually feels like a lump in the breast. Sometimes, these are the only symptoms and the lump will disappear on its own if you continue to breastfeed.

At other times, the mother will have painful breasts, the area around the inflammation will be red and swollen, and breastfeeding is painful. A high fever is also a possibility. The symptoms typically occur suddenly.
We will focus on inflammation of the clogged milk duct, which is most common.

__Inflammation of the milk duct can occur for various reasons__
-	Baby does not have a large portion of the breast in his or her mouth when sucking.
-	Baby has, for some reason, not nursed as actively or strongly on the breast as before—either because the baby is ill or because it takes a long time between feeding sessions.
-	You remove baby from the breast before he or she has finished feeding.
-	Tight bras or tight-fitting clothes.
-	Feedings are suddenly spaced farther apart because baby is sleeping longer.
-	Stress, fatigue, pain and anxiety can cause mastitis since stress hormones can inhibit oxytocin and thereby also the let-down reflex.

__What to do__
-	The first thing you need to do is determine the cause of the clogged duct in order to treat the underlying problem. It usually passes on its own, but you may need medical attention.
-	The treatment involves breastfeeding frequently from the breast with the clogged ducts. Try to hold the baby so that baby’s chin is touching the area where the clogged duct is located. Gently stroke the area that is red or affected. Drum your fingertips, play the piano or move your fingers gently over the red area and down toward the nipple, ideally while your baby nurses.
-	If breastfeeding is too painful, hand express or pump your milk. It’s good to know that your baby can always extract more milk than you can by hand expressing or with a pump.
-	Remember to nurse from the healthy breast as well.
-	If heat feels good, place a warm wheat bag or warm towel on your breast before breastfeeding to alleviate the pain.
-	Shower while hand expressing as a form of treatment.
-	Rest a lot.
-	Drink plenty of fluids.
-	Try to find a quiet place.
-	Use pain medication when necessary.

Other infections and when you need medical attention
It’s important to rule out other infections. Make sure that you do not have a urinary tract infection, a uterus infection or some other infection. Get medical attention immediately if you suspect you have an infection.
If your general wellbeing is affected, call your healthcare provider for advice.

If you are pregnant and develop clogged milk ducts that do not go away after two days, call your child health clinic, breastfeeding clinic or healthcare provider. If you have stopped breastfeeding and develop clogged ducts, always contact your healthcare provider.

If a lump does not go away within two months, always contact your healthcare provider.

It is important to distinguish between engorgement and clogged milk ducts, two completely different ...

I think I have clogged milk ducts

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The most likely cause of breastfeeding pain is that your baby is not latching correctly or that your baby is not close enough to you. Another reason could be baby’s position in your arms—either that your baby is too close to your armpit or too close to your chin. Or your little one has not latched correctly, causing sores or cracks on the nipple. Tongue tie, or ankyloglossia, could be yet another reason.  

## Breastfeeding should be painless
There is no reason to settle for painful breastfeeding, either at the beginning or later. When your baby first starts to suck it is normal to feel some pain or tenderness, but it shouldn’t last more than that. Be aware of how it feels and respect how it feels when baby sucks.

## When breastfeeding hursts—do this
-	Look to see that baby latches correctly and has a large portion of the breast in his or her mouth. Wait until baby opens wide and hold your baby very close. Not all babies open wide, in which case you will have to wait until your baby opens as wide as possible. 
-	If you feel that breastfeeding is painful/hurts after the first few sucks, carefully switch your baby’s position in your arms. It’s often a question of lowering baby from your armpit and bringing your shoulders down so that baby is positioned below you. 
-	Hand express some breast milk before and after baby nurses. When you hand express before baby nurses, you help baby to initiate the let-down reflex so that baby can suck more calmly from the start. Soothe your nipples after nursing by hand expressing a drop of milk that you apply to your nipples. 
-	Air-dry your nipples. Oxygen heals wounds. Restrict the use of creams and ointments since they block oxygen in the air from reaching the wound. If you feel that an ointment is soothing, alternate between using and not using it.
-	There are different types of breast shells that provide relief. They relieve the pressure on the nipple and are stocked by pharmacies.
-	Take a few deep breaths and drop your shoulders while your baby first latches—this is when it feels the most.
-	You can also try using a nipple shield. This can make nursing feel more manageable (unless making minor adjustments to baby’s position reduces the pain).
-	Hand express or pump for relief on the nipple and reduce tenderness.
-	Do an evaluation using Checkup—5 steps to successful breastfeeding.
-	If you have a partner, involve them to get help and relief.

## When breastfeeding is painful even later
If breastfeeding becomes painful later (when baby is a bit older and breastfeeding has not been an issue before), there are a few reasons:
-	Bacteria or yeast infection
–> Consult your child health clinic, breastfeeding clinic or healthcare provider.
-	White spots, tiny white spots that form on the nipple, are like small salt crystals inside the breast that also form on the inside of a milk duct and can cause pain during and after feeding.
–> Consult with your child health clinic, breastfeeding clinic or healthcare provider.
-	The nipple turns white and it’s like a vasospasm, which also causes breastfeeding pain.
–> Consult your child health clinic, breastfeeding clinic or healthcare provider.
-	Baby has tongue tie -->  Contact your child health clinic or breastfeeding clinic for a referral to a pediatrician or an ear-nose-throat specialist to perform a clip. 
-	There are also other reasons why breastfeeding is painful.

## Baby bites
When your baby’s teeth come in, he or she might bite your nipple, which can be immensely painful. Say “No” clearly and succinctly, and take him or her off the breast for a while. Resume nursing in a few minutes. Repeat as needed.

## Find what works for you
The most important thing is that you respect how it feels when you breastfeed. Test various breastfeeding positions and make minor adjustments to baby’s position in your arms in order to find what works best for you and to ensure that feeding is painless.

If this does not help, contact your healthcare provider.

The most likely cause of breastfeeding pain is that your baby is not latching correctly or that your...

Breastfeeding hurts

River-Birth-Story-131

During the nursing period, it’s common that baby suddenly refuses the breast for some reason.

__The first day__, the reason could be that baby is nauseous and vomiting, or quickly falls asleep at the breast. But a healthy baby born at term can survive fine on the reserves accumulated while in your belly. Hold your baby skin-to-skin with his or her airways free, stimulate your breasts/hand express and wait.

__Days 2–4__, when the milk comes in, your breasts could be swollen and firm, making it difficult for baby to open his or her mouth enough and properly latch. It’s important that baby eats while you continue to stimulate breast milk production. In order to soften a firm breast (so that baby can latch onto the breast properly), use a technique called reverse pressure softening (RPS). 

Other reasons why your newborn refuses the breast are that baby is making an immature tongue movement, or lifting the tongue up to the roof of the mouth or that baby has tongue tie.

__At between two and three months__, baby starts taking a greater interest in his or her surroundings. Suddenly, a baby who previously nursed well starts reacting to external sounds and voices. Although baby has started to nurse, he or she will pull off the breast to see where the sound or voice is coming from and does not continue nursing.

Many babies recoil if you hold your hand behind the head and press baby’s head against the breast—even if your intention is good. Your baby might react by pulling back instead. Most babies want to decide themselves when they can withdraw their head while nursing. Place your hand on baby’s shoulders/back.

When baby refuses to nurse, this can cause frustration for the mother, the baby and oftentimes, even the partner. The sound of a crying baby goes straight to a parent’s heart and can be extremely stressful.

## Try this
-	If your baby refuses the breast, start from the beginning. Frequently hold your baby skin-to-skin with his or her airways free.
-	Hand express or pump to stimulate your breast to ensure milk supply.
-	Offer the breast when your baby is calm and not extremely hungry—perhaps at the first rooting and suck signals, or pick up your baby while he or she is sleeping and offer the breast.
-	Reverse pressure softening, see above.
-	Try different breastfeeding positions, such as laid-back nursing which gives baby full control, or whatever feels best for you.
-	Give baby some expressed milk from a spoon or cup before your offer the breast to calm down baby. Then allow baby to start nursing in baby’s own time.
-	Find a quiet place. You may have to rethink where you breastfeed. It may not be possible to nurse just anywhere and that baby needs a quiet place with subdued lighting for a while. Try to find a good spot, and take your time.

## Remember
-	Try to find quiet, stress-free moments together with your baby, even when baby is full and satisfied. Hold your baby skin-to-skin (with his or her airways free). Don’t forget to take care of yourself. Rest and drink plenty of fluids.
-	Make sure that baby eats somehow. Give baby expressed milk from a cup, bottle or spoon to calm your baby.
-	Stimulate your milk supply by hand expressing or the use of a pump.

During the nursing period, it’s common that baby suddenly refuses the breast for some reason.

Baby refuses the breast

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Babies are occasionally born with tongue tie, an overly tight lingual frenulum, that can affect breastfeeding. When tongue tie gets in the way of breastfeeding, it is important to get help since the condition is treatable. A tiny clip in the lingual frenulum can help.

__Signs that baby has tongue tie that affects breastfeeding:__
-	baby cannot latch firmly to the breast
-	baby often chokes on the breast milk
-	baby is not gaining enough weight
-	baby has a heart-shaped or bowl-shaped tongue
-	baby gets frustrated while nursing
-	baby struggles to stay latched
-	you hear smacking sounds when you nurse.

## Symptoms for the mother
The most prominent symptom in the mother is that breastfeeding is painful when baby has tongue tie. Other symptoms include:

-	sore nipples
-	low milk supply despite nursing frequently, and it takes a long time to nurse
-	the nipple is crooked after nursing (looks like a new lipstick)
-	vasospasms while nursing.

## What to do 
A tight frenulum stems from the fetus stage. It fills no real function and can therefore be clipped. The frenulum is clipped by a pediatrician or an ear-nose-throat specialist. Your child health clinic or breastfeeding clinic can write a referral.

## How it’s done
Baby should be full when the procedure is carried out. Using a little syringe, he or she will be given a sugar solution to swallow and a local anesthesia under the tongue. The tongue is lifted up and a quick incision made in the frenulum. Most often the baby cries and there is only a drop of blood. 

We recommend giving the breast immediately after to calm the baby. The mother can occasionally feel the difference in breastfeeding immediately after, but it could also take some time. Try to be patient. 
There is generally no noticeable change in baby after the procedure. Baby might be fussy the first day and a little sore. If your baby seems to be in pain after the procedure, you can administer pain medication in consultation with your physician.

## Lip tie
Recently, it has been discovered that lip tie can cause similar difficulties and can also be clipped. There is clinical data about this, but not enough scientific studies as yet.

## If you suspect your baby has lip tie
Many times, tongue tie is not the only issue that makes breastfeeding a challenge. Other issues can play a part, such as baby’s breastfeeding position. Contact your maternity ward, child health clinic or breastfeeding clinic first. Problems can usually be resolved without a procedure.

Babies are occasionally born with tongue tie, an overly tight lingual frenulum, that can affect brea...

Tongue tie

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When you feel that you are nursing frequently and large amounts, the first question is how old your baby is. There’s a huge difference in the advice we give the mother of a newborn and the mother of a slightly older baby.
The newborn infant

The first three days when your milk comes in, baby will nurse very often. This gives baby access to the colostrum in your breasts. Colostrum is not always visible to the naked eye, but it contains everything your newborn needs, and is rich in antibodies, proteins and other good substances. A healthy baby born at term generally nurses directly after birth and might then sleep for a long period the first day. The next few days after birth, baby wants to nurse at least eight times a day, and usually more often.
It is common for baby to nurse more frequently and intensely in the evening. Try to prepare during the day by resting and eating and drinking well if possible.

## Recommendations
-	Let your little one nurse from different breasts (switch between breasts). When baby pulls off the breast, falls asleep and wakes again, switch to the other breast. Babies can often nurse “four breasts” per feeding session. For example: Start with one breast, switch to the other and then take a break. Maybe change the diaper and then nurse again from the first breast (the third) and finish with a good-night slurp from the second breast (fourth). Imagine it as a four-course meal.
-	Hold your baby skin-to-skin with his or her airways free.
-	Remember that when your baby nurses, this stimulates an increase in milk supply—the more baby nurses, the more milk later. The less baby nurses, the less milk later. Imagine that baby is placing an order for milk by nursing.
Many parents feel that it is difficult to know if baby is eating enough. It is seldom a matter of tummy issues when a baby wants to nurse the entire time, urinates and has bowel movements several times a day. Just nurse more, rest and drink plenty of fluids. Pay attention, see what baby does while at the breast and evaluate each feeding.

## Remember
When you sit with your newborn infant at your breast nonstop, bear in mind that it will not be like this the whole time you breastfeed. Feedings will become more infrequent in time. You will find a routine that works for you both. Remember that this will last only a short period.
It’s a few days/weeks now in the beginning that your baby wants to eat very frequently (keeping in mind that all babies are different) and that the more baby nurses the greater your milk supply/the more milk baby is ordering for later.

## Breastfeeding and closeness
Baby wants to lie close to you and your partner—perhaps all the time. Breastfeeding is not just food, but also closeness and security. Until recently, your infant was inside of you. Baby will need a lot of closeness for a long time after birth. You can try using a sling from the beginning. This keeps baby near and your hands free.

## A slightly older baby
When your baby is older and you feel like you’re breastfeeding very often, pay a bit more attention to baby’s behavior when he or she is at the breast, nursing. Is your baby sucking actively? Maybe sucking off and on, even dozing off with the nipple in his or her mouth? That’s fine. However, if you feel that your little one wakes and is hungry as soon as you move him or her from the breast, shorten the time you allow him or to sleep with the nipple in his or her mouth. Let baby nurse, but more actively, by waking baby between feeding sessions from the different breasts. You can give one to four breasts per session.

## Recommendations
Wake baby by putting your finger in baby’s hand (the gripping and sucking reflex are related) and this will cause baby to start nursing again. It is perfectly normal for baby to take mini breaks. Let your baby do that and don’t move your baby too soon from the breast. Occasionally, when you move your little one from the breast, you’ll notice that baby is hungry, wakes immediately and wants to nurse more. Give baby the breast again. This mentally prepares you for the fact that the feeding session is not yet over. However, if you’re thinking that “Baby has finished eating, now I can eat something, have a shower” or whatever you’d planned to do, then it can feel more challenging to start nursing again.

Always make sure that baby is really full. After that, it’s your turn to do what you want to do.

When you feel that you are nursing frequently and large amounts, the first question is how old your ...

Help, I’m nursing nonstop!

Detroit-birth-photography-HannahS (268)

You will receive information about newborn jaundice before you leave the maternity ward. It is important to know what it is and the symptoms in case your newborn infant develops signs of jaundice.

## Yellow skin and fatigue
Monitor to see if baby’s skin or the whites of the eyes turn yellow, or if baby is more tired and sleeps more, falls asleep on the breast or perhaps does not want to suck as before. If you notice any of these symptoms, it is important that you call the maternity ward immediately for a personal medical consult.

## How breastfeeding is affected
Infants who are slightly yellow also become more tired, which affects breastfeeding. You may have to wake your baby, monitor how he or she is sucking and be more attentive. If your infant releases the breast and falls asleep, you may need to wake him or her. Change the diaper and then take your baby back in your arms and offer the other breast.

You will receive information about newborn jaundice before you leave the maternity ward. It is impor...

Newborn jaundice

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