Breastfeeding: Why Is It So Hard To Breastfeed A Baby?

This is the first in a multi-part series Ask Moxie is going to run on breastfeeding. My guest expert is Jamie. She's a lactation consultant, mother of four, raconteur, and tireless supporter of all things boobular. She's the person you want to talk to when your tits are in a vise (literally or not). In addition to writing these articles for Ask Moxie, she's written an amazing series of posts on breastfeeding, breastfeeding support, and breastfeeding in U.S. culture on her own blog. You should check them out.

And now, on with the show:

Why Is It So Hard to Breastfeed a Baby?
One thing that complicates breastfeeding for new mothers is the abundance of myths steering her in the wrong direction (or at least in unhelpful directions) as she's getting started. 
Myth #1: It's so much easier to learn about breastfeeding these days. There is a ton of breastfeeding information floating around out there. Unfortunately, a lot of it is bad. My copy of the Sears & Sears Baby Book instructs mothers to center the nipple in baby's mouth and RAM the baby on. Some babies are fine with that. Others will respond with the same indignation I would feel if someone shoved my face into my plate and expected me to eat that way. So choose your sources carefully to find current, research-based recommendations. (I am partial to and LLL myself.)
Myths #2 and #3: It won't hurt if you're doing it right vs.  Early breastfeeding is painful and you just have to suck it up. If breastfeeding hurts a lot, something isn't right. It may be that a tiny adjustment in the baby's latch (usually helping him to latch more asymmetrically, taking a deeper bite with his lower jaw -- details on these pages) will make a vast difference. The problem may be an anatomical varation like a tongue-tied baby or a mother with larger-than-average nipples (technically known as "oro-boobular disproportion"). Significant pain should signal you to get help pronto, before your nipples turn into steak tartare.

On the other hand, a lot of women experience a little pain. Your nipples have never been stretched so far; your ducts have never been distended to such a degree. Sometimes, especially before the milk starts flowing, it makes a person say ouch. According to The Breastfeeding Atlas, this type of pain should last about 20-30 seconds per feeding and resolve within a week. But if you hear that you shouldn't be saying ouch, you may worry that you're doing it wrong. Motherhood presents many and varied opportunities to worry that you're doing it wrong. Whenever possible (this is just such an instance), decline them.

Myth #4: A lactation consultant is a lactation consultant. As far as I know, no state in this country regulates lactation consultants. You can get tired of your career in furnace repair one day and hang out your shingle as a lactation consultant the next. This is part of why lactation support in hospitals is so uneven. You can find some wonderful nurses and LCs with a magic touch -- and, more importantly, the ability to transmit same to you. You can also encounter nurses whose idea of evidence-based practice is "Good Enough For My Baby In 1982 Is Good Enough for Yours in 2006." If you need breastfeeding help, you can search here for an IBCLC. You might also call a local LLL Leader (start here).  If you need more assistance than she can provide, ask her whom she would call if she had a stubborn breastfeeding problem.
Perhaps most pernicious is myth #5: Breastfeeding has to get off to a good start or it won't work out. A good start is a big help, but here's what you do if you get a rocky start instead (courtesy of Linda Smith):

  1. Feed the baby. If possible, your own expressed milk, given in whatever way works for your family. If you opt to use a bottle, this is a helpful article  on using bottles to transition a baby back to the breast.
  2. Protect the milk supply. To bring in a milk supply, rent a hospital-grade pump. If your insurance company balks, an LC should be able to drop them a letter explaining why it's important.
  3. Fix the breastfeeding. If you can keep something relaxed happening at the breast, offering the baby a chance to nurse when you're both calm and he's not too hungry, many babies will catch on all on their own. Most will figure it out in time, with assistance from an experienced LC.
One last note: many of the women who read and comment here are infertility veterans. Lactation consultants report, anecdotally, a higher rate of breastfeeding difficulties among women with a history of infertility. Sometimes the cause is physical (PCOS can be related to supply issues); sometimes the reason is unclear. I mention this not to alarm anyone, but because forewarned is forearmed. The same tenacity that brought you to motherhood can also help you, given good information and support, to get past most breastfeeding hurdles. Good luck!