Nutrition

What to do when breastfeeding just doesn’t work

International experts agree that breastfeeding, as the biological norm, is important for mothers and babies. But it’s also true that not every woman will choose to breastfeed or can meet her goals when she does. And experts agree on this too: That’s OK.

“Hopefully women have been given honest information about the possible challenges of breastfeeding,” said Teresa McCullen, lactation consultant at Augusta University Health. “If you’re not able to nurture your baby through breastfeeding—for whatever reason—it’s unreasonable not to consider other options.”

Why Other Options?

Cancer in and of itself may not be a reason to avoid breastfeeding, although active chemotherapy is, and certain types of radiation may be. Still, if the timing’s right, moms can breastfeed once they’ve stopped chemo or radiation treatments. It’s important to make a plan with both your health care team and your baby’s doctor.

Then there’s the low-milk question. Cancer and cancer treatment can impact the amount of breastmilk a mom can produce. And in general, while every breastfeeding mother worries about whether or not she is producing enough milk for her baby, about 0.1 percent of women really can’t produce enough milk. Then, because it’s a lot of work not only to have a baby and then take care of a baby, there’s the larger number of women who don’t produce enough because of sheer exhaustion or depression. For still others, breastfeeding just hurts, whether it’s because the baby isn’t latching properly or other reasons—and because of that, baby isn’t getting enough. Then there’s the challenge of outdated information, which causes some new moms to really not know how to breastfeed. Skilled and adequate assistance is essential in all of these situations.

So How Can I Tell?

It’s definitely tricky to know how much breastmilk your baby is getting. For one, babies are able to get more out of you than a pump can, so how much you pump is not a clear guide.

A couple days after your baby is born, you should have your first visit with your child’s pediatrician. This is when your doctor can check in on how much baby weighs compared to birth, and you can ask any questions related to breastfeeding or mention signs you may have noticed, like extreme fussiness, dry lips or very few wet diapers. These, combined with your baby’s weight not being where it should be, could all mean your child isn’t getting enough milk.

Here’s what you should expect too:

  • The first couple of days after birth, your baby will be very sleepy and will wake up mainly to eat.
  • By day three, your baby will settle into a routine of eating eight to 12 times a day on average—and will tell you vigorously that he or she wants to eat.
  • By day four, your baby should have at least four wet diapers and four stool diapers.
  • By day five, after your baby eats, he or she will be more likely to stay awake and should have about six to eight good, wet diapers along with four stool diapers. The color of the stool should change from dark to light, from black to a yellowish-orange in color.

If your baby is extremely fussy, seems sleepier instead of more alert or if stool color hasn’t changed, these are major warning signs. “Call your doctor or lactation consultant to get help,” said McCullen.

Here’s What You Can Do

If your milk is low, there are strategies that lactation consultants can offer, including latch improvement, increasing milk removal, and help with identifying other issues with mom and baby that could be causing problems.

But partial breastfeeding allows for all of the great things about breastfeeding—comfort, antibodies and many of the nutritional goodies—plus ensuring your baby gets all the nutrition he or she needs. “It has to be what works best for mother, baby and the whole family,” said McCullen.

One example is to use a lactation aid, which lets your baby latch on both your breast and a thin tube that’s connected to a container holding the mother’s own milk, donor milk or formula.

Bottle feeding breastmilk and formula or straight formula is another option. There are so many bottles and nipples on the market today that moms may need to do a bit of trial and error to see which one they and their babies like the best. The most important consideration is the nipple, since you want one where the flow of milk is how your child likes it. Too fast, and he or she may gulp or choke. Too slow, and he or she will get frustrated.

Then, when you feed your baby, do your best to hold the bottle parallel to the floor so that he or she has a choice on how much to eat. “When you point a bottle down, too much may come out too quickly,” said McCullen. “Babies should be allowed to guide the feeding and how long it lasts. When babies turn their heads or bite on the nipple, it usually means they’re full.”

For moms who were set on breastfeeding their babies, the decision to go to formula can be extra tough. “Have the confidence to seek out the support and skilled guidance you need to feel secure in making the best decision for you and baby,” said McCullen. “And remember, it’s always OK to follow your inner instinct.”

Want some breastfeeding advice?
Breastfeeding can be hard. Augusta University Health’s certified lactation consultant can help. Visit augustahealth.org/breastfeeding or call the lactation consultant at 706-721-0190 or 706-721-8283.

About the author

Children's Hospital of Georgia

Children's Hospital of Georgia

Children’s Hospital of Georgia is the only facility in the area dedicated exclusively to children. It staffs the largest team of pediatric specialists in the region who deliver out- and in- patient care for everything from common childhood illnesses to life-threatening conditions like heart disorders, cancer and neurological diseases.

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