Breast-feeding is natural, but that doesn’t mean it’s easy.

It’s really common to have difficulty breast-feeding, especially at first, and around 70 percent of first-time mothers don’t meet their breast-feeding goals. Usually the reason why mothers don’t breast-feed as long as they want to is because of problems they face during breast-feeding. Luckily, most of these problems can be solved.

Here are some of the most common problems and what you can do about them.

1. Perceived low supply

The problem

Low milk supply is one of the most common breast-feeding concerns of new mothers. However, some common and normal breast-feeding issues can be misdiagnosed as low supply. This includes the following:

  • It’s normal for your newborn to lose weight during the first week after birth. If you had intravenous (IV) liquids or an epidural during labor, your baby’s weight loss could be slightly more, due to extra fluid weight gained from the IV during birth.
  • A breast pump isn’t as efficient as your baby nursing, so the amount of milk you’re able to pump is not an indication of low supply.
  • Frequent nursing and fussiness at the breast are both normal behavior for newborns, so they aren’t an indication of low supply.

How you’ll know

The best way to recognize true low supply is by counting diapers. If your baby is producing at least one wet diaper per day for their age, or at least six wet diapers if they’re more than 5 days old, then they’re getting enough liquid.

Most babies will have three to four dirty diapers per day by the time they’re over 4 days old, but it can be normal for a breast-fed baby to go up to 10 days between dirty diapers as their digestive system matures and becomes more efficient.

Weight gain is also an important indicator. If they aren’t back to their birth weight by 2 weeks, or they aren’t gaining steadily after that, supply could be the problem.

The solution

Before you supplement or take measures to increase your supply, talk to a certified lactation consultant to evaluate whether your supply is the problem.

2. Maternal medical conditions causing low supply

The problem

Low supply does affect a significant portion of nursing mothers.

There are several conditions that can make it more likely you’ll have trouble producing enough milk, including:

  • hormonal imbalances
  • diabetes
  • hypothyroidism
  • breast tissue damage
  • smoking

How you’ll know

Your baby isn’t producing enough wet or dirty diapers, even though they’re nursing frequently and nursing isn’t painful.

A lactation consultant has confirmed that their latch is good and that their nursing is effective.

The solution

Talk to your doctor and lactation consultant about ways to increase your supply. If the problem isn’t related to the mechanics of nursing, then hormonal treatments or medical supplements may help raise your supply.

Supplementing with an at-breast supplementation system, which enables you to feed your baby both formula and breast milk while your baby is at the breast, can also be a good solution to keep breast-feeding when supply is insufficient.

3. Low supply affected by breast-feeding practices

The problem

Low milk supply can also be caused by factors in your breast-feeding relationship with your newborn.

If your baby wasn’t able to latch on within the first hour after birth, then your milk may take more time to come in. This may lead to a need to supplement in the first few days of your baby’s life, which in turn can lower your production even more.

Breast milk is produced “on demand.” Your breasts produce more milk as more is taken out, and your body regulates how much milk it produces based on how much your baby drinks. So early supplementation can make it harder to get a good supply established.

Frequency of nursing is also an important factor in how much milk your body produces, so scheduling feeds or delaying feedings, especially in the first few weeks, can lead to low supply.

How you’ll know

Your baby isn’t producing enough diapers or isn’t gaining enough weight, even though his latch is good and not painful.

If they needed supplemental formula during the first few weeks of life, or if you weren’t able to nurse them at least every two to three hours during the first few weeks, then that can lead to low supply.

The solution

By increasing your baby’s time at the breast, you can signal your body to produce more milk. Here are steps you can take to increase your production through breast-feeding management.

  • Nurse frequently, and nurse for as long as possible. Offer the breast whenever your baby is fussy. Encourage your baby to nurse whenever they’re awake in the first few weeks.
  • Switch sides several times during a nursing session. This will help them stay awake and nursing longer, and it will signal both breasts to produce more.
  • Don’t offer any artificial nipples.
  • Make sure your baby’s latch is good. They should be nursing effectively, not just frequently.
  • Talk to a lactation consultant. They may advise that you try medicine that increases milk supply (galactagogue).

4. Poor latch caused by positioning

The problem

Poor latch is another common breast-feeding problem. A poor latch can lead to low supply, since it makes it harder for your baby to remove milk effectively.

It can also cause nursing to be painful. Poor latch can lead to cracked nipples, bleeding, and even thrush. A good latch is key to a successful breastfeeding relationship.

How you’ll know

If breast-feeding is comfortable for you, then your baby’s latch is probably good.

If you experience any pain while nursing, a poor latch is the most common cause. A lactation consultant can watch your baby nursing and tell you whether the latch looks effective, but there are several things you can look for when diagnosing yourself.

Check that your baby’s chin is moving slowly in a circular motion, not quickly up and down.

  • If you pull their bottom lip down while they’re nursing, you should be able to see their tongue.
  • You should hear them swallowing, but you shouldn’t hear any clicking or smacking.
  • The latch should be painless! It can be normal for breast-feeding to be uncomfortable for the first week, but if it continues to hurt, something is wrong.

The solution

Sometimes poor latch is caused by your baby’s anatomy, but sometimes you can improve it with positioning. Here’s how:

  • Hold your baby with their tummy facing yours. For most moms, the “cradle hold” is the easiest way to breast-feed, with baby lying on their side across your arms, facing you.
  • Point your nipple toward your baby’s upper lip. Try touching their lip to your nipple to encourage them to open their mouth wide.
  • Cup your breast with your hand in a C-shaped position, making the tissue of your breast (not the nipple) more flat so your baby can fit more into their mouth.
  • When your baby opens their mouth wide, let them latch onto your breast. They should take as much of your breast as possible and most of your areola into their mouth.
  • When latched on, your baby’s lips should be flared out.

A certified lactation consultant can watch you breast-feed and advise you on the best way to position your baby for a good latch.

5. Poor latch caused by tongue-tie

The problem

If you’re positioning your baby well but still having trouble getting a good latch, the problem could be anatomy.

One common culprit is your baby’s frenulum, which is the skin that attaches the bottom of your baby’s tongue to their mouth. To latch well, your baby needs to be able to extend their tongue out. For some babies, the frenulum is too short for an effective latch. This condition is called a “tongue-tie,” and it can cause your baby’s latch to be painful and ineffective.

How you’ll know

Look in your baby’s mouth and gently lift their tongue. If the skin attaching their tongue to the bottom of their mouth is well to the back of the tongue, then they probably don’t have a tongue-tie. If the skin extends forward toward the middle of their mouth, then it could be affecting their latch.

Talk to a lactation consultant or a doctor who specializes in tongue-tie for a diagnosis.

The solution

Your doctor can clip the frenulum in a simple outpatient surgery, enabling your baby to latch and nurse much more effectively. If you suspect your baby might have tongue-tie, talk to your doctor right away, since a poor latch is much easier to fix before it becomes a habit.

6. Poor latch caused by flat or inverted nipples

The problem

Another anatomical problem that often causes a poor latch is inverted nipples.

If your nipples are inverted, your baby may not be able to compress your breast effectively, which can cause low supply since it reduces the efficiency of their nursing. Many women with inverted nipples breast-feed with no problems, but if your baby’s latch is painful or seems ineffective, the shape of your nipples could be the cause.

How you’ll know

If your nipple doesn’t extend out from your breast in a small bump, then you may have inverted nipples. Gently pinch your areola an inch behind your nipple. If your nipple doesn’t point out when you pinch, then it may be inverted.

The solution

You can gently stretch your nipple out with your thumbs by pressing your breast tissue in to make your nipples more erect. You can also use a breast shell or breast pump to help make your nipples erect right before you breast-feed your baby.

Finally, a nipple shield can help your baby learn to latch correctly while protecting your nipples from soreness. Talk to a lactation consultant to make sure that’s the right choice for you.

7. Engorgement

The problem

Engorgement occurs when you have too much milk in your breasts. This can lead to plugged ducts and mastitis. It can also make nursing painful and difficult and affect your baby’s latch, especially if your baby is still small.

Engorgement is normal when your milk first comes in, but it should stop as your milk supply regulates.

How you’ll know

Your breasts will feel full, hard, and painful. Your skin may feel stretched or look shiny, and your nipples may be hard to touch. Your breasts may also feel warmer than usual.

The solution

Nurse your baby frequently, for as long as they’re willing to eat. Make sure they empty the first breast before you switch to the other side.

If they have trouble latching on because of the engorgement, then you can hand express or pump a little milk before nursing, but avoid doing this if possible since it can lead to oversupply. Use a cold compress to reduce inflammation and swelling.

If engorgement continues for several days, ask a lactation consultant about taking further steps to lower your supply.

8. Imbalance of fore and hindmilk

The problem

Your breast milk changes a lot over the course of your breast-feeding relationship. It adjusts to meet your baby’s needs at different ages, and it also changes throughout the course of a single feed.

The milk that comes out first, known as foremilk, has more lactose and water. As your baby continues to eat on one side, your milk transitions to hindmilk, which is creamier and has more fat.

The fat helps balance the lactose for your baby’s digestive system. If you have an oversupply of milk, then your baby might fill up on foremilk and not get enough hindmilk.

How you’ll know

Your baby might have thick, green, foamy stools, or a lot of gassiness.

The solution

If you’ve been switching sides during a feeding, try staying on one breast throughout a single feeding. Nurse from the other breast for the next feeding.

This can help regulate your supply, and it will help make sure your baby gets enough hindmilk at each meal. You can also try expressing a little bit of milk before your baby eats to get rid of some of the foremilk, but that can exacerbate the problem of oversupply by telling your body to produce more milk, so avoid doing it often.

9. Overactive let-down

The problem

Your breasts are always producing milk. But the flow of milk is slow when you first latch your baby onto your breast. After your baby has been nursing for a minute or two, the action of sucking will trigger your let-down reflex. Your milk will start flowing faster, and you’ll see your baby drinking more quickly.

Sometimes, this let-down reflex can be “overactive.” This is often caused by oversupply, and it means your milk will flow faster than your baby can drink it.

How you’ll know

Your baby might gag, choke, or gasp while they’re nursing as they struggle to deal with the fast flow. They might bite you or clamp down hard on your nipple to try to slow the flow down. They might also sometimes refuse to nurse, and they might have no interest in comfort nursing.

The solution

Positioning can help slow down the flow. Try nursing in a laid-back position with your baby on your stomach as you lie on your back or lean back in a chair. This can help your milk flow more slowly, since it’s working against gravity.

You can also take your baby off the breast for a few minutes when your let-down first starts, since it’s most active at the very beginning of a feed. Catch the milk with a towel for a minute, until your let-down slows down, and then put your baby back on the breast.

Meanwhile, you can take steps to lower your oversupply by only nursing on one side per feeding. However, don’t try to lower your supply if your baby is less than 6 weeks old. Overactive let-down and oversupply are normal as your body is adjusting, and it usually resolves on its own as your supply regulates.

10. Clogged ducts

The problem

A clogged duct is caused by a milk blister or lump of milk getting stuck in a milk duct. This blocks the flow of breast milk, which can lead to an infection. It’s usually related to engorgement, which may be related to oversupply, poor latch, or infrequent nursing. It can also be caused by pressure on a duct from a poorly fitting bra.

How you’ll know

Your breast may feel tender and sore, and you may notice a lump or swollen spot on your breast. It might be reddish. It’s important to treat a clogged duct quickly, since it can develop into mastitis.

The solution

The best solution for a clogged duct is frequent nursing. Your baby can pull the plug out by sucking, and although the milk may look lumpy or stringy, it’s not harmful for your baby to eat.

A warm compress on the sore spot can also help loosen the plug, and massaging your breast can help as well. Breast-feed as frequently as possible. If your baby is finished eating and your breast still feels engorged, you can pump or hand express to try to get the plug out, but don’t do that too much since it can exacerbate oversupply.

11. Mastitis

The problem

Mastitis is an infection in your breast. It often starts as a plugged duct, and it can be caused by oversupply, infrequent breast-feeding, or exhaustion and stress.

Mastitis can lead to serious infection, since the plugged milk makes space for bacteria to grow. It’s important to treat it quickly.

How you’ll know

Like a plugged duct, mastitis can cause a lump and soreness in your breast. You may also see red streaks on your skin around the sore area, and you may have a fever.

These indications of infection are the main difference in symptoms between a plugged duct and mastitis.

The solution

Like a plugged duct, you can treat mastitis with frequent breast-feeding, massage, warm compress, and pumping or expressing. In most cases, mastitis also needs an antibiotic to kill the infection.

If you suspect you have mastitis, call your doctor immediately.

12. Thrush

The problem

Thrush is a yeast infection on the skin. It can infect your breasts, the inside of your baby’s mouth, or both.

It’s normal for yeast to populate your skin, but an overgrowth of yeast can cause pain while nursing, cracked or bleeding nipples, and itchiness. Yeast infections are common after antibiotic treatment, so treating mastitis can put you at risk for thrush.

How you’ll know

A thrush infection can make breast-feeding very painful. You may feel shooting pains while feeding your baby, or you may have a rash or blisters on your nipples. The inside of your baby’s mouth may appear white.

The solution

Your doctor will probably prescribe an antifungal medication to treat thrush. You can supplement this with home treatments like vinegar or gentian violet.

It’s important to treat your baby at the same time, since thrush is often passed back and forth. You should also boil all bottle nipples and pacifiers and wash all your bras and clothing in hot water with bleach. If you use cloth diapers, wash them with bleach as well.

13. Reynaud’s phenomenon vasospasms

The problem

A vasospasm is a sudden, sharp pain caused by a constricting blood vessel. Poor latch can cause vasospasms, but in some cases they’re caused by a condition called Reynaud’s phenomenon. It triggers vasospasms in various parts of the body, often as a result of cold or stress.

This condition is not related to breast-feeding, but symptoms may appear for the first time while breast-feeding because of the stress on the nipples.

How you’ll know

Vasospasms are often misdiagnosed as thrush, since they cause a similar sudden, piercing pain while breast-feeding.

The key symptom to look for is color change in your nipples. If the pain is accompanied by your nipples turning white, and especially if it happens sometimes while you’re not nursing, then it may be Reynaud’s phenomenon.

The solution

There’s no cure for Reynaud’s phenomenon, but you can reduce symptoms by reducing stress and cold on your nipples. Use a warm compress immediately after nursing to restore blood flow to your nipples, and massage your nipples with oil during vasospasms. Nutritional supplements and medicines that improve blood flow, like ibuprofen or a calcium-magnesium supplement, may also help.