Breastfeeding is credited with multiple benefits for mom and baby: ideal nutrition for the infant, quicker childbirth recovery for the woman, and mother-baby bonding, to name a few.

But what happens when breastfeeding isn’t “clicking”?

Kimberly A. Klein, MD, IBCLC, FAAP, explains nursing misconceptions, common challenges, and how Kaiser Permanente provides help.

Dr. Klein is a pediatrician at the Kaiser Permanente Antioch Medical Center, Northern California chair of the Lactation Strategy Group, and a mother of 3.

Please explain initial breastfeeding.

During pregnancy, the breast tissue increases and develops to make milk. Mothers start producing the very first drops of a very rich milk called colostrum during their third trimester.

The baby is very alert and awake for the first couple hours after birth, so while it is rooting for milk, mom needs help to achieve a good latch-on to the breast for the first feeding. Baby then goes into a very long sleep state before starting to feed every few hours for the first weeks; at the same time, mom’s mature milk comes in.

What are primary misconceptions?

That mature milk comes in between days 3 and 5 — not immediately. Also, it’s normal for babies to lose as much as 10 percent of their birth weight in the first days of life because they are sleepy after the stress of birth and begin to shed some excess fluids. Infants may only get about a teaspoon of colostrum in their first feeds, but that’s actually all they need.

Some discourage the mother from using the breast as a pacifier. But as long as the baby is eating and growing, it’s okay. Finally, many think that breastfeeding simply comes naturally to mother and baby, when it’s actually a combination of innate and learned behavior.

What are the main challenges?

Even though newborns are prewired to search, latch on, and suckle at the breast, moms and babies still need to figure out how to be a team.

Nipple pain is not uncommon. Breastfeeding is a brand-new sensation for mom that may come with some discomfort as she learns how a correct latch-on feels and the baby learns to suckle effectively. Enough of the areola with its many milk ducts needs to make it into the baby’s mouth for an optimal feeding, thus reducing chance of nipple injury. This can be addressed by trying different nursing positions and assisting baby with a wide latch.

Sometimes the issue is on the baby’s end, with the most common being tongue-tie. That’s when the cord that stretches from under the tongue to the floor of the mouth is short and restricts the mobility of the tongue, impacting getting milk to the baby and resulting in pain, nipple injury, or mastitis for the mother. There’s a procedure to fix tongue-tie.

Finally, some common and often necessary birthing interventions may impact early breast milk production and infant wakefulness, including routine C-sections, fluid administration, and some medications. Sometimes, moms may need additional support with pumping or temporary supplementation to get off to a good start. 

How does Kaiser Permanente help?

Our care is integrated — from prenatal lactation support to outpatient pediatrics after delivery. All bedside nurses who provide care for moms and babies are trained to support breastfeeding, while specialized lactation experts assist moms with challenges and develop comprehensive feeding plans. After hospital discharge, call center advice nurses are available 24-7. For anything complicated, moms can get a video, phone, or office appointment quickly.

We support women every step of the way to meet their own breastfeeding goals — whether that is exclusive breastfeeding for the first 6 months of baby’s life or any amount of breastfeeding that the mother chooses. Our ultimate goal is health and happiness for both baby and mother.

Read “A Leader in Encouraging Breastfeeding” and learn more general information about breastfeeding at kp.org. 

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