What's Normal and What's Not in Breastfeeding
By Kasey Erin Phifer-Byrne
In our last post in this breastfeeding series, we decided to come clean that in the beginning, breastfeeding will hurt for many women, and that it's normal to feel some pain at first. But what if the pain is so extreme that you start to dread baby's feeding cues? What if it goes on for many weeks, with no signs of improvement? What if baby's latch is causing your nipples to look misshapen after a feed?
These are things that aren't normal, and now it's time to talk about how to recognize when you may need more help from a lactation consultant. The gold standard in breastfeeding support is an International Board Certified Lactation Consultant (IBCLC). A good IBCLC will help you work through breastfeeding problems both common and uncommon, and can refer out to speech-language pathologists, occupational therapists, pediatric dentists, ear-nose-throat specialists, and other professionals who may also be able to help.
So how do you know where to draw the line? Let's break it down. (A heads-up here: we won't be talking about weight gain in this post, although lots of mamas worry about it. Regular visits to your pediatrician, an IBCLC, or both can help you monitor baby's weight and figure out what to do if things don't seem quite right.)
Normal: A "normal" breastfeeding experience may involve some pain that last through the first 30 seconds or so of a feeding, and then lessens as baby gets a deeper latch. It's common for this type of pain to improve with time as you and your baby get the hang of breastfeeding. It can also be normal to experience nipple soreness during the first few weeks as you both adjust, but after a feed, your nipple should look mostly the same coming out of baby's mouth as it did going in.
For the first few days of breastfeeding, your nipples might be a bit chapped and sore. Normal soreness can be soothed with coconut oil or nipple butters/balms, and should lessen as you and your baby get used to breastfeeding.
Not Normal: Excruciating pain that leads you to dread feeding your baby, or pain that lasts through the entire feed and doesn't seem to improve within a few weeks, is not normal. Your nipple also shouldn't be discolored or misshapen. If you notice that it looks white or purple, or that it's smushed/beveled, dented, or otherwise shaped not-quite right, this is a sign that baby's latch needs some help. This type of latch issue can also cause deeper breast pain that shoots back beyond the nipple itself.
Nipples that are cracked, bleeding, or don't seem to heal can be a sign of a latch problem, or sometimes an infection such as thrush. See a lactation consultant, who can do some detective work on baby's latch and on your breast to find the source of the problem. You'll also want to seek help if you have a clogged duct that you can't get rid of by massaging or one that comes along with redness, swelling, or a fever. These could be a sign of mastitis, a painful breast infection, and you'll want to give your OB a call.
Feeding Frequency and Length
Normal: Breastfeeding newborns will usually feed 8-12 times in a 24-hour period. Feedings can last up for 30-40 minutes in the beginning, while you and your baby are getting used to nursing—and a newborn isn't quite as efficient as an older baby. You might notice that your baby has times of the day where he or she wants to feed All. The. Time. And this is usually normal, too. It's called cluster feeding, and it can happen because of a growth spurt, or because baby is working on adjusting your milk supply to be exactly what they need. Evening/night is a pretty common time for cluster feeds, even though you'd rather be sleeping. In general, though, by 2-3 weeks old, babies will feed every 2-3 hours or so, often going without nursing for one longer stretch at night.
Try not to watch the clock while you're nursing, if you can help it. You'll know baby is finished when he or she pops off the breast on their own (seeming satisfied rather than upset), stops their long suck-swallow drinking pattern and begins to comfort suckle, and/or relaxes with open hands instead of tight fists.
Not Normal: While some fussy times of the day are absolutely normal, and so are cluster feeds, your baby should generally seem satisfied after a good number of their nursing sessions. Wanting to feed all day and night without ever being satisfied isn't normal, and can mean baby isn't drawing milk from the breast as efficiently as they should (and therefore not getting enough milk at each feeding to be full and satisfied).
Diapers and Breastfeeding (Yes, Let's Talk About Poop)
Normal: Breastfed baby poop, once baby has gotten that meconium out of his or her system, looks a lot like mustard. It's runny, seedy, and yellow—maybe a brownish yellow, orangey yellow, etc. It doesn't have a strong smell, and it's okay if it's occasionally green.
Up to 5 or 6 days old, babies should have at least one wet diaper for each day of their age. Your baby should also poop regularly, although older babies might go a few days in between, and this *can* be normal as long as there are no other issues at play.
Not Normal: Poop that is black, white, or red. It also shouldn't be stringy or have lots of mucus, at least not regularly.
Normal: Babies spit up—it's a fact of life. You may feel like yours spits up more than most babies, but as long as he or she isn't upset about it, it's more of a laundry problem than anything else. Infants have tiny tummies, and sometimes they just take in a little more than they have room for. Fun fact: breastmilk is just as protective and good-for-baby coming back up as it was going down, and coats the esophagus and nasal passages with antibodies, healthy bacteria, and other good stuff.
Not Normal: Spit-up that looks like something other than slightly curdled milk, or that upsets your baby coming up, could signify a problem. You'll want to talk to your pediatrician.
Bonus: What's a Tongue Tie?
I thought tongue ties would be worth addressing here, because lots of mamas hear or read about them and don't quite know what they are—and a tongue or lip tie *can* be a source of breastfeeding pain or problems.
A tongue tie, known in the medical world as ankyloglossia, is a tight piece of flesh that tethers the tongue to the bottom of the mouth. It can tether the tongue all the way in the back, all the way to the tip, or anywhere in between. This can make it difficult for baby to move his or her tongue the way it needs to for sucking properly or forming a good seal around the breast.
A lactation consultant can assess whether a tongue tie might be causing problems for your baby. You'll receive information on who can "release" the tie if you choose to do that, and what the procedure looks like (it's simple and fast!).
There's one more thing I want to talk about, and that's how you feel about breastfeeding. Guess what? It's perfectly normal if you don't absolutely love breastfeeding at first, or if you don't love it every time your baby feeds. Breastfeeding involves a complicated dance of hormones on top of social and emotional factors, and it's normal to have mixed feelings about it, to feel out-touched at 8pm when you've had a baby hanging on you all day, or to just plain not love it all the time.
What isn't normal is feelings of depression or more-than-occasional anxiety. If you don't feel right, mama, talk to someone. Your lactation consultant or OB is a great place to start. For normal feelings of being a bit overwhelmed, your local breastfeeding support group (try La Leche League if you aren't sure where to start) can be a great source of encouragement.
You got this!
And if you feel the need to Google something in the middle of the night, try Kellymom instead. Kelly Bonyata is a mother and an IBCLC, and her website is a wealth of solid, evidence-based information about breastfeeding and what's normal or not. There's a lot of misinformation on the internet, and this is one website my mentors and I trust enough to recommend.
Kasey Phifer-Byrne is an English professor, poetry-writer, lactation consultant in training, and mom to one cat and one soon-to-be-born human. She teaches from home while balancing clinical hours for lactation support, preparing for new parenthood, and enjoying a good hike near her home outside of Philadelphia. Kasey is passionate about supporting breastfeeding mamas and advocating for family leave and work-life balance despite today's challenges to working parents.