5 Tips for Getting Breastfeeding Back on Track After a Tough Start

You had a birth plan and a plan for breastfeeding, but now the baby has been born and breastfeeding has not gotten off to a good start. Maybe you had a difficult delivery, or baby is struggling to latch on to the breast. Maybe you have pain when trying to latch the baby, or the baby is very sleepy and won't feed. Maybe someone has suggested that the baby needs more milk. Or your baby needed to go to the NICU due to being early or having trouble. Any of these can be reasons why you are struggling now. 

As an International Board Certified Lactation Consultant (IBCLC), I see a lot of babies and parents in the first weeks who have struggled to get started with breastfeeding immediately after birth. It is both physically and emotionally difficult, when birth and breastfeeding don't go as planned or expected. 

if that is you, I want to give you some reassurance that it is not too late to turn these struggles around. Many people struggle in the first few days and even weeks to get started.  Here are 5 Tips to help get breastfeeding back on track after delivery when you had a tough start. 

1. Have Appropriate Expectations  

Often parents will tell me about their experiences in the first few days of breastfeeding and I realize that what they were experiencing was actually normal. But, because they didn't know what to expect, they were worried that something was wrong. or they aren't doing something right.  (And sometimes, they are even told this)

I hear things like "I didn't have enough milk" or "The baby was too sleepy" or "I was pumping and I wasn't getting any milk out"  or "My baby was too hungry" so we did XYZ. 

Having the right expectations will help you to know if something is normal or going wrong.

Let's talk about what is normal.  

Breastmilk is present in the form of colostrum even before baby is born. This highly concentrated early breastmilk is thick and sticky and usually yellow in color.  It is present in very small amounts. It is supposed to be this way. That small volume of milk is normal for a reason. Immediately after birth, babies need to learn to coordinate the skills of sucking, swallowing and breathing. The small volume of early milk helps the baby practice learning these new skills. If there is a large volume of milk, the baby may struggle to breathe or swallow well. 

Babies also have very tiny tummies. So, they only need about a teaspoon of milk at a time on that first day as they are learning to feed and digest their milk. Each day, the amount of colostrum increases and baby is able to take in more at each feeding. 

The tiny amounts of colostrum that your baby gets from you is all they need right after birth.

It is important that babies feed very frequently so that they can get the nutrition they need while they are learning.to feed.  

It typically takes between 3-5 days after delivery for your colostrum to increase in volume as it transitions to a combination of colostrum and more mature milk. This is sometimes referred to as "your milk coming in". Remember, you always had milk, it is just increasing in volume. Breastfeeding parents will often feel that their breasts are much more full when this transition happens. 

Because the colostrum is so thick and in such small amounts, you may not see it before the baby is born.  After birth, it is hard to know how much you are making and how much baby  is getting. Parents are often tempted to use a breast pump to see if they have milk. But, because this colostrum is present in such small amounts, it often just gets stuck in the pump tubing and is wasted. You should not expect to see large volumes of colostrum when pumping. For that reason, it is better to use your hands to express milk from your breasts in these early days. (If you don't know how to hand express milk, watch this video)

Unless your milk is truly delayed coming in, there is no need to rush that milk transition along. Babies need that colostrum for its immune properties. They also need it to help them learn to feed.

Sometimes parents are concerned that their baby is losing weight after being born and they feel that is because the baby isn't getting enough milk. 

ALL babies lose weight after birth. Some babies lose more than others. For example, if you received a lot of IV fluids during your labor and delivery, your baby may be born with excess fluid weight and they will may look like they lost more weight than expected. There is an expected and acceptable amount of weight loss for babies after birth, and if baby has not lost more than this, it is not concerning. If your baby has lost more than 8 - 10% of their birth weight, then they will need more milk earlier. 

It is normal for baby to want to feed very frequently. Sometimes parents are told to feed baby every 2-3 hours. But, early on, babies often need to feed more frequently than this. This doesn't necessarily mean that you don't have enough milk. This is the way that baby can take in more nutrition when their tummies are so tiny. This is why it is important to watch the baby for hunger cues and not the clock. 

What are some common problems that make breastfeeding get off to a rough start?

Baby is having trouble latching onto the breast

Mother has pain when baby latches onto the breast

Breasts are very full and hard and  baby can't latch on

Baby needs to take in more milk for jaundice, or low blood sugar, fussiness, or excessive weight gain. 

Mother and baby are separated from each other and feeding at the breast is not an option. 

Baby is not gaining enough weight. 

Mother's milk supply is not coming in as expected 

What should you do if breastfeeding is not going as expected? 

Know that what happens on the first day or several days, does not decide how successful you will be at breastfeeding. Breastfeeding is a skill that both you and the baby have to learn, so neither of you will be experts at this. Over time, you will both figure out what works for you. So, be patient with yourself and baby (You both just went through the delivery, after all ). Even if you are having a lot of problems, this doesn't mean that they can't be turned around. This may take some time.  Be patient with yourself -  you just delivered a baby and your body has to have some time to recover. Baby just  went through the same birthing experience that you did.  You both need patience. Just keep in mind that there are just a few things that are important in these few days to weeks. Everything else can be figured out later.

2. Feed the Baby

The most important thing to focus on is feeding the baby. If feeding at the breast is not going well or if baby is not able to get the milk that they need from the breast, baby may need to get some extra milk. If baby is latching well, you might just try feeding baby more frequently at the breast. Feeding more often gets more milk into the baby if they baby is able to latch and get milk out. 

If baby is not latching onto the breast well or is not able to get out enough milk, then other solutions for getting milk into the baby will need to be decided on. 

The best way to feed a baby who is just a few days old, is to express colostrum from your breast into a spoon or cup and feed that extra colostrum to the baby with a spoon. This is good to do if baby is latching onto the breast well but still seems hungry. You also can do this if baby is not latching at the breast or if breasts are painful when baby latches. 

By feeding that colostrum with a spoon, baby is able to use their own sucking skills, and they can get small amounts of colostrum more often. This is a great way to get in more nutrition into the baby. You can do this in between the times baby latches to get more breast stimulation and to get more nutrition into the baby. 

You can also feed the colostrum to the baby with a syringe. 

Spoon and syringe feeding are good ways to get babies to take milk in the first few days of life. As baby is able to take in larger amounts of milk, it becomes harder to spoon feed or syringe feed enough milk. At that point, you may need some help to figure out how best to provide milk for babies who are not feeding at the breast. Bottle feeding or using a tiny tube to provide extra milk at the breast are both options here. 

A lot of parents are worried about giving  a breastfed baby a bottle. Ideally, you want baby feeding at the breast only. But, if a baby needs to get in more milk, a bottle may be needed. Remember, the main goal is to feed the baby. Bottle feeding alone will not destroy your breastfeeding journey. Sometimes, if baby is losing weight or is very sleepy,  they don't have the strength to stay awake and suck well at the breast. The extra milk they are  supplemented with will help baby grow and get enough strength to suck more efficiently at the breast. If your baby needs that extra milk, don't be afraid to give it. But make sure that you get some help for how to give the baby a bottle to protect breastfeeding,  now much to give and  to have a plan for stopping the supplemental feeding when the time is right. Just because a baby needs some extra milk early on doesn't mean they will always need this. 

Parents are also worried about supplementing with formula or donor milk. If mom has enough milk to use, providing her breastmilk to the baby should  be the first choice. But, if it is early and you don't have enough milk yet, formula or donor milk may need to be used.  Remember, feeding the baby is the first priority and as milk supply increases, you can stop the supplement. 

3. Protect your milk supply

The next, and equally important, thing to do when breastfeeding is not going well, is to protect the milk supply of the breastfeeding parent. 

If your baby is needing to take some supplemental milk, or not feeding at the breast at all, we need to make sure that a healthy milk supply is being established. 

When breasts are stimulated, they get the signal to produce milk. So, if baby is not feeding at the breast, the breasts will not receive the signal that milk is needed. Also, if baby is taking extra milk in addition to being at the breast, your breasts will not be stimulated then either. Because of this, you will need to provide some  stimulation to your breasts to help build an adequate supply for your baby. You can provide this stimulation by hand expression in those early days or by adding in expression of milk from a breast pump once your milk is increasing. Early stimulation of your breasts helps your body to produce more milk in the long term.

Here is an important tip: If your baby is feeding well at the breast, extra pumping in those early days and weeks is NOT needed. More milk is not always better. You just need ENOUGH milk for your baby. This is not the time to be building a milk stash for later.

4. Protect the physical connection with your baby

Even if breastfeeding isn't going well, you can still protect the physical connection with your  baby. Keeping the baby skin to skin and in contact with your heart will help that transition back to successful breastfeeding. But more importantly, your baby needs to be near your body for regulation and soothing of their nervous system. Keeping baby in close contact with you will help to soothe your baby because being on your body is their natural place to be. This skin to skin and heart to heart contact with the baby also helps to establish an adequate milk supply for the baby because of the oxytocin hormone release. Try to keep the baby at the breast and in skin to skin contact as often as possible, especially if baby is needing supplemental milk. You can feed the baby in a skin to skin position from the bottle too. Keeping that physical connection with your baby is often the best way to overcome many struggles that infants have.

5. Get support from a Lactation Consultant early. 

Sometimes the whole birthing experience just doesn't go as expected and breastfeeding can get off to a rocky start. That is very frustrating. But, it doesn't have to be the end of your breastfeeding journey. There is no timeline for successfully breastfeeding your baby. Your baby wants to breastfeed and almost all parents have the ability to produce milk for their baby. But, most often, breastfeeding isn't successful because there was a lack of support for  breastfeeding in the beginning when it was needed. 

Iff you have a lactation consultant available to you in the birthing hospital, seek out their help right away if you have concerns that breastfeeding isn't going as expected. 

If you are struggling, remember that feeding the baby and supporting your milk supply are your first priorities while in the hospital. Then as soon as you get home, contact a lactation consultant to help evaluate what the problems are and to help you develop a plan for success. The earlier you get help, the quicker you will be on the road to better breastfeeding. But, it is never too late to work on breastfeeding. I have had many moms and babies successfully breastfeed after struggling in the hospital. Even those who struggled for months have been able to latch well and establish a full milk supply. Whether it is days or weeks, you goals continued to be Feed the Baby and Protect the Milk Supply while you work on the plan. Getting off to a rough start does not have to put an end to  your breastfeeding goals. 

Where to find a lactation consultant?

You can sometimes get a lactation consultant referral from your pediatrician or  OB. You an ask your friends if they have an IBCLC they have worked with. The  Zipmilk website will help you connect to a lactation consultant in your area.  Your insurance company may be able to connect you to a lactation consultant in their network. I partner with The Lactation Network to provide insurance covered lactation consultations and also provide non insurance covered consults at this link  I provide in - home visits,  office visits and virtual visits so every parent can access a consult when needed. 

Schedule a prenatal lactation consult

Having a consultation with a lactation consultant before the baby is born will often give you some skills and knowledge to avoid some of the most common breastfeeding problems after birth. I recommend that all pregnant moms meet with a lactation consultant for this reason. But, if you have any high risk factors that may lead to an induction or a c-section birth, or you have a history of breast surgery, medical conditions or take medications, you would particularly benefit from a prenatal consult. If you had previous breastfeeding struggles with another baby, you will definitely want to seek help from a lactation consultant before your delivery. 

If you and your baby are having trouble getting off to a good start with breastfeeding, remember the most important things to prioritize are 1. Having appropriate expectations about what normal breastfeeding looks like. 2.  Feed the Baby  3.Protect your milk supply  4 . Maintain a physical connection with your baby  and  5.Seek out expert help from a lactation consultant early. It is never too late to get back on track with your breastfeeding goals, especially if you have the help and support you need.