Expert: Sally Wendkos Olds - 9/10/2009

Question
I have a nine week old son who I am trying to breastfeed. Initially, I breastfed him for the first 4 weeks but stopped because I had cracked and bleeding nipples for the duration of it and also got mastitis. I put him on formula and expressed milk approx 2-4 times a day to keep my milk supply going and let my nipples heal. I tried to breastfeed again at 7 weeks when they healed but they started to split again after two days. But he attached fine and did not have any problems. I am now trying again, this time putting him on more slowly, to try and 'toughen' up my nipples. I have been feeding him for two days now, the first day I put him on one breast every feed for ten minutes, the second day I have been put him on one breast each feed and also both breasts each feed several times, ten minutes each again. He has been on each breast approx 5-7 times a day. I have been supplementing his feeds with a small amount of formula after he has been on the breast. However, he pulls or lets go and gets a bit upset after a few minutes. I put him on again but the same happens after about a minute or so. Is this because my milk supply is low or is it nipple rejection because he has been on the bottle? How long will it take for my milk to build up to full supply again? How long should I leave him on the breast once everything is 'back up and running'? I look forward to your reply and thank you in advance.

Answer
Dear Tammy,

First, congratulations for giving your son the best start in life by breastfeeding him. I'm so sorry to hear about all the problems you and he have been having.

You don't mention whether you have sought help from a lactation consultant, a La Leche League leader, or someone else knowledgeable about breastfeeding. Also, you don't say how your baby's weight gain is going and what his pediatrician is saying. If not, I urge you to get help immediately from someone on the scene. The situation as you explain it is too complex to get an easy answer by email, and I would be doing you and your baby a disservice by trying to do this.

You need someone to watch you nurse, to see what is going on with your baby's latch, to evaluate your milk supply, and to give you guidance. If your nipples split after two days, it's likely that your son was not attached fine. And if you went from exclusively nursing a 4-week-old to pumping 2-4 times a day, that's not enough to keep up your milk production.

So I urge  you to work with someone who can watch what you're doing and provide ongoing follow-up care to help things improve. I know that you do have very knowledgeable lactation people in Australia, and I hope you can find someone near you. If you have trouble finding help, you can go to www.ilca.org, the website of the International Lactation Consultants Association, which can provide a referral.

Best of luck,

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.