When Breastfeeding Seems Impossible
Jan. 24, 2001 -- Despite a mother's desire to breastfeed, often it just doesn't seem possible.
"It can be tough when you have a mother who seemingly can't breastfeed but really wants to," Andrea McCoy, MD, chief of pediatric care at Temple University Children's Hospital in Philadelphia, tells WebMD. "When I sit with mothers who have tried, I tell them there are options we can work through. But it's important that the mother is having fun, that she's not feeling like a bad mother because she can't do this."
Anatomical problems -- in mother or baby -- often make breastfeeding difficult or impossible.
One common problem is a mother's inverted nipples. The solution: "inserts for the bra that help the nipple become a bit more everted, which is what's necessary for a baby to latch on well," McCoy says. By her third trimester, a pregnant woman should be talking with her obstetrician about her desire to breastfeed so such problems can be addressed, McCoy advises.
Also, the baby's frenulum (the tissue that holds the tongue to the bottom of the mouth) may be tight, which prevents the baby from latching on, McCoy tells WebMD. That can be fixed in a minor surgical procedure performed by a dentist; an ear, nose, and throat physician; a pediatric surgeon; or a general physician, she says.
Small and premature babies often have mouths that are too small to properly latch on. "Those babies will get bigger," says McCoy. Until then, she advises pumping and providing baby with breast milk by "cup feeding" -- using a little medicine cup like those that come with over-the-counter medicines. "The baby almost laps it out like a little kitten," McCoy tells WebMD. "It's amazing to watch, and with the right technique, preterm babies can actually take adequate amounts until the baby is big enough that he can get an adequate latch onto the breast."
The medicine-cup technique "takes a highly motivated mom," says McCoy, "but these are the babies who really need the breast milk. They are born with much more immature immune systems, so their risk for infection is higher. Also, their intestines are more immature, so they have a harder time with infant formulas. Mother's milk is much easier for a baby to digest."
Women who have had breast implants and reconstructive surgeries -- which cause trauma to breasts -- may have difficulty breastfeeding, says Joan Downey, MD, MPH, who directs labor and delivery at Barnes-Jewish Hospital and is assistant professor of pediatrics at Washington University School of Medicine in St. Louis.
"But there are very few cases where a woman cannot lactate. Very often, it's just a case of misconception or misinformation," Downey tells WebMD.
Mothers who must take medications often worry about drug exposure to the fetus and newborn infant -- and therefore are reluctant to breastfeed, says Downey. "We review the fetal exposure literature as well as neonatal exposure literature about the specific drugs, whether they are antibiotics, heart medicines, over-the-counter cold and sinus medicines. There's very good reference material on this," she says. "In general, there are very few medications for mothers that are not advised during breastfeeding."