Successfully Breastfeeding a Second Child
After a Bad Experience with the First
By Michelle Branco
Q: I am
pregnant with my second child. My daughter is almost three and weaned.
I’m feeling very worried about breastfeeding the new baby. My first
breastfeeding experience was so terrible: horrible pain that never
really went away and constant stress about the baby gaining enough.
Truthfully, I never really enjoyed it (although my daughter nursed until
I got pregnant). I can’t imagine doing that again, and I don’t really
want to. Yet I do want to breastfeed this baby. Can you help?
many of my clients are first-time mothers, people are surprised to hear
how many women seek out my help with a second or subsequent baby. Every
baby is a unique individual. Your new baby may nurse painlessly right
from the start or share some sibling similarity. What surprises me is
how many women tell me that they nursed for extended periods of time in
a mother wean primarily because of her own pain, although her suffering
may be significant.
Pain is something we have wrongly come to expect
with breastfeeding. We rely on experts to tell us that the latch looks
good and thus ignore the fact that the pain is still there. While
soreness is to be expected with any new activity, pain, cracking, and
bleeding are not normal.
Breastfeeding difficulties that persist almost never have a single
cause. Nature builds in mechanisms to ensure that babies thrive despite
obstacles. Pain usually arises from either compression/abrasion or
infection. It may not be possible to determine for certain what caused
your troubles the first time. It’s critical, though, to understand what
it was not: It was not your failing or that of your baby. Some causes
may have been unique, while others may be more likely to repeat.
of the nipple: This can happen for a number of reasons, but ultimately
what it means is that the nipple is not deep in the baby’s mouth where
the soft and hard palate meet. When we talk about getting “a good
latch,” this is essentially what we are aiming to achieve. A nipple that
is elsewhere is getting pressed and rubbed against the tongue and hard
palate (or lips) – and the baby is not getting the most milk she could
out of the breast, ultimately leading to difficulty with weight gain and
Information on how to position a baby at the breast is widely available
from good sources as such as La Leche League and others. If you suffered
with pain at the breast for two years, I suspect you’ve read most of
those. There are a couple of good graphics that I’ve found helpful.
While these are helpful once you are developing pain and trying to
figure it out, there are risks to a rigid approach before you know have
trouble (see next).
Patterns: One of the greatest barriers to comfortable breastfeeding for
mothers is recognizing the variability in nursing patterns among
perfectly normal babies. The frequency and duration of breastfeeding is
a key way in which Nature makes up for the endless physical variations
that happen in every nursing duo. A baby who nurses very often and who
needs to stay close to his mother as he figures out how to get the food
he needs is often flagged as not doing well – which leads to a cascade
of instructions on how to nurse “better” and when to nurse on which
breast. Interfering with the baby’s access to the breast is the first
step away from Nature’s plan. It’s often accompanied by well meaning but
misguided attempts to teach a mother how she “ought to” breastfed and
ignore her own instincts to protect herself and her infant. Trust that
your baby knows when she is hungry and that you know when you are in
pain – regardless of any expert opinion.
Often, but not always, infection is secondary to damage in the nipple or
poor draining of the breast. Infections can happen in the skin or the
tissues of the breast (mastitis or abscess). Treatment is effective, but
undertreating can allow chronic infections to remain and, without
addressing the underlying cause, recurrence is common. Whether you have
a yeast infection (thrush) or a bacterial one, getting the appropriate
treatment is critical and not always straightforward. Thrush is probably
over-diagnosed and yet under-treated versus the number of bacterial
infections present in breastfeeding mothers – although they can occur at
the same time (and yeast is sometimes triggered by antibiotic use).
Using a lubricant with anti-infective properties may be helpful, such as
coconut oil or olive oil. If you find you have pain, the all-purpose
nipple ointment created by Dr. Jack Newman (often referred to as “APNO”)
can help head off minor infections. If you do have an infection, be sure
that you are treating the right kind of infection with the appropriate
Ties tend to run in families – they occur when the tissue (frenulum)
that attaches the fetal tongue to the bottom of the mouth fails to
completely die away as it should. The tongue lacks the full range of
motion needed to cup and properly compress the areola during
breastfeeding, causing nipple compression and damage as well as poor
milk transfer. Persistent, long-term pain and poor weight gain are
common. Better positioning and gentle bodywork can help babies optimize
their latch despite the tightness. Sometimes, a release (cutting the
excess tissue to allow full motion) is needed. This is often overlooked
as a breastfeeding barrier; most physicians are not trained to identify
any but the most obvious tongue ties. See the website www.tonguetie.net
for more information.
physical factors: Although it may seem like it’s all we talk about,
latch is not the only variable. In an effort to encourage women,
breastfeeding advocates (myself included) have tended to minimize the
impact that these variations of normal have on breastfeeding
experiences. For example, it is absolutely true that a woman with truly
inverted nipples can breastfeed pain-free. However, it is unlikely that
she will right from the beginning, particularly given our modern birth
practices. Given time and support, almost any anatomical combination can
work, but it’s also true that some of those are legitimately harder to
make work than others. While most women have heard of flat nipples,
there are a number of other types of anatomy that can make breastfeeding
more difficult: variations in infant palate, nipples size, and facial
structure are some that I see fairly often. Injuries from birth (or
continued pain from pregnancy for moms) can also set patterns that are
less than ideal in the early weeks. These types of challenges will often
work themselves out with time, continued breastfeeding, and support.
list is far from comprehensive, so moms with problems should keep looking for a solution.
your previous breastfeeding experience with an empathetic listener will help you
to unload some of the weight you are carrying on your heart – both in
your memory of your suffering and the guilt you feel for questioning
whether breastfeeding is something you are willing to do again. If a
professional, one-on-one conversation is more comfortable for you, many
breastfeeding clinics and private lactation consultants also offer
prenatal consultations. La Leche League and other peer support
organizations (often run by public health units) are good sources of
free help, as are supportive members of your health care team.
This is a
new start and you deserve to enjoy your baby without suffering. I hope
you find the answers and support you need to get there.
Michelle Branco is an International Board
Certified Lactation Consultant in private practice, a La Leche League
Leader, and mother to Isabelle and Thomas, both breastfed. She provides
evidence-based breastfeeding care to mothers at
www.latchlactation.com through phone, email, and in-person consultations.