Breastfed Matters:
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?

A: While 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 pain.

Rarely does 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.

Compression 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 supply.

Positioning: 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).

Nursing 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.

Infection: 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 treatment.

Tongue-tie: 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.

Other 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.

The above list is far from comprehensive, so moms with problems should keep looking for a solution.

Debriefing 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.