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."

In some cases, a mother may be advised to vary the medication schedule -- with her doctor's approval -- so that she is not pumping or breastfeeding at the medicine's peak time. "You can individualize the process to maximize her ability to breastfeed," Downey tells WebMD.

Also, when babies are latching on well but they're still not gaining enough weight, it may be that the mother just isn't producing enough milk, says McCoy. Solutions to increase milk supply? Pumping between feedings -- or putting baby to breast much more often than mothers think the baby should need to nurse.

One volume-building prescription medication -- Reglan -- has been used by mothers in Downey's neonatal intensive care unit to help them maintain volume when they are exhausted and under stress. "It's been very effective in 5- to 10-day treatment periods," she says.

As far as dietary supplements sold through health food stores, "I just can't endorse them," says McCoy. "The American Academy of Pediatrics still has some skepticism about them."

Supplementing with formula is certainly appropriate when things just aren't working, says McCoy. "There is nothing like breast milk, but we have to look out for the baby's overall nutrition and weight gain," she says. "I'm always amused by formula manufacturers who say that theirs is more like breast milk. You can change the proteins and fat to be more like breast milk, but you can't give formula the antibodies and white blood cells and other proteins that have protective factors that keep viruses from binding to the lining of the intestine."

Breastfeeding troubles can be disappointing for some moms, says McCoy. "But if a mom says, 'I can't' or 'I don't want to,' we have to be really supportive of them. It's important to be positive about her experience, to let her know she's given her baby the best possible start she can," she says.

McCoy reassures every mom that a formula-fed baby is well-nourished. "And the baby has the benefit of all that bonding," she tells WebMD. "Bonding has just as many positive effects on her baby's health."