Breastfeeding Challenges
Although breastfeeding is “natural” it’s not always “easy”. In fact, it’s a new skill that both mother and baby need to learn. The on-the-job-training happens at a pretty rough time too! When you are very newly a mom, probably sleep deprived, and at the bottom of a steep learning curve for a whole bunch of new stuff.
We prepared this resource to help you troubleshoot the challenges so you are making progress while you are waiting for hands-on-help from a lactation consultant.
Lactation Consultants / Counsellors we Love:
First Feedings
Brianna Krall, IBCLC. CCC-SLP
Melody Stoker, IBCLC, PTA
940.331.5288
firstfeedings.bk@gmail.com
NectarAndNurture
Breastfeeding & CranioSacral Therapy
Amanda Telthorst, RN, BSN
469.592.7364
Lumps & Bumps - How do I know if I’m getting mastitis
It’s very normal for breasts to feel lumpy, heavy, or full in the first week as milk is “coming in.” This is not automatically a clogged duct. Signs that breastfeeding is going well include:
Baby feeds at 8 - 10 times in 24 hours.
Swallowing is heard/seen after the first few sucks.
Breasts feel softer after feeding.
Baby has at least 3–4 wet diapers and stools each day by day 3.
Stools are transitioning from “dark brown” to green and then bright yellow.
Baby seems content and sleepy after most feeds.
What’s a Clogged Duct?
As your milk comes in/ after your milk comes in, you may have specific bumps in your breast. It’s important to know if it’s normal, or if it’s a clogged duct.
A clogged duct usually feels like:
A firm, tender lump in one spot.
Discomfort that improves after a feeding.
No fever, or only a mild temperature.
If you have fever, chills, or flu-like symptoms, that may be mastitis. Call your midwife if you think you have mastitis.
How to Prevent Clogged Ducts
Feed often & don’t skip – aim for every 2–3 hours, including overnight.
Good latch – baby’s mouth covers more of the areola below the nipple than above.
Vary positions – different holds help drain different parts of the breast.
Gentle massage – before and during feeds, stroke toward the nipple or squeeze and hold the breast to nudge milk toward the nipple.
Avoid tight bras – or pressure from straps, carriers, or sleeping positions.
Stay hydrated & rested – easier said than done, but it matters.
Apply ice – if you are uncomfortable and having swelling, apply ice for 15-20 minutes before feedings.
Resources to Share
What about Mastitis?
1. Skip the pumping and the massage torture
The Academy of Breastfeeding Medicine’s (ABM) 2022 Protocol #36 shook things up. Mastitis isn’t about “clogged ducts” needing obliteration with pumping or massage. It’s now understood as inflammation from oversupply (hyperlactation) and microbiome imbalance (dysbiosis), which causes duct narrowing—not actual blockages. So, aggressively emptying the breast via pumping or breastfeeding? That risks worsening inflammation and perpetuating oversupply. The Lactation Collection+6Nest Collaborative+6Nest Collaborative+6
2. Ditch the deep heat and hand-grenade massage
Deep massage, heat, or even vibrating devices used to “unplug” the breast can exacerbate inflammation and cause tissue damage. It’s like rubbing salt in an ankle sprain—just no. La Leche League InternationalPhysician Guide to BreastfeedingMassachusetts General HospitalThe Lactation CollectionWikipedia
3. Cool, Gentle, Calm: The New “Go-To” Strategy
The modern recommendation emphasizes reducing inflammation—not increasing milk production or blood flow:
Cold compresses (e.g., ice packs) to calm swelling.
NSAIDs like ibuprofen (and/or Tylenol) to reduce pain and inflammation. Brigham and Women's Hospital+15Mayo Clinic Health System+15Nest Collaborative+15The Lactation Collection
Gentle lymphatic-style touch—think “petting a cat,” sweeping upward toward armpits or collarbone—nothing forceful. Wikipedia+3Massachusetts General Hospital+3Mayo Clinic Health System+3
4. Breastfeed on demand—but don’t empty excessively
Continue to nurse as baby asks—no need to “empty” the breast completely or add extra sessions. Let baby dictate. Physician Guide to Breastfeeding+15Nest Collaborative+15The Lactation Collection+15
Pumping? Only to meet baby’s needs—not to drain the breast—because pumping can stimulate milk production and inflammation. Nest Collaborative+1
5. Supportive care and monitoring
Supportive bra: comfy, non-constrictive; avoid underwires that may press on tissue. Massachusetts General Hospital+1
Rest, hydration, good nutrition, and emotional support help too. Mayo Clinic Health SystemThe Lactation Collection
If symptoms don’t improve in 24–48 hours, or if system symptoms flare (fever, chills, flu-like feelings), call your healthcare provider—antibiotics might be needed. La Leche League InternationalMayo Clinic Health SystemThe Lactation CollectionWikipedia
Quick Reference Summary
Don’t go wild with pumping or force-feeding the breast empty—it can feed the beast of oversupply.
No deep, aggressive massage or heat therapy—that's old-school and just fans the inflammatory fire.
Ice and ibuprofen (or Tylenol) are your new go-tos—think “cool it, calm it.”
Gentle “petting” strokes toward lymph sites—like telling the breast, “Hey, let go of that swelling.”
Nurse on baby’s schedule, not yours trying to “empty.” Pump only when necessary for baby feeding.
Comfortable bra, rest, hydration, and support—because you matter too.
Watch for a high fever, no improvement in 1–2 days, or feeling super under the weather—time to dial call the midwife.
