Your breastfeeding problems solved

What to expect ...

Babyexpert has teamed up with Clare who is breastfeeding counsellor to the stars. Kate Winslet, Emma Freud and Kate Beckinsale have all endorsed her book, and she's helped Trinny and Susannah, Helena Bonham-Carter and Gabby Logan make breastfeeding a success.

Her book What to Expect When You're Breastfeeding and What If You Can't? is published by Vermillion, £7.99. 

Babyexpert members posted questions for Clare throughout National Breastfeeding Awareness week. Here are her answers: 

Flat nipples

Q: My midwife blushes every time we discuss breastfeeding which makes me uncomfortable so I'm glad I've been given this opportunity. I have 1 flat nipple (the other is fine) and I have received conflicting advice regarding breastfeeding. My midwife mumbled that there wouldn't be a problem but I have read that flat/inverted nipples need preparing before commencing breastfeeding. Unfortunately no further details were given on what sort of preparation needs to take place nor at which stage the preparation should begin. I am 32 weeks and starting to get a little worried. Any advice would be gratefully received.

Clare says: I'm afraid it's a bit late to do anything now but for future babies you could try using a device made by Avent called a Nipplette. This is a suction cap that fits over the nipple and pulls it into a better shape - but it can't be used after about 28 weeks. However, flat nipples don't always need preparing as your baby should latch onto your breast, not just your nipple. But, as flat nipples can be slightly harder to latch onto than a well-shaped nipple, you may need to help your baby by the 'shaping and shoving' technique that I describe in my book and demonstrate on my DVD. Using the 'nose-to-nipple' method is unlikely to work with flat nipples! Hopefully you will succeed in latching your baby on, but if you can't, you can always try nipple shields or, as a last resort, you could express your milk and give it in a bottle.

Latching on

Q: My baby is now 5 months old. I have experienced great difficulties with breastfeeding - including my baby having a tongue tie that has been corrected. But, I am still not able to breastfeed him as I cannot get him to latch on and suck. I have kept my milk supply going by expressing but it is very low. Is there any way I can get my baby to latch on or is it too late now? 

Clare says: Sorry to hear that you are having so many problems. It shouldn't be too late to get your baby to latch on correctly BUT realistically you may well find that he won't be prepared to suck for very long if there is not much milk for him. Also, some babies genuinely can't or won't suck efficiently and if he is one of these babies he is even less likely to want to suck on your breast when he knows there is an easier alternative (the bottle!) on offer after each attempt. My view is that it is only worth trying to get him back on the breast if you manage to increase your milk supply by doing more expressing etc. I know you get told that a baby will increase your supply better than a pump, but I do not agree with this theory, especially when you have such an old baby who is likely to get angry and upset if you try to make him suck on an empty breast when he is used to a full bottle. Good luck!

Sore nipples

Q: My daughter is 11 weeks old. As I have flat nipples I had problems latching her on initially and ended up with extremely sore and cracked nipples. I used nipple shields for a few weeks until they healed and this also helped to draw them out. I have stopped using the shields now but I am still getting sore nipples (although nothing as bad as before). Two health visitors have checked her position and say she is latched on correctly so why are they still getting sore?

Clare says: Sore nipples are nearly always caused by poor latching but unfortunately it takes an experienced eye to recognise a less than perfect latch. Almost all the mothers I see with sore nipples have been told by their midwife and / or their Health visitor that the latch is correct, and yet the soreness goes as soon as I move the baby to a better position! My DVD (Breastfeeding without Tears) shows how to shape your breast to help your baby latch on better, so you might find this helpful - some libraries stock the DVD so don't feel that you have to go and buy a copy! You also need to check for Thrush on your nipples as this will make feeding painful even if the latch is correct. I hope you find these suggestions helpful, but if you can't resolve the problem you could always go back to using nipple shields. It is perfectly OK to use them for months on end providing you have a good flow of milk that enables your baby to get the milk as easily through them as she does when feeding direct from the breast.

Expressing

Q: Mine isn't really a problem but i would like some advice as i have been breastfeeding my daughter for nearly 8 months now and am finding it harder as i am back at work now. My parents and partner have her 3 days a week and i am trying to express but sometimes don't get a chance, will this make my milk supply dry up? She always seems to have plenty when i am around!
Clare says: Some mothers are lucky and have such a good milk supply that they can get away without expressing on a very regular basis. But, if you DO find your supply starts diminishing, you can usually build it up again by expressing more often for a few days. Well done for breastfeeding for so long!

Slow feeder

Q: Hi there. I have a 3 week old girl, been doing okay with the breast feeding. Although at the moment for the last week or so she has been feeding over a longer period, on and off both breasts and having full feeds. This would happen twice a day, from approx 10am to maybe 2pm and then from 9pm to 12am. She demands these feeds, feeling pretty tired, don't seem to have much time to myself. Is this normal? Have not got much idea about expressing or anything as I'm a first time mum.

Clare says: The most likely reason your baby is spending ages feeding at 10am and 9pm is that your milk supply is a bit low at these two times. I think it would be a good idea to get a breast pump so you can see what the problem is. At the 10am feed, you should let her suck for a maximum of one hour. You should then take her off the breast and use the pump to see how much milk is left - if your breast is empty this will explain why she is unable to settle back to sleep. If this proves to be the case, try to express some milk after a feed when she settles well (maybe the first feed in the morning) so you can offer this as a top-up at the 10am and 9pm feed. You should then use the pump after these feeds to try to stimulate your breasts to produce more milk. Hopefully your supply will improve after a day or two. Also, make sure that you are resting as much as possible and eating regular meals and drinking plenty of fluids.

Breast to bottle

Q: I am breastfeeding my 5 month old daughter Aimee and will be going back to work soon. My daughter will be in childcare on a part time basis but I can't get her to drink from a bottle or a cup, I have been trying with a bottle but was given advice to stop as it wasn't successful and try with a cup, only problem is Aimee will not drink from it and I am worried if I go back to work she will not get her milk in the afternoon. Could you please advise me on the best possible way to get her to feed from a cup so I can carry on breastfeeding and expressing my milk for cup feeding?

Clare says: This is a horrible problem to deal with but the sooner you tackle it head on the better as the older your baby gets, the harder it is to get her to take a bottle. I think she is far too young to take all her feeds from a cup as babies love sucking and a cup doesn't give the same pleasure as a breast or bottle. A cup from six months is fine for her midday water with her meal, but is not a solution to a baby who is totally hooked on the breast. Essentially my advice is to spend a full 24 hours teaching Aimee how to feed from a bottle and during this time she should not be given the breast, even if she refuses the bottle. If you went under a bus tomorrow she would have to give up breastfeeding and take a bottle, so I do not think it is cruel to teach a baby to take a bottle as well as a breast and cup. I cover the subject of refusing bottles in great detail in my book, giving advice on the best teats and bottles to use, how to distract the baby etc. I am afraid it would take to long to go into all the detail in this answer, so you will need to buy or borrow my book to get the full information. I regularly see babies with this problem and I want to reassure you that once Aimee gets used to the bottle she will be just as happy on that as she is on your breast. Good luck!

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