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Breastfeeding, while natural, may not be second nature for many families. While there are many benefits for both mama and baby, there’s a lot that goes into breastfeeding besides just getting a baby to latch. You might have questions like ‘is it normal to leak breast milk?’ or ‘Can I breastfeed with inverted nipples?’ that you’re embarrassed to ask your provider. Sometimes, the perceived taboo around breastfeeding can make us hesitant to voice such concerns.

As an IBCLC-certified lactation consultant, a registered dietitian, and a mother of two exclusively breastfed children, my professional and personal experience means I fully understand the hesitancy and potential embarrassment behind these questions. But I’m here to address 5 of these commonly unasked concerns and provide some clarity.

A lactation consultant answers 5 embarrassing breastfeeding questions

Q. “Is it OK if I don’t feel my letdown?” 

It’s completely OK if you don’t feel your letdown during breastfeeding. Letdown, also known as the milk ejection reflex (MER), is the process by which your body releases milk from the milk ducts in response to your baby’s suckling, or the pump’s stimulation. Some women may feel a tingling or slight discomfort in their breasts during the letdown, while others may not feel anything at all. 

Not feeling the letdown doesn’t necessarily indicate a problem with breastfeeding or your milk supply. The letdown reflex can vary from person to person and even from one breastfeeding session to another. As long as your baby is gaining weight, seems satisfied after feedings and has an adequate number of wet and dirty diapers, it’s likely that your milk supply and letdown are functioning well. 

A note on DMER: DMER stands for dysphoric milk ejection reflex, a relatively rare but documented phenomenon experienced by some breastfeeding mothers. DMER is characterized by feelings of sadness, anxiety, irritability or even mild nausea occurring just before and during the letdown reflex. These feelings typically last only a short time, often just a minute or two, and then resolve as the milk starts flowing. It’s important to note that DMER is not the same as postpartum depression, postpartum anxiety, or other mood disorders, although it can sometimes be mistaken for these conditions. If you are experiencing symptoms of sadness or other negative feelings during letdown, reach out to a healthcare professional or a lactation consultant. They can provide strategies and emotional support to help manage these feelings while continuing to breastfeed, if so desired.

Q. “Should breastfeeding hurt?” 

Breastfeeding should not be painful. While some initial discomfort or mild sensitivity might occur as you and your baby adjust to the breastfeeding process, ongoing pain is usually a sign that something isn’t quite right—and is always a good reason to reach out to an IBCLC. It’s important to address any pain or discomfort you’re experiencing, as there are often solutions to improve your breastfeeding experience. 

Possible reasons for breastfeeding pain and discomfort include: 

  • Latch issues: If your baby is not latching properly onto the breast, it can lead to sore nipples and discomfort. A proper latch involves the baby taking in a good portion of the areola along with the nipple. A shallow latch can cause friction and soreness. 
  • Tongue tie/lip tie: Some babies are born with a tight or restrictive frenulum (the tissue that connects the tongue or lip to the mouth). This can affect their ability to latch correctly and lead to pain for the mother. 
  • Engorgement: Overfull breasts can become engorged, making it harder for the baby to latch properly. This can result in pain and difficulty breastfeeding. 
  • Mastitis or clogged ducts: Inflammation of the breast tissue can cause pain and discomfort. Clogged ducts, for example, is inflammation of the milk ducts that can occur when milk ducts become inflamed. 
  • Nipple damage: Sore, cracked, or bleeding nipples can occur due to incorrect latch or positioning, as well as other factors.
  • Latch learning curve: In the early days of breastfeeding, both you and your baby are learning. As you both become more comfortable and skilled, the discomfort should decrease. 

Q. “Does what I eat affect my milk supply and composition?” 

Yes, your nutrition can influence both your milk supply and breast milk composition while breastfeeding. However, breast milk is still very beneficial for your baby regardless of your diet. That said,you can enhance the nutrient composition in your breast milk by increasing your nutrients, as well as ensure you’re getting adequate calories for yourself. 

A well-balanced and nutrient-rich diet is important to support your own health as well as the health and growth of your baby. Here are some key points to consider: 

  • Adequate caloric intake: Breastfeeding requires extra energy, and not consuming enough calories can potentially affect your milk supply. It’s recommended to increase your caloric intake by roughly 500 calories to support your body’s needs and milk production. 
  • Hydration: Staying well-hydrated is helpful for milk production. Drink plenty of fluids throughout the day to ensure you are properly hydrated and be sure to include electrolytes, like Needed’s Hydration packet which contains electrolytes that you can easily add to your water to replenish nutrients. 
  • Macronutrients: Consuming sufficient amounts of carbohydrates, proteins, and healthy fats is important for overall health and energy levels. Proteins are particularly important as they provide amino acids that support milk production as well as keep your blood sugar steady. An easy way to incorporate more protein is by adding collagen, like Needed’s Collagen Protein, into your coffee, yogurt, oatmeal, smoothies etc. 
  • Vitamins and minerals: A varied diet rich in vitamins and minerals, including choline, calcium, zinc, iodine, selenium and vitamins A, K and D, is important for both you and your baby. Some vitamins and minerals play a role in immune function, bone health and other vital processes. A quality prenatal vitamin like Needed’s Prenatal Multi can ensure you’re filling in the nutritional gaps, even when you’re postpartum. 
  • Omega-3 fatty acids: Omega-3 fatty acids, found in foods like fatty fish, flaxseeds and walnuts, can contribute to brain and eye development in your baby. Your breast milk’s omega-3 fatty acid composition is directly related to the your omega-3 intake.
  • Herbs and galactagogues: Some herbs and foods have a history of use in helping to support milk supply and milk production. Examples include moringa, oats and fennel. Consult with a healthcare professional before using any herbal supplements.
  • Allergens: If your baby shows signs of allergies or sensitivities, you may need to adjust your diet by eliminating potential allergens. The most common allergens include dairy, eggs, soy, nuts and gluten. 
  • Variety and quality: Eating a variety of nutrient-dense foods can help ensure that your breast milk contains a wide range of nutrients for your baby’s growth and development.

It’s important to note that individual nutritional needs can vary based on factors such as your age, activity level and underlying health conditions. While a well-rounded diet is crucial, perfection is not necessary. It’s normal to have days when your diet isn’t perfect, and rest assured that occasional indulgences won’t dramatically affect your breast milk. 

Q. “Is it normal to leak breast milk during sex?”

Yes, it’s normal to leak breast milk during sex, thanks to the hormone oxytocin—which not only is the love hormone, but is behind the milk ejection reflex (MER), too. Because of the increase in oxytocin that happens during intimacy, it’s possible your letdown reflex could kick in, leading to leaking breast milk during sex. But it’s nothing to worry about—try laughing it off, or consider the following tips.

Tips for how to prevent leaking breast milk during sex: 

  • Breast pads: Disposable or reusable breast pads can be placed inside your bra to absorb leaks.
  • Nursing bras: Wearing a supportive nursing bra can help prevent friction that might trigger leaks.
  • Hand expression: If you feel your breasts becoming too full, you can use gentle hand expression to release a small amount of milk and relieve pressure. 
  • Breastfeeding or pumping: Feeding your baby or pumping before intimacy to empty your breasts can help manage oversupply and reduce leaking. 
  • Sex positions: Experiment with different positions to help control the flow of milk and reduce the chance of leaking. 

Leaking breast milk outside of breastfeeding or pumping is a common occurrence for many breastfeeding mothers, and it can happen at any time, not just during sex. 

Leaking can be triggered by a variety of factors, including: 

  • Oversupply: If you have an oversupply of breast milk, your breasts may release milk more frequently and in larger quantities, leading to leakage. 
  • Strong letdown: A forceful letdown reflex can sometimes cause milk to leak from the opposite breast that your baby is nursing on. 
  • Hormonal changes: Hormones play a significant role in milk production and release. Hormonal fluctuations, such as those that occur in response to your baby’s cues (like if you hear a baby crying you might leak) or during emotional moments, can lead to leaking. 
  • Engorgement: When your breasts are engorged, they may release milk involuntarily. 

Remember that leaking is a normal part of the breastfeeding journey for many mothers and some may leak more than others. Don’t worry if you’re not leaking—this doesn’t always point to a supply issue. If you have concerns about your milk supply, comfort or any other aspect of breastfeeding, meet with a lactation consultant or contact your healthcare provider to provide you with personalized guidance and support.

Q. “Can I still breastfeed if I have inverted nipples?” 

Yes, it is often possible to breastfeed with inverted nipples, though it might require some additional support and techniques, such as using a nipple shield to draw the nipple out, especially in the early days. Inverted nipples are those that do not protrude outward when stimulated, and they can be a result of the way the underlying breast tissue is connected. While inverted nipples can present some initial challenges, many women with inverted nipples successfully breastfeed their babies. If your baby is a competent feeder, they should be able to latch onto flat skin, so drawing out an inverted nipple should be possible. 

A note on breastfeeding concerns

If you have concerns about your breastfeeding experience, it’s a good idea to reach out to an IBCLC lactation consultant or a healthcare professional who can answer any questions and provide personalized support. They can help address any challenges you may have and ensure that breastfeeding is going smoothly for you and your baby. With the right support and adjustments, breastfeeding can become a positive and pain-free experience for both of you.

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