Photo by Maureen Noce Photography

Breastfeeding was not intuitive for me and I struggled. I had low milk supply early on and had difficulty with getting Madi to latch. Fortunately, with the help of a lactation consultant after two weeks, breastfeeding improved.

There are two main reasons why mothers and their infants may have breastfeeding difficulties.  The first reason is inadequate milk production from the mother. The second reason is inadequate milk extraction by the baby. 

Some common causes an infant may not get enough milk while breastfeeding are anatomical issues with the breast, the nipples, or interferences from hormones and medication.

Frequency of feeding contributing to breastfeeding difficulties

The breast and nipple is a complex system of tissues and nerves that help signal to our bodies when more milk needs to be produced. 

Many women believe that it is best to wait for breasts to be engorged with milk to breastfeed, but it is really the opposite.  Milk supply is related to the frequency of breastfeeding or pumping.  The more you pump or breastfeed, the more milk you will produce.  When the breasts become engorged with milk, a signal is sent to the body to slow down milk production. This then leads to milk undersupply. 

That is why it is best to breastfeed more frequently and on demand to avoid overfilled breasts and maintain consistent milk production. 

It may be tempting to stretch out feeds to 4 hours, or give your baby a pacifier to prolong the time between feedings.  Milk is produced when the breasts are empty. So the more frequently the breasts are emptied, the more milk will be produced. 

Breastfeeding more frequently (and fully emptying the breasts with each feed or pump) will likely increase milk supply and reduce breastfeeding difficulties.

It is not recommended to use a pacifier to prolong times between feeds as infants should be nursed on demand.  A pacifier should only be introduced after an effective breastfeeding routine has been established.

Inconsistent feeding routine may contribute to trouble breastfeeding

After birth, both mother and baby are often very sleepy. Establishing a consistent breastfeeding routine can be difficult. The lack of frequency or consistency in feeding can lead to inadequate milk transfer to the baby. this may decrease milk supply and lead to breastfeeding difficulties.

Poor and inconsistent feeding routines in the early postpartum period are the most common cause of breastfeeding difficulties.

Be careful not to confuse routine with scheduled feeding.  I nursed Madi on demand, rather than on a set schedule. Most newborns need to be breastfed 8 to 12 times per day. Sometimes even more. 

Supplementing with formula too early may lead to trouble breastfeeding

Sometimes mothers supplement with formula until their milk comes in which can take a few days.  The important thing to remember is that if you are supplementing with formula, you still breastfeed or pump at the same frequency as providing formula.  This is because the breasts rely on frequent filling and emptying to produce milk.  You may produce less milk if you supplement with baby formula right away (that is if you do not continue to breastfeed or pump at the same feeding times). 

Not breastfeeding or pumping at night may lead to breastfeeding difficulties

Although sleep training is safe starting at 4-6 months, it may disrupt your breastfeeding routine. Eliminating nighttime breastfeeding may lead to overfilled breasts and signal to the body to produce less milk. This may lead to trouble breastfeeding. 

Some women can avoid disrupting milk supply while sleeping by pumping just before bed, or waking up in the middle of the night to pump.  If your baby is consistently sleeping through the night, then you might wake up engorged and uncomfortable. In this case, it is recommended to pump or manually express for comfort only until your milk supply adjusts itself.

Nipple pain and trouble breastfeeding

Many women get sore nipples while breastfeeding.  This may reduce breastfeeding frequency. This can lead to decreased milk supply and lead to trouble breastfeeding. 

Nipple pain can be caused by improper latching, abnormalities of the infants tongue or mouth, or abnormalities of the nipple (such as small, flat, or inverted nipples).  Sometimes tight bras, or reactions from lotions and soaps can irritate the nipples, which can result in pain while breastfeeding. 

It is normal to experience some nipple sensitivity and discomfort during the first few days postpartum, but this should go away after a week or two.  If nipple pain becomes more severe after a week of breastfeeding, then a physician or lactation consultant should evaluate both mother and infant. 

Some breast surgeries may contribute to breastfeeding difficulties

Generally speaking, breast augmentation does not impact a woman’s ability to breastfeed.  However, surgeries where incisions are made through the nipple or disrupt the tissue within the breast may impact a woman’s breast sensation. Similarly, some breast biopsies may disrupt the anatomy of the breast. Any surgery where there has been disruption of the breast tissue can potentially alter the ability to breastfeed.

Breast reduction surgeries are associated with insufficient breast milk production.  Women with previous history of breast reduction surgeries may find it helpful to discuss with their doctors about breastfeeding.

Medications and their impact on breastfeeding

Some common medications that women take during breastfeeding may impair their ability to have an adequate milk supply.  Oral contraceptive pills, especially ones with a high estrogen content, are possible culprits contributing to breastfeeding difficulties.

If you are breastfeeding, it is generally not recommend to use a birth control pill that contains estrogen since they decrease milk supply. 

Other medications that may decrease milk supply include:

  • Pseudoephedrine or other over-the-counter cold medicines
  • Nicotine
  • Excessive alcohol intake

Hormonal influences in pregnancy that lead to trouble breastfeeding

After delivery, there are sometimes retained products from the pregnancy, like the placenta. This can disrupt your hormone system and impair your ability to breastfeed. 

Polycystic ovarian syndrome is a disorder where the ovaries develop cysts and may also disrupt the hormonal system. 

Preexisting diabetes or gestational diabetes is also associated with a disruption of a woman’s hormone system and ability to product a sufficient milk supply, especially if the diabetes is not well controlled. 

Poor milk extraction

Poor feeding can be caused by difficulty with the baby latching.  Other potential causes that may make it difficult for the baby to latch and extract milk from the breast include:

  • Malformations of the lip and palate – cleft palate, lip
  • Sucking and swallowing issues
  • Neuromotor delay
  • Premature infants

If the baby has experienced a prolonged separation from mother, they may forget or fail to learn how to breastfeed.  Breastfeeding as early as possible after delivery, and keeping a consistent and frequent breastfeeding routine is vital to having a baby that can successfully breastfeed. 

Late preterm babies and breastfeeding challenges

Babies that are born in the late premature age (34 to 37 weeks gestation) may have more difficulty feeding compared to full-term infants.  This may lead to insufficient nursing, inadequate milk production, and trouble breastfeeding.

Milk production to a certain extent is a supply-demand situation.  Frequent breastfeeding or pumping will help to increase your milk supply.  If you are having breastfeeding difficulties, talk to your doctor or a lactation consultant. 

This post was co-authored by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.


  1. Reilly S, Reid J, Skeat J, Academy of Breastfeeding Medicine Clinical Protocol Committee. ABM clinical protocol #17: Guidelines for breastfeeding infants with cleft lip, cleft palate, or cleft lip and palate. Breastfeed Med 2007; 2:243.
  2. Thomas J, Marinelli KA, Hennessy M, Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #16: Breastfeeding the hypotonic infant. Breastfeed Med 2007; 2:112.
  3. Academy of Breastfeeding Medicine. ABM clinical protocol #10: Breastfeeding the late preterm infant (34(0/7) to 36(6/7) weeks gestation) (first revision June 2011). Breastfeed Med 2011; 6:151.
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