A – Should all women breastfeed?

Health care providers agree that breastfeeding is one of the healthiest choices a mother can make for herself and her child.  Your body provides the ideal way to give your child a perfect source of nutrition.

But many moms experience challenges with breastfeeding along the way. 

Breastfeeding takes time to learn and can be more difficult than anticipated. Not all babies latch on immediately and it’s not uncommon for new moms to feel disappointed or discouraged. 

B – Is breastfeeding an option for me?

For some women, breastfeeding may not be an option. This is true for women who:

  • Take certain medications or use illicit drugs.
  • Have been exposed to certain infections.
  • Have a chronic medical condition.
  • Have had an environmental exposure and are clinically ill from toxins such as lead or mercury.

Also, in rare cases, breastfeeding is not advisable if the infant has certain medical conditions such as galactosemia, a rare genetic metabolic disorder.

That said, I like to stress that breastfeeding doesn’t have to be all or nothing. If you decide to breastfeed exclusively, that’s great. If not, there are other ways you may choose to breastfeed. Some women choose to partially breastfeed by combining breastfeeding with formula feeding. Some mothers only pump, or may transition to formula feeding.

You have options. Speak to your health care provider or lactation consultant. Ultimately, it’s about choosing what works best for you and your baby.

C – When should I be concerned and seek help?

Be sure to talk to your provider about any concerns you may have. You may experience some of these common uncomfortable or painful problems while breastfeeding.

Breast engorgement

Breast engorgement may occur when a mother makes more milk than her baby uses. More often, it’s associated with the baby, or breast pump, not effectively removing breastmilk at each feeding, or pumping. The breasts become firm and swollen, which can make it hard for the baby to latch and breastfeed, making the condition even worse! Prolonged engorgement will eventually lead to an inadequate supply through a negative feedback loop on the milk making process. The risk for infection (mastitis and abscess) also increases with engorgement. 

Nipple soreness

It’s common for nipples to feel sore when moms first start to breastfeed. This is almost always a short-term problem, and can usually be corrected in a matter of days. The degree of soreness varies, with some mothers experiencing slight tenderness, and others noticing bleeding, cracked nipples. Cracked nipples can be caused by irritation, dry skin, pumping improperly, or latching problems. 

Plugged ducts

Some mothers nurse several babies and never experience plugged ducts or mastitis, while others have recurrent episodes. A plugged, or clogged, duct is a sore, tender area of blood vessels and breast tissue surrounding a milk duct. It is not a "plug" of breastmilk that needs to be pushed out. Plugs may occur with hyperlactation, oversupply, and excessive or aggressive breast massage. The area may be warm to the touch and red, and if it’s located in a duct close to the surface of the skin, you may be able to feel a distinct lump with your fingers. In order to treat a plug, apply ice, use ibuprofen and acetaminophen, and avoid massage, overfeeding, or overpumping. Symptoms should improve within 48 hours. If they do not improve or worsen, seek medical assistance. 


Mastitis is no longer considered a single breast condition, but a spectrum of conditions in which the breast is painful, swollen, and red. It typically begins from prolonged engorgement or poor breast milk drainage. As the condition progresses, fever, chills, and body aches can develop. Initial treatment is the same as management of plugged ducts (avoiding excess massage or pumping, applying ice to the breast, taking ibuprofen). Symptoms that do not resolve or worsen require a medical evaluation and potential antibiotics. 

Breastfeeding tips to remember

  • When a baby is fussy or wants to nurse again shortly after eating, it’s natural to worry that you’re not producing enough milk. However, these can be normal behaviors. The baby gaining weight can reassure mom that breastfeeding is going well.
  • If the baby is losing excessive weight, needing less frequent diaper changes, becoming lethargic or jaundiced (yellowing of the skin), the baby needs to be evaluated by the pediatrician immediately. 
  • If you’re asked to supplement your baby with formula, don’t despair! Once your baby is getting adequate nutrition, he or she is less likely to be fussy and may even be able to sleep for longer stretches of time. When mom and baby are feeling more rested and satisfied, they’re more willing to work on the nursing process and more likely to achieve exclusive breastfeeding, if desired. 
  • Remember, you’ll need to continue a regular cycle of breastfeeding or pumping (every 2-3 hours in daytime and at least 5 hours at night in the first few months of life) to maintain a supply, even if you are supplementing with formula.  

Our breastfeeding medicine team is available to help you. Our program offers comprehensive, individualized treatment for women who are experiencing complicated breastfeeding issues or have a medical condition which can complicate the lactation process.  Learn more about our Breastfeeding Medicine Program.

Courtney Clark Bilodeau, MD, FACP

Dr. Courtney Clark Bilodeau is a physician in obstetric medicine at the Women's Medicine Collaborative, with clinical and research interests that include breastfeeding, evidence-based complementary medicine, and peripartum management of chronic medical conditions from preconception through postpartum.