Breastfeeding Q&A with a lactation consultant: 'Natural doesn't mean it's easy'

There’s a discomfort that happens soon after birth. It happens as your heart tries desperately to expand to contain all this new love for a fresh human.

It’s a good pain. The next isn’t as welcome. Nursing parents, especially if they’re lactating for the first time, might have all manner of twinges, soreness or tenderness.

“Breastfeeding is a natural thing, but natural doesn’t mean it’s easy,” Montreal lactation consultant Marion Fréchette says.

People are sent home very soon after birth, often before their milk comes in, and can quickly feel isolated and confused. Their need for support doesn’t end in a day or a week, Fréchette says.

“It’s about the family’s journey. Breastfeeding changes at one week, at one month, at one year.”

Fréchette sat down with us to talk about common breastfeeding issues and how parents can access support. This interview has been edited for length.

What is your role?

I’m a new lactation consultant. I just started my practice in January. But for three to four years before, I did parent-to-parent peer support, making sure parents don’t feel isolated and answering basic questions. I decided to pursue it in a more professional way.

In our society, there are a lot of parents who are home alone. One often goes back to work after a few weeks and the parent who is lactating is home alone — and it’s a lot. It’s a lot of change, it’s a learning curve. With peer support, someone can tell them, “It’s normal that that baby falls asleep at the breast, it’s normal that they wake up in the night.”

I see people who have pain while breastfeeding or babies who are crying at the breast. We do breast exams and physical and oral exams of the baby to see what could be amiss. Maybe it’s the first time they’ve lactated and they have discomfort. Is the baby latching properly? Maybe the birth was difficult and the baby has trouble turning their head to one side. We help them find solutions, which could be seeing an osteopath or holding the baby a different way.

What are the most common issues you see?

Some of the most common issues we see are perceived — because it doesn’t mean it’s true.

A big one is that the baby isn’t gaining enough weight or there is a perception the baby is supposed to gain more than they are.

They ask if they have enough milk and whether the milk is fatty enough. Weight gain is sometimes a problem, but also society uses numbers a lot: “Oh, baby was at this weight, was on this curve, and now it’s a little bit different.”

Nature fluctuates. Sometimes we gain a little more, sometimes we have a runny nose and don’t gain as much.

Your body makes what the baby needs. The baby at the breast to send a signal to your body that they need a certain amount of milk. If you could stimulate enough, you could make a lot of milk at once.

What about when it’s not only perceived?

Some parents are breast-cancer survivors or neurodivergent or trauma survivors.

You’re close to someone else, your body is being touched a lot. Your nipples are being stimulated and it might be difficult to have this new type of relationship with someone with their own body because they’ve been through other things. We are there to acknowledge that and see if there’s a way to make them more comfortable.

I know someone who had only one breast and wondered if they could do it, was it possible? It was.

We have babies who were premature or had problems breathing at birth and now have trouble swallowing. They might refuse the breast because they don’t like it. Or they might have a cleft palate — it can be so many things.

It covers the whole spectrum.

What about such things as cracked nipples or mastitis?

Cracked nipples can be caused by many things, such as a baby with a tongue tie, or just a small baby who has a tiny mouth, or a baby who had a birth with forceps, which could cause some tension in their jaw.

With mastitis (an inflammation of the breast that usually happens when people are nursing), if we see any kind of infection or possibility of infection, we will refer them to a health professional right away. We are trained to keep an eye on things like infection or cancer, and we refer those right away. Once they have a diagnosis, we can help them manage it. We can help maintain that nice supply they had or help cope with the pain. We consider what causes it and how we can avoid it for the future, because some people are more prone to mastitis. They should talk with their doctor and then we can discuss what supplements or probiotics can be introduced that might help prevent a recurrence.

There are other things, such as jaundice or dehydration in a baby, that we are trained to catch and we refer them immediately.

Are nursing strikes — when a baby suddenly rejects the breast — real?

I don’t think there’s any scientific proof that says it’s part of development. Breastfeeding occurs in a natural environment. When paleontologists find old skeletons of humans, they can see how far along they were breastfed. We can see that at two years old, they will still have breast milk in their diet, along with other food.

At nine months, a baby’s digestive system isn’t ready to eat solids. It goes from human milk gradually to solids.

A nursing strike can be different things. If milk flowed very fast and a baby choked, they might suddenly get a little bit anxious about the breast.

You might not understand why they’re refusing the breast, but then in 24 or 48 hours they see they’ve caught a viral infection, so actually they weren’t feeling that well.

They might have been at the breast and heard a loud sound that made them anxious.

If they are also having milk or a supplement with a bottle, it’s not necessarily a strike, but they can develop a preference.

One of the first steps for a breast strike for an older baby, like nine months, is to not push the baby to feed or push their head toward the breast. Offer them skin-to-skin contact in a very nurturing way. Have a nice bath with the baby. With that warmth, they are free to come to the breast or not. You don’t want to create a negative environment.

It’s by going back to this very loving, nurturing, skin-to-skin environment that will dissociate the bad experience. They will come back to a soothing space.

It’s feeding, but not only food, it’s feeding nurture and soothing and building up their immune system.

How can you support a parent who is ready to stop breastfeeding?

We are not there to judge. It depends on what feels good for them and what they want as a family. We want a healthy family as a whole. If someone calls me and says, “I don’t want to do this anymore,” or “I want my partner to feed at this time of day,” or “I’ve decided to go back to work earlier,” or “this is not for me,” I will try to understand where it’s coming from and whether it’s because of outside pressure.

But it’s not my decision. I help deliver the tools to follow what’s good for you and your family. We can work on ways to stop lactation and make a transition.

Some people breastfeed for a very long time and at one point they’re like, “I don’t want to any more and my child is very attached. What should I do?” We put different plans in place when the kid is two or three or four years old than we do when the kid is two or three months old.

What is the best way to find a lactation consultant?

One of the best ways is through the Association québécoise des consultantes en lactation. Consultants are listed by region and the website (ibclc.qc.ca) offers resources to contact us.

For people who have small questions or would like to be in contact with other parents, Nourri-Source (nourrisourcemontreal.org) lists drop-ins where parents can talk to each other and with nurses and lactation consultants. At the drop-ins, we can weigh the baby, check to be sure the baby is latching properly and troubleshoot what might be causing nipple pain. This is good for someone who wants to see someone quickly before deciding on a private practice or going to a clinic.

When talking with other parents, other topics come up. Some people who are lactating have a disruption of their sexual lives, and we can talk about that, too. Some have had problems with fertility, they struggled to have that baby and now they’re struggling to breastfeed. Some people have very difficult birthing experiences; we’re there to talk about it.

We want to make this better for them.

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hjuhl@postmedia.com

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