We Asked a Lactation Expert the Questions New Mums Keep Sending Us

After we published Keji’s account of the breastfeeding pain she hid from everyone for weeks, the messages did not stop. Most of them were versions of the same thing. Was that normal. Is this normal. Is it just me.

The questions kept coming, and most of them deserved a better answer than any of us could give.

So we took them to Maryam Sanuth. She is a pharmacist and an International Board Certified Lactation Consultant, the highest breastfeeding qualification there is, and the founder of BreastfeedingNG, where she has spent years untangling exactly these problems for Nigerian mothers.

Twelve questions. Her answers, in her own words.

Is breastfeeding pain normal, or should I be doing something about it?

Do not believe it is normal. Breastfeeding for most people is painless. Discomfort from engorgement is normal. Cracked, bleeding nipples, or pain that makes you want to scream, is absolutely not.

Do not endure this pain. Speak to a lactation expert, someone trained to help you fix breastfeeding troubles.

Pain is a protective response from your body. It is your body’s way of telling you that something is wrong.

Common problems that cause pain include a poor latch, or an infection in the breast or nipple.

What is usually causing it, and how quickly can it be fixed?

The most common cause of pain during breastfeeding is a poor latch. Contrary to popular belief, mothers are not born knowing how to breastfeed. A lot of people need help figuring it out, and that is normal. A poor latch can sometimes be fixed with something as simple as changing the position you feed in.

Another common cause is a tongue tie. This is when the stretch of tissue that holds the tongue down to the floor of the mouth, called the frenulum, is shorter or tighter than it should be. A tongue tie can be harder to resolve. Sometimes the baby needs to see a healthcare practitioner to have the tissue released, and exercises may be recommended afterwards because the frenulum can reattach.

The first step, either way, is finding someone who can identify the problem.

How do I tell normal early tenderness from a real problem?

The degree of pain is usually the first sign that something is genuinely wrong.

If the pain is at the point where you are scared of breastfeeding, then you need help.

What are the signs I should stop waiting and go to a clinic?

The biggest warning sign is your baby losing weight, or not producing enough wet and dirty nappies. In the first week after delivery, your baby should be having at least six nappies a day, wet and dirty combined.

It is also important that mothers attend their postnatal checks. That appointment is often the opportunity for the baby to be screened for feeding problems before they become serious.

Should I give my baby water because of the heat, or start pap early?

Rest assured. Babies who are exclusively breastfed do not need water or solids until around six months of age.

Breast milk is primarily made up of water, combined with carbohydrates, proteins, fats, vitamins and immune substances. Trust your body to respond to your baby’s needs.

Introducing water early can be harmful, because babies need all the nutrition they can get in those early months. Water contains no calories, and a baby’s need for rehydration is not the same as an adult’s.

My baby cries a lot. Does that mean my milk is not enough?

A baby who cries a lot is a baby trying to communicate something. The job for parents is working out what the need is. Is the baby tired? In pain? In a wet nappy? Sleepy? Hungry?

More often than not, a crying baby is easily comforted by breastfeeding, because it is so much more than nutrition. It is warmth and comfort too.

If you genuinely think your baby is not getting enough, speak to a healthcare professional who can help.

So what should I actually be watching to know my baby is getting enough?

The best way to know is to look at the whole picture, rather than relying on whether the baby seems hungry or how often they feed.

For a young baby, good signs include:

From around day five onwards, a baby getting enough milk will generally have at least six wet nappies in twenty-four hours. Growth should also be monitored at routine health visits.

Frequent feeding, wanting to breastfeed again soon after a feed, or fussiness do not automatically mean your milk is not enough. Babies have growth spurts, and they can sometimes feed very frequently.

How do I keep breastfeeding when I go back to work with no private space?

First, please know that you do not need a perfect setup to continue breastfeeding. Many working mothers get creative with the space and time available to them.

If there is no dedicated lactation room, speak to your employer or HR about finding a clean, private space where you can express without interruption. A lockable office or a meeting room may work, depending on the workplace.

The bigger conversation is planning. Before you return to work, practise expressing if that is your intention, understand how to store your milk safely, and work out roughly when you will need to express based on how often your baby normally feeds.

If your workplace is not supportive, do not feel you have failed. Sometimes the challenge is not a mother’s commitment. It is the environment she is working in.

Breastfeeding support also means creating workplaces that make it possible.

What do you say to mothers carrying guilt about combination feeding or stopping?

Breastfeeding is such a small part of motherhood. It is one aspect out of hundreds of other ways you show up for your child.

Make peace with whatever choice you make to feed your child. Whatever choice you make, you are doing great, mama.

What is the one piece of breastfeeding advice in Nigeria you wish would disappear?

"Breast milk is not enough, give the baby water or formula."

This is the one I would really love us to reconsider, especially when it is given to mothers of babies under six months without first establishing that there is actually a feeding problem.

Breast milk is more than eighty per cent water, so a healthy, exclusively breastfed baby does not need additional water, even in hot weather. The World Health Organization recommends exclusive breastfeeding for the first six months, meaning no other food or drink including water, unless medically indicated. And breast milk is not just water. It contains the energy, nutrients and other components a baby needs through those first six months.

That does not mean every mother will have an uncomplicated journey. Some babies genuinely do not get enough milk, and there can be several reasons, including poor attachment, ineffective milk transfer, infrequent feeding, and certain conditions in the mother or the baby.

The important thing is not to assume a baby needs supplementation simply because they are feeding frequently, crying, or because the mother feels her breasts are soft. Those things alone do not tell us a baby is not getting enough.

If there is a genuine concern about supply or growth, that is when we assess the situation and provide the right support, rather than immediately telling a mother her milk is not enough.

What do you wish every woman knew before she gave birth?

Breastfeeding is natural, but that does not mean it always comes naturally.

I wish more women knew it is okay to need help. Learning how to position your baby, getting a comfortable latch, understanding feeding cues and knowing what normal newborn feeding looks like can make an enormous difference.

I would also tell every expectant mother this. Do not wait until you are struggling badly before asking for help. If you can, identify where you will get reliable breastfeeding support before your baby arrives.

And perhaps most importantly, do not measure your journey against another mother’s. Your baby, your body and your circumstances are your own. You deserve information, support and reassurance, not pressure to have a perfect breastfeeding experience.

Where should a Nigerian mother actually go for help?

The first step is knowing what kind of help you need.

For breastfeeding-specific concerns, look for a trained lactation expert or breastfeeding counsellor who can assess feeding, positioning, attachment and milk transfer. Your hospital, maternity centre, paediatric clinic or primary healthcare centre is also a good starting point, especially if you are worried about your baby’s weight, feeding, dehydration or general health.

For mothers outside the major cities, do not assume that being outside a big city means figuring it out alone. Start with your nearest reputable health facility and ask whether they have somebody trained in breastfeeding support, or whether they can refer you to one. Qualified virtual lactation support is also an option where appropriate.

And if your baby is not gaining weight, is unusually sleepy or difficult to wake for feeds, has noticeably fewer wet nappies, or you have any concern that they are not getting enough milk, seek medical attention promptly rather than relying only on advice from social media, family or friends.

The goal is not simply to tell a mother to keep breastfeeding. It is to help her understand what is happening, why it is happening, and what support she actually needs.

Have a question we did not ask?

Send us the breastfeeding or feeding question you have never had a straight answer to, and we will put it to an expert for the next one. Email askimumzone@gmail.com or send us a DM on Instagram. You can ask anonymously.

About our expert

Maryam Sanuth (RPh, IBCLC) is a pharmacist and International Board Certified Lactation Consultant, and the founder of BreastfeedingNG. You can find her on Instagram @breastfeedingng

A note from iMumZone

This article is general information and is not a substitute for advice about you and your baby. If breastfeeding is painful, or you are worried about your baby’s feeding or weight, go back to the hospital or clinic where you delivered, visit your nearest primary health centre, or ask to be referred to a certified lactation expert. If you have been feeling low, anxious or unlike yourself since giving birth and it has lasted more than two weeks, that is worth speaking to a doctor about too.