Breastfeeding Support for Complex Concerns

If you struggled with milk supply during a past pregnancy or had breast surgery, you may benefit from a prenatal consultation with a lactation consultant. These consultations are offered by appointment at the Duke Family Medicine Center. During your appointment, a lactation consultant will review your health history and discuss a breastfeeding plan to follow when your baby arrives. You will receive educational materials specific to your breastfeeding needs and can use My Duke Health (previously Duke MyChart) to communicate with a lactation consultant during your pregnancy and after you deliver.

If you are pregnant with two or more children, we will meet with you before your expected delivery date to talk about your breastfeeding plans. This allows us to identify any risk factors and discuss potential challenges you may have with breastfeeding, including the complexities of feeding more than one child. A lactation consultant can work with you to identify different techniques that can make it easier to produce additional milk to feed your children. You’ll leave with educational materials about feeding your babies.

Common issues after birth such as low milk supply or oversupply, nipple pain, or swollen breasts can impact your ability to breastfeed. We evaluate your concerns and provide treatment recommendations to help you and your baby. 

Lactation can be induced with medication and through physical techniques such as breast stimulation via feeding, electric breast pumps, and massage. These techniques help induce lactation in the birth parent and in non-gestational parents including parents who adopted a child, used a surrogate, have a partner who is delivering a baby, and are transgender. 

A low milk supply can occur when breasts don’t empty effectively or efficiently, or when your baby’s latch does not create enough suction to stimulate milk production. An over- or under-active thyroid or polycystic ovary syndrome can also alter milk supply. Once we diagnose the cause, we may prescribe oral medication to increase your body’s milk production. We can monitor your milk supply with a breast pump or by weighing your baby before and after feeding. Dietary changes and herbal supplements may also be recommended to increase your milk supply.

The way your baby latches for feeding, the fit of an electric pump, nipple spasms, and skin irritation are all common causes of pain during breastfeeding. Clogged ducts and mastitis can also cause pain. We identify the source of your pain and recommend ways to relieve symptoms so you can breastfeed comfortably. 

Our prenatal consultations address concerns about your baby’s health and your ability to breastfeed. If you can’t have immediate contact with your child after birth, we help you with techniques such as hand massage to encourage milk supply within hours of delivery. If your child needs intensive care, we work with their providers to identify opportunities for short feeding sessions. These may include a combination of bottle and breastfeeding or alternative feeding methods combined with breastfeeding. When your baby is healthy enough to spend more time with you, we devise a feeding plan to meet your and your baby’s needs.

Children born with a cleft lip and/or palate can have a difficult time creating suction to breastfeed. Breastfeeding can also be difficult for babies with low muscle tone, like those who have Down Syndrome or are born premature. We coordinate with surgeons, speech pathologists, and pediatricians to help you and your child adapt in ways that encourage breastfeeding. 

Some babies are born with a “tongue tie,” a piece of tissue that connects the base of their tongue to the floor of their mouth. This can restrict movement of their tongue and make it hard to latch and breastfeed. We may perform a frenotomy to clip the extra tissue. Once healed, your baby can breastfeed normally.

It is safe to breastfeed your baby if you have chronic inflammation and pain in your breasts, but it may be uncomfortable to do so. Problems can arise from past breast surgeries, oversupply of milk, clogged ducts, or a combination of issues. Antibiotics help relieve symptoms and make it more comfortable to breastfeed. We will test your milk to find answers and prescribe the right kind of medication that is safe for you and your baby.

Surgical procedures and most cancer treatments do not prevent you from breastfeeding safely. A prenatal consultation will help you understand your options. We may recommend feeding or pumping around scheduled surgery or cancer treatments including chemotherapy. We also coordinate with your providers to adjust or prescribe medication so it remains safe to breastfeed your baby.