Overcoming Barriers to Breastfeeding and Advocating for Yourself

Authored By:

Courtney Miller, R.N.

Courtney Miller is a registered nurse on the mother-baby unit of a Georgia hospital. She recently began her dream job of becoming a lactation consultant and just took her exam to become an International Board Certified Lactation Consultant (IBCLC). Her passion for breastfeeding began after giving birth to her son in March 2019, and quickly realizing there wasn’t enough readily-available breastfeeding education and support – Now she says she has found her calling of helping moms and their families along their breastfeeding journey! Courtney regularly uses her personal breastfeeding experience, along with evidence-based research, to help educate and support the families she works alongside.

Learn more about Courtney on Instagram @thebetterboob and read about her unique breastfeeding journey – in her own words! – below.

What Are Barriers to Breastfeeding and How Do They Happen?

My passion for breastfeeding started after giving birth to my son in March 2019. I quickly realized there is not nearly enough breastfeeding education and support out there and, having worked as a mother-baby and labor and delivery R.N. for a year and a half before having my son, I thought I knew everything I needed to know about breastfeeding. Boy, was I in for a big surprise – particularly when it comes to all the different challenges and barriers to breastfeeding!

Prior to becoming pregnant, I knew I wanted to breastfeed and I had the mentality of “if it works, that’s great and if not, that’s okay too.” I had inverted and flat nipples, which I knew could be a challenge to establishing nursing. In addition, my son decided to join this world a few weeks early at 37 weeks and 3 days. This was also an unexpected barrier as, even though he was considered “late-preterm”, he was still preterm. If that wasn’t enough, my son also had a severe tongue tie that was identified shortly after delivery – by my very engaged husband nonetheless!  We had taken birth classes before our delivery and tongue ties came up during one of the classes. Again, I had naively thought that was something we likely wouldn’t have to worry about – but was proven wrong.

After delivery, we attempted to latch with the midwife and nurse (both of whom were my coworkers at the time). With many early barriers to breastfeeding facing us right off the bat – including my baby being preterm, his severe tongue tie, and my less-than-ideal anatomy – getting him to latch was not successful. We opted to try a Medela nipple shield and my son latched! During that first night, we continued to work on latching and, by morning, the neonatologist was able to revise his tongue tie.

Our Story: Continuing to Advocate for Myself and My Baby

Fast forward two months: Up until this point, my son had been gaining weight appropriately and feedings were going well with the nipple shield. Unfortunately, my son’s weight then plateaued and he had “fallen off” his growth curve – In fact, he had dropped all the way to the 2nd percentile. I was doing weekly weighted feeds with our lactation consultant and the mother’s support group at my hospital. He was transferring appropriate amounts. When we followed up with his pediatrician at the time, I was told to supplement with formula. I was devasted. I was told that, although I already had a freezer stash of breast milk, that my son wasn’t being fed enough and I’d need to supplement with formula or pumped breast milk after every feeding.

At this doctor’s appointment, my son’s pediatrician also told me that he needed double the amount of breast milk that he was currently receiving when we did the weighted feeds with my lactation consultant. I was torn, I was confused, and I was angry. Why had I been told by the lactation consultant that feedings were going well and then being told by his pediatrician that I was only providing him with half of what he actually needed? I was frustrated with our medical care system as a whole.  As a registered nurse, I work with mothers and newborns all the time and, because of my experiences, I knew information was incorrectly presented to my husband and I. But what if I didn’t have experience with newborns and breastfeeding, like so many other first-time moms out there? What if I had no medical knowledge and wasn’t already a registered nurse? This is where the medical system would have failed us without even trying to overcome these barriers to breastfeeding. This is where my own journey could have very easily ended.

*Clinical Tip: This is one mother’s personal, anecdotal experience. It is important to adhere to guidance provided by your pediatrician and other healthcare providers; however, moms should be encouraged to ask questions and seek second opinions if they wish. Every feeding situation is unique and there may be rare occasions where supplementing may be necessary. Chat with your doctor, pediatrician, and a lactation consultant to determine the best course of action through any breastfeeding challenges and to ensure the safe growth and development of your little one.

I was instructed by my son’s pediatrician to supplement with formula, but I was not told to work with an IBCLC. I was not told how to protect and/or maintain my breast milk supply. I was not told to pump and I was not educated on paced feeding. I was instead told to give formula and follow up a few days later. If I would have done this, I am positive my supply would have tanked. I would have run through my freezer stash quickly and my breastfeeding journey would have ended, due to the fact that I thought I didn’t have enough supply and that I didn’t have enough to provide for my son.

Instead, I advocated hard. I advocated not only for my son, but also for myself as a mother. I trusted my mom-gut and I wasn’t going to give up. I called my lactation consultant and, together with the advice from my pediatrician, we came up with a feeding plan to continue exclusively breastfeeding my son and also protect my breast milk supply.

At the follow up appointment for my son’s weight check, he had gained a few ounces since the previous visit and the pediatrician was satisfied. During that visit, I asked his pediatrician about the calculation that was used to determine the amount of breast milk versus formula that my son needed. I was told that the amount of milk required was equal to half of the baby’s weight in pounds: Because my son was roughly 10 pounds at the time, it was determined that he needed 5 ounces of breast milk (or formula) every feeding. This was much different than the calculation that was given to me by the lactation consultant. Because of this misinformation and these miscommunications, this was still another point when simply weaning from breastfeeding could have been the easier choice – particularly for moms without a medical background, who may be even more confused and anxious as they face breast milk feeding challenges and infant weight gain concerns.

As a nurse, we are taught in school about evidence-based research. We want information that is backed by research and information that has been proven correct by thorough studies. I asked the pediatrician what her source was. Her reply was that she had recommended this “because that is what I have always heard and that is what I have always been taught.” This was frustrating to me, because it felt as though she was providing information without understanding the reason behind it or verifying it with current research and recommendations. She was giving information that may not have been evidence-based. Later that day, the pediatrician called me to tell me that the information that was previously given to me was incorrect and that, after she looked it up, the calculation given to me by the lactation consultant was correct and I should follow it.

I am so thankful that I advocated for myself and my son through all the barriers to breastfeeding that we experienced, both right after delivery and in the later newborn stage. For my own journey, the Medela nipple shield saved my breastfeeding relationship so it could have the start it deserved – And I am so thankful for that! I am also proud that, later on, I went beyond just one medical provider’s opinion and instead continued to research and got a second opinion.

Today, my son is a happy and healthy 19 month old toddler and he is still breastfeeding! My initial goal was 6 months, which then became 1 year. We had challenges and we had hurdles along the way. Together, we shed a few tears at times but we overcame. We tackled the nursing strikes, the distracted nursing, and the “gym-nurstics” that developed as he grew into a mobile, independent toddler. We encountered cracked nipples, clogged ducts, and even mastitis. But we persevered, we did it, and we are still breastfeeding!