Navigating Common Breastfeeding Concerns During the Uncertainty of a Pandemic
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Navigating Common Breastfeeding Concerns During the Uncertainty of a Pandemic

Breastfeeding can be complicated and difficult enough during “normal” times. However, new mothers’ concerns become magnified during a pandemic when in-person resources, like local breastfeeding classes, are not as available.

As a certified lactation consultant, I’m here to help by sharing answers to the most common breastfeeding questions and concerns I receive from clients and providing insights on how to breastfeed safely during the pandemic.

Concern 1: Side Preferences

Having a side preference is not uncommon, nor is it something that only happens during a certain age or stage, or that lasts for any set amount of time. It can start from the beginning at birth or can be onset during a major change, such as teething.

Potential causes:
  • Torticollis (muscle-shortening / tension in the neck)- can be related to the birth or even the positioning while in the womb. This causes asymmetry in posture/ rest positions and makes it quite difficult to get into alignment to feed. Ex: Torticollis/tilt on the left may make it difficult to line up to feed from the right breast
  • Tongue / Lip ties (Ankyloglossia)- Overcompensating muscles in the mouth may lead to tension and stiffness on one side of the mouth or neck; can possibly be connected to torticollis
  • Positioning – repetitive positioning that is not conducive to comfortable latching over time
  • Teething – general crankiness and irritability, one side of the face hurting more than the other at times
What to do:

Even if there is nothing otherwise wrong or noticeably so, it may be a good idea to set up a consult or virtual consult with an IBCLC to discuss. Advice may range from simple positioning changes to considering bodywork or revisions. Pumping on baby’s non-preferred side may be part of the care plan, which an IBCLC can assist in planning out.

Concern 2: Flange Sizing–Wrong size?

Finding the right size flange is important for pumping, both for comfort and for maximized output. Too small, and the nipples are pinched and rubbed raw. Too big, and the areola is clamped, blocking output. It’s important to individually size each nipple (they can vary in size from breast to breast) for the proper size!

How to measure:

To manually measure, place a flange over the nipple as if to use. Check the narrowing tube. Does the nipple touch the sides? If so, the flange is too small. Is the areola completely covered by the funnel and sucked into the narrow? It may be too large of a size.

Many pumping manufacturers now offer measuring tools, in mm, to either print or purchase. Inserting the nipple into the appropriately fitting hole of this tool allows the mother to determine her size quite accurately.

The third option is to use the sign language for “I love you.” These three fingers can give a rough idea of where to start. The tips of each finger simulate the size and diameter of the nipple. The pinky is roughly 21mm, the index 24mm, and the thumb 27mm. While not 100% accurate or encompassing of all sizes, it’s an easy starting place.

Concern 3: Inverted Nipples

Some nipples simply sit slightly inward when at rest but extend once stimulated and fed from. Others have difficulty with extension, as there may be a piece of tissue on the inside actually restricting the ability for the nipple to extend.


If the nipple can be drawn out, which may be noticeable in the shower or after pumping, manually stimulating by hand can help a breastfeeding baby get started. Circular massage of the breast, followed by “twiddling” the nipple, gets blood flow to the area, which firms the nipple for feeding. It also encourages the release of milk, or the letdown, to happen sooner.

If the nipple(s) have a more severe degree of inversion, it may be impossible or painful to properly draw out. Gently pumping or using a specifically designed nipple suctioning device, which has a bulb to manually squeeze, may help, but in many cases, a nipple shield may be advised. It’s a good idea to work with an IBCLC in this case to discuss protecting long term supply goals and methods since skin-to-skin contact through feeding is limited and blocked by the shield.

How Do I Stay Safe with COVID-19?

While there is not ample research in regard to the pandemic available in terms of the spread from mother to baby, vice versa, and specific antibody production and transfer, it is known that the general production and acclimation of immune boosting leukocytes and antibodies happen in real time to be added to the breastmilk to pass to the baby. Acclimation to an environment happens in roughly 6 minutes, meaning a mother’s body is exceptionally responsive to protecting the baby. The breastfeeding baby may also ask to feed more frequently as an instinctive response to foreign pathogens. With that in mind, it’s important to feed on demand. Masks for the mother are still advised to help protect the spread and contraction of the virus that happens through water vapor travel that occurs while talking or mouth breathing, as the virus is airborne.

  • Keep baby close
  • Feed on demand
  • Wash hands frequently
  • Wear a mask
  • Practice social distancing
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