Pam Lemon was so upset during the early nursing sessions with her 1-month-old daughter that her husband was beginning to suspect postpartum depression.

“I was in so much pain. I cried when she cried,” says Lemon, a mother of two from western Howard County.

She had breast-fed her first daughter, now 8 years old, without any problems. But with her second baby, she was questioning her commitment to breast-feeding.

But before she gave up, she sought out the advice of a lactation consultant at Greater Baltimore Medical Center (GBMC).

“I’m so glad I did,” Lemon says. “She was able to diagnose the problem right away.”

Her infant’s tongue didn’t come out as far as it should and needed a simple laser procedure. She also had thrush, a common type of oral yeast infection.

Now, Lemon says, “Things are so much better.”

Nursing can bring a host of painful problems from cracked nipples to plugged milk ducts. But eventually, experts say, it becomes easier than fixing a bottle. Unfortunately many women don’t have the patience, information or support they need to make it through what can be difficult first days or weeks.

The learning curve is especially steep initially, says Doris Cybert-Wilcher, a board-certified lactation consultant at Howard County General Hospital.

“There’s an awful lot to learn after delivery,” she says.

Katie Vaeth, a Mount Washington mother who has a 5-month-old daughter, also had painful nursing sessions until she saw a professional lactation consultant who helped her train her infant not to gum her during feedings.

The tearful nursing sessions ended and, Vaeth says, “I like that time with her. It’s a quiet time for the two of us.”

Getting to that point can take a while since problems during that period are quite common. But they can be fixed — often within a few minutes by an experienced lactation specialist. These wise women, who are trained in such matters, offer remedies to engorgement and other discomforts and can diagnose more serious issues.

“Ninety-eight percent of it is getting the baby on well and keeping her there,” says Marla Newmark, a lactation consultant at GBMC.

Almost all nursing moms have or will experience sore nipples at some point, usually at the beginning before they’ve mastered how to latch and position their infant.

The other common complaint about what makes breast-feeding so trying is that you can’t see how much milk is being produced, which can shake a new mother’s confidence and send her running to formula.

“Some moms worry about their milk supply, the emptier they feel,” says Newmark. “But if we wait to feel full, we waited too long.”

Getting a good start can make a big difference, so don’t hesitate to seek help, experts say.

“The first week is so important for supply,” says Susan Weyer, a mother of three and a board-certified lactation consultant who works in Carroll and Howard counties. “If you’re not emptying the breasts every three hours, you may find that in the second week, you don’t have enough.”

Many hospitals have lactation consultants, but often mothers — especially first-time mothers — are discharged before their milk supply has come in. And problems can pop up even after mothers have mastered their basic technique. This means they may need to seek out professional guidance. We’ve consulted some local experts about frequent nursing problems and compiled some resources, including helpful Web sites and information about local lactation consultants.

Sleepy baby:
What it is: A baby who is more interested in sleeping at the breast than nursing from it. The baby will latch on, but then only suck for a few minutes before going back to sleep. Not only can this affect milk supply, the long and unproductive nursing sessions can quickly frustrate inexperienced and very tired new mommies.
What causes it: It’s fairly common after long labors, when intervention is used during a labor (such as vacuum extraction), and when babies are premature.
What to do: Skin-to-skin contact may help. This means the nursing mom removes her top and the baby’s clothes down to the diaper. Sometimes, the baby will also need to be spoon-fed colostrum, the antibody-rich secretion that comes from the breast before milk. A bit of sugar water or expressed milk may also be fed using a syringe while mom is nursing to stimulate the baby’s sucking.
“Most don’t want to wake a sleeping baby,” says Newmark. “But if we’re successful, within 24 hours, they’re pretty perky.”

Cracked, sore nipples:
What it is: Painful, irritated nipples that may bleed.
What causes it: Most often, an incorrect latch is the culprit. Some more minor discomfort occurs as the breast gets used to the rigors of nursing.
What to do: Make sure your baby is latching on correctly. You may need the assistance of a lactation consultant. Also, hydrogel pads, Lanolin or other breast creams may help soothe and repair some of the cracks and soreness.

Engorgement:
What it is: Swollen, too-full breasts. Usually, this is a temporary, but often painful, condition.
What causes it: The supply of milk is greater than the baby’s demand. This can happen when the milk is coming in, or when the baby hasn’t nursed in a while.
What to do: Nurse the baby. Express the milk or pump it for storage. Cold compresses may reduce swelling.

Plugged duct:
What it is: Areas inside the breast where milk flow is blocked. A lump may be present or the area may be red and tender.
What causes it: Not emptying the breast completely.
What to do: Even though it hurts, nursing is the best relief. Also massaging the area and using warm compresses may help. If left untreated, it can become an infection called mastitis.

Mastitis:
What it is: An infection characterized by redness, tenderness and pain, often accompanied by flu-like symptoms including body aches and fever.
What causes it: Bacteria enters the breast. Women whose breasts aren’t emptied sufficiently or who have a break in the skin may be more susceptible to the infection.
What to do: Call your doctor if you experience symptoms, which include a fever of 101 degrees or higher, body aches, localized pain and a decrease in milk production. Antibiotics may be prescribed.

Inverted or flat nipples:
What it is: Nipples that aren’t raised may not be as a pliable, which can make it harder for the baby to draw in the nipple.
What causes it: Sometimes, it’s just the woman’s anatomy. Often, though, the problem stems from childbirth, possibly caused by fluids administered or by an epidural. In this case it is temporary and should last no more than a day.
What to do: You may need to use a nipple shield — a thin, soft silicone covering that has holes allowing the milk to flow to the baby.

Regardless of what you think the cause may be, seek medical attention when:
• You’re in pain with sore, cracked or bleeding nipples.
• You have a fever.
• The baby is losing weight.
• The baby isn’t wetting five to eight diapers and soiling at least one diaper per day.

Sources:
• Marla Newmark, lactation consultant at GBMC
• Doris Cybert-Wilcher, lactation consultant at Howard County General Hospital
• Susan Weyer, lactation consultation who also works at Howard County General Hospital

Websites:
www.drjacknewman.com
www.lowmilksupply.org
www.bfar.org
www.hcgh.org/content/greystone_2356.htm
www.llli.org
toxnet.nlm.nih.gov/cgi-bin/sis/search (includes information about medications taken during breast-feeding.)
www.lactations.com 

Local lactation consultants:
The hospital where you deliver may provide a phone number, such as GBMC’s Warm Line, which is staffed by certified lactation consultants.
The hospital may also offer consultations for a fee, or they may provide a list of local certified consultants. Some pediatricians offices also have experts on staff. Fees will depend on whether the consultant comes to you or whether you travel to their office.

To find local experts:
• www.ilca.org/i4a/pages/index.cfm?pageid=3337
• www.lilaguide.com/categories/local-baltimore-md-lactation-consultants-3137.aspx?page=1