Breastfeeding Not Working: Transition from breastmilk to formula?

One of the most important things to know is the signs that breastfeeding isn’t working.  More and more women are finding that biologically breastfeeding is NOT working — and they are not actually feeding their baby (often accompanied by guilt). This post teaches the signs that breastfeeding isn’t working (when you aren’t getting enough milk) and share’s this RN’s tale of when breastfeeding didn’t work for me.

**If you are concerned that breastfeeding really isn’t working — my friend Katie (actual friend) has a course on troubleshooting breastfeeding and the price is right!

First off, let me state CATEGORICALLY, I am a STRONG proponent of breastfeeding. I think it is the A#1 best way to feed your child.  There are so many wonderful things about it.  

I won’t get into all that here (because I have a lot of other awesome breastfeeding posts).  But suffice it to say that I push breastfeeding hard as a labor nurse & prenatal educator.

There are times when breastfeeding isn’t working – it didn’t work myself and my first baby (or any of my other kids).  And I didn’t know it for days.  I had a constantly screaming baby, bleeding nipples, and emotions that could’ve exploded our 2 bedroom apartment.  

I had been told that breastfeeding ALWAYS works — it’s the most natural thing in the world! Sadly, that is a lie we tell a lot of new mothers, sometimes it truly just doesn’t work.

In fact, I just recorded a podcast about it (it’s with Katie that does that troubleshooting class)

Before we get going, who am I and why do I know so much about breastfeeding?

Hi, I’m Hilary — many people know me as The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. 🩺​ I’ve helped troubleshoot a LOT of breastfeeding in that timeframe and honestly I’m best at knowing when it is NOT working — so I’m a good resource on this!

Signs That Breastfeeding Isn’t Working

Hilary is a nurse who has worked in various medical fields for the past 26 years, however, none of the information on this blog should be substituted for the care of a physician. The information provided on this blog is informational only and shouldn’t be taken as medical advice. If you have questions, please ask your doctor or a certified lactation consultant. Also, please don’t delay contacting a physician due to something you have read on here. Please read my full terms here.

There are a few basic ways to feel like breastfeeding isn’t working (although it is better/easier to look for signs that it IS working in general — and we will cover that next):

** Keep in mind that understanding milk flow with breastfeeding is HARD so don’t be tough on yourself. You can’t see what baby is eating like you could with a bottle — but these are some serious signs:

1. Baby cries a lot, even after a feeding.
2. Baby isn’t having frequent wet/poopy diapers (we’ll talk about what to watch for in a second)
3. Baby isn’t gaining weight — and that is likely something you would see at a pediatrician’s or a lactation visit.

Pro Tip: It is VERY normal to think you’re not giving your baby milk in the early days, or that they aren’t getting enough. In the vast majority of cases your body works perfectly and you do have a supply for them. Baby nurses make it look so easy in the hospital, and it always seems like it’s falling apart when you get home. Totally normal.

Keep in mind that these things are all important to keep an eye on through the first month as your milk supply is regulating. Good milk supply doesn’t always stay that way — especially until you get into a great breastfeeding groove.

BTW, if you’re reading this article pre-birth just to get an idea of what’s to come and what to watch for — come join me in here!

Signs Breast-Feeding IS Working

One quick tip is that baby needs very little milk in those first few days. Their stomach is the size of a marble when they’re born, and it slowly expands as they get large.

1.  Wet Diapers is a sign breastfeeding IS working

Babies should have 6-8 wet diapers/day.  Newborns should have a wet diaper per day of age up until they’re getting 6-8).  So, on day two — they should have 2 wet diapers.  If they’re not producing that much, you need to think about what is not working.  

There are reasons BESIDES breastfeeding, why this might be — but breastfeeding is something you should consider. Babies poop should also start to change from the black tar to another color (depending on your feeding method — but mustard yellow if you’re nursing).  

These are my favorite newborn diapers, love the line that shows if they pee’d (because you can’t always tell).

2. Engorgement is a sign that you have milk!

On day 2-5 (sometimes longer) you’ll feel your breasts “turn-on” and fill with milk.  If you don’t feel any differences with your breasts, it may not be filling with the milk. Many providers will ask “has your milk come in” — so just be honest with what you are feeling.

I get hot boobs, but I never feel them fill.  I never have them over-fill, they just don’t fill.  Don’t forget some washable breastpads while we talk engorgement!

3.  Milk in their mouth is a sign breastfeeding IS working

If you pull them off, you should see milk in their mouth (once your milk has come in).  Make sure you use your finger to break the latch, don’t just yank them off.  Babies tongues already look a little white, but if you SEE milk, you know you’ve struck gold.  Mind at ease.

Please note, you won’t see this as much before your milk comes in, because colostrum looks fairly clear.

4.  Weight gain is a sign breastfeeding is working

I would guess most pediatricians will come let you do a weight every day to see if they’re gaining.  At Kaiser (where I had my last 2 babies) they do a weight check, let you feed, and weigh again — to see how they’re doing. 

They often do those at in-person lactation consults (not just at Kaiser). It is a downfall of internet-supported lactation consults. You can always go to your pediatrician’s for a weight check though (or buy a baby scale — it’s actually a lot cheaper than I thought it would be!)

This one from Hatch Baby is pretty cool!

Princess P was such a great sucker, and we had a good latch.  I’d latch her on for half an hour and she’d go to town.  I thought for sure she was getting milk and it was GOING TO WORK that time!  She would lose weight instead of gaining — just because she was working so hard to suck with no reward.

5.  Swallowing is a sign breastfeeding is working

This is actually one of the very best, and the easiest ways to tell.  My oldest never swallowed.

You need to have a quiet room to hear this one, but you’ll kind of hear a whispered letter “C” sound when they swallow.  You can also, sometimes — depending on your position — see their Adam’s apple bob when they swallow.  Baby’s mouth should swallow every 3-4 sucks.

If they’re not swallowing, either you’re not noticing it, or something is wrong.

If all of these are overwhelming you and frankly, the whole baby thing is overwhelming you I do have a course called Newborns Made Easy (I realize that title is a lie, but it will make them EASIER) — it goes over these signs to watch for, as well as newborn care and SLEEP in those first few weeks!

When breastfeeding doesn’t work

The thing, with nursing, is that the more you stress out about it, the worse the problem gets.

You’re the cow.  You need to be healthy and happy to produce for your little wonder.  But, the worse it got and the more he cried I just felt like the biggest failure that God ever created.  The simple truth is that sometimes breastfeeding doesn’t work.  It’s a small percentage (although I hear it is on the rise), but it’s true.

I say try, try, try, but if it’s not working, the good news is that there is infant formula.  It isn’t poison, it won’t kill your baby and it may put your mind at ease remembering it’s an option.

The most important thing is truly a healthy, happy mom and baby. That’s it. Long term studies don’t show that breastfeeding actually has that big of a change on a child’s health/well-being (especially when compared with twins who one was breastfed and the other one wasn’t).

Pro tip: Baby having difficulty latching isn’t always a sign that breastfeeding IS or is is NOT working. How baby latches has to do more with their suck, their mouth and your boob — it doesn’t always mean they’re getting milk (and difficulty latching doesn’t mean you don’t have milk — it is a reason to seek help though). My friend Katie also offers virtual consults as well!

Ways to Make Breastfeeding Work

If you do think a lack of milk production is your problem, you will likely need help troubleshooting. There are things they can recommend to increase your supply (fenugreek, nipple shields, different positions, increasing fluids, skin to skin contact) — I even tried Reglan — which made me crazy — so be mindful).  It is certainly worth it to try to build it up.

You can start with any helpful family members, or friends — but you will likely need someone with more experience if it’s really a problem.

With lactation consultants being so available anymore, the best thing is to schedule an appointment with an IBCLC (international board certified lactation consultant).

Reasons you can’t breastfeed

There are LOADS of reasons that breastfeeding may or may not work.  The reality is that you really need to try.  Give the breasts lots of stimulation, even if you think it won’t work.  Reasons I have seen (and there are a lot more than this)

• Previous breast surgery (implants or reductions)
• Hormonal imbalances
• Tubular breasts (you’ll often have less milk ducts, which isn’t really apparent on a visual assessment).
• Stress (more women can’t breastfeeding during war time vs non-war time — in historical studies)
• Lack of stimulation (you’re not doing frequent feedings)
• Baby needs a tongue release or a lip release
• Nipple Issues (often make it a lot more difficult but usually can be worked around if you work hard at it and seek help from a lactation consultant) — really sore nipples are not a good sign. If you’re in severe pain you need to contact someone ASAP.
• You go back to work and pumping just isn’t something you want to do (and frankly, very valid).
• It is driving you crazy… {also valid}

Blood vessels and breast tissue are tricky things!

We do talk about some of the reasons in that podcast I mentioned above.

Why to try a Lactation Consult

I would try a consult with a IBCLC. You will find a LOT of people who say they have credentials to teach you how to breastfeed, but as an RN the IBCLC is truly the gold standards for help you out on a one on one basis. They can check baby’s mouth, talk to you about nipple pain, show you how to express milk, look for any breast infection, and make sure that baby’s needs are being taken care of (while also balancing mom’s needs).

Let me say it one more time — IBCLC’s are the ones trained to troubleshoot. That is different than a lactation educator or a lactation consultant. In the land of breastfeeding education online experience REALLY varies and you want to stick with someone who is super experienced and knowledgeable.

They are really skilled at looking at the mother’s nipples to see if THAT is the problem, and what they can do to fix it. They can also talk to you about your baby’s current weight vs their birth weight. AND they are experts at checking out baby’s mouth to see if that is the issue (including a tongue tie or lip ties and any palate issues).

Most of all they are great at assessing baby’s latch to make sure THAT isn’t the issue. Keep in mind that the latch is just a portion of your breastfeeding scenario (and they are trained to assess the whole thing).

They’re also going to be the most helpful for any medical conditions that are causing an issue. They are truly your breastfeeding expert (keep in mind that most pediatricians are not). Many IBCLC’s are also RN’s (and have a lot of breastfeeding experience across many types of people) and can just have a really good handle on your entire needs.

Breastfeeding Didn’t Work For Me

For my first time, I thought breastfeeding would just work.  I had heard countless times that breastfeeding works for everyone if you work hard enough when I was in nursing school.

So, I just tried and tried.  He screamed and screamed. Our first week together was a real doozy.

I finally noticed a lack of wet diapers and no poop… so I started to get a little nervous.

But, I kept trying… I called lactation.  We were really poor, so having an in-person consult was out of our price range (this is back before insurance even considered paying for it).  We did rent a hospital pump (remember you can get one free).

I THOUGHT I was getting breast engorgement, but I think I just had some hormonal fluctuations (they never got hard or really painful). Breast fullness can be hard to assess (especially if you’ve never felt it before).

In retrospect, I spent a 20-minute call with a woman, spent the majority of it crying — and her advice was to get up every 2 hours at night to pump, and to finger feed so I could prevent nipple confusion (I finger fed so much my finger nails started to hurt).

Keep in mind that when you pump you might not get much milk. It IS stimulating your breasts, but because you don’t love the pump like you love your baby, production is often less.

To a woman who was clearly on the edge (because I was also crying for the majority of the time I wasn’t on the phone with her), she told me to basically stop getting sleep and put every last ounce of myself into a bottle.

**AS an L&D RN of almost 20 years I can tell you that this was 100% the WRONG ADVICE** At no point should someone’s mental well-being come before their low milk supply.

Simply put (and I can say this now that I’ve been an L&D RN for 17 years), Her advice was not the right advice.

At a certain point, you may need to throw in the towel and do what works for you.  Some lactation consultants aren’t very good at remembering that you aren’t a cow, and you have feelings and a brain.

And breastfeeding isn’t worth losing your mind over.

I remember fighting the urge to shake him when he wouldn’t latch right or would just sit there and scream at me.

No mom should be at that point.  I should have popped a bottle in his mouth.  He was starving.  And I 100% believe that fed is best (although I don’t find that page to be particularly breastfeeding-friendly).

Studies do reveal that a mom with good mental health is much more important than breastfeeding. Taking care of YOU is just as important (if not more important) than taking care of them.

Unable to breastfeed guilt

I feel this every. time. On my second child I was sure the second time would be the charm…. that I’d just not tried hard enough time #1.

Somehow, during those 9 months, I somehow think it WILL work this time.  I will get more than just a small amount of breast milk when I pump.  Everything will work out this time.

But, it doesn’t.

And I cry and cry (this post shows that pretty clearly, and I actually wrote it RIGHT after my 3rd baby), it just feeding my postpartum depression.  And then I pop in that formula bottle.

With my last one, I already had two successful readers by the age 3.  It didn’t make a difference, I still felt guilty.

Just recently my formula-fed baby (that I almost starved) scored on the 99th percentile on the ACT, so I guess I still made smart little brains with formula (I can’t tell you how many times I’d burst into tears when I’d see a news story about how much smarter breastfeed babies are than formula babies).

Hang in there new moms.  It’s a tough, long, journey.

Breastfeeding Isn’t Working FAQ’s

Here is my promise to you:  (and I can 100% promise this) that your choice to breast or bottle feed your baby (as long as you FEED your baby) is not the worst parenting choice you’ll make — not by a longshot.  🙂

Just wait til’ they’re teenagers (I want to shake him a lot now too — and yes, he does still scream at me).

The Online Prenatal Class for Couples does come with a breastfeeding class, but if you’ve already had your baby I would recommend having a consult with a local IBCLC, or a virtual consult.

I have a whole post on when to take a breastfeeding class, where I go over those options a bit more thoroughly.

Don’t forget to get my best tips to make sure breastfeeding IS working.

This post was originally writte in 2014, but has been updated.