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Solutions to Breastfeeding Problems at Every Stage

Breastfeeding is good for babies. So we’ve heard – from every health expert, website and media outlet out there.

But guess what? It’s also hard work . . . at least in the early days.

Haven’t heard that almost every nursing mother has to struggle a bit with getting it right? Don’t be surprised. Those same health experts – from the CDC to the American Academy of Pediatrics – are beating the drums to urge women to jump on the breastfeeding bandwagon. In the push to ensure moms know the benefits of breastmilk to baby, the voices of frustrated new mothers are often drowned out.

“I wish I had known about the ups and downs of breastfeeding and how to actually do it,” says Andi Silverman, author of Mama Knows Breast: A Beginner’s Guide to Breastfeeding. The moment she knew she had to write the book? “When I realized that I knew more about my baby’s carseat, stroller and crib than I did about breastfeeding.”

Yes, it’s hard. That doesn’t mean mothers can’t or shouldn’t do it. Nor does it mean mothers need the sometimes tough reality of breastfeeding sugar-coated.

The same women who have heard horror stories about labor have willingly signed up to bring a child into this world, pain be darned. Now they’re ready to give that child the best start to life; so how about a real look at how you can make it past the most common hurdles?

FIRST DAY

Day One: The Big One

“You’re feeling kind of rollercoaster of emotions,” says Dr. Ann Kellams, M.D., head of the nursery at the University of Virginia Medical Center in Charlottesville, Va. “Nothing went the way you planned because the best laid labor plans and birth plans can go out the window when you end up in that delivery room.”

First problem solved? Let your partner, the doctor – anyone but you – tell the family in the hall the big news, and make them wait outside. It’s time for everyone to get naked. Really. “There is plenty of evidence that babies who breastfeed within the first hour of life do better,” Kellams says.

The best way to make that happen, according to breastfeeding success plans devised by the World Health Organization and UNICEF, is for mom and baby to have skin-to-skin contact as soon as possible after the baby is born. That means no top for you, no swaddling blankets for baby. And it means no squadron of relatives piling in to cuddle and coo.

Hospital maternity wards are moving more toward the skin-to-skin concept, but it’s still common at many birthing facilities for nursing staff to immediately hustle babies off to a bath and wrap them tight in blankets. The concept takes some getting used to for mothers, Kellams pointed out, but the baby will actually use the familiar scent of Mom to work his or her way to the breast and make that first, practice latch.

“Practice is as much for the baby as it is for you.” “That first twenty-four hours, you’re just going for practice,” Kellams explains. “They might just get one ounce of milk all day, and that’s fine.”

Practice is as much for the baby as it is for you. You just went through labor, and so did they – a baby who goes to sleep for eight hours after that first feed is fine, says Laura Keegan, a family nurse practitioner in private practice in upstate New York and author of Breastfeeding With Comfort and Joy. In that first day, as long as the baby is awake, Keegan suggests letting the baby to the breast as often as possible, but the average is probably going to be closer to three feeds in twenty-four hours than the standard “every two hours” of your standard breastfeeding manual.

“However, you may bring the baby to the breast more often than this, attempting to nurse every 1-1/2 to three hours from beginning of feed to the beginning of the next feed,” Keegan says. “These frequent attempts allow both of you time to practice the first couple of days.”

You’re going to need it. Because every baby and mom have the perfect latch – a position just right for the baby’s mouth and the mom’s breast size and shape that will enable the baby to get enough milk without pain for the mother. Kellams and Keegan agree – breastfeeding shouldn’t hurt.

Related Resources

 

Until you find that right latch, however, breastfeeding most definitely does hurt. Michelle Manuel, a mom of two from Kansas City, Missouri, had cracked and bleeding nipples for days after her son was born. She remembers calling on a nurse to help her get her sleepy newborn son to latch on, only to be told it was “easy.”

“Finally after an exhaustive, emotional hour-plus of trying things the way she suggested, I called her back into the room. Her response to my feeling of helplessness? ‘Well, you’ll just have to keep trying,’” Manuel recalled. “I know now that if I had napped for that hour (and so had he) in the hospital that we might have both been better rested and more ready to take up the task. Instead I was worried about doing it right and by the book, and I ended up exhausted and frustrated.

“I also wish I’d realized that while many labor and delivery nurses are wonderfully gifted, not every one is a lactation consultant. It would have been okay for me to ask for a nurse with more experience in lactation on duty at that time, or asked to have the lactation consultant come first thing in the morning.”

Unfortunately, Keegan says, many mothers are looking for a “right” way – but every baby is different, and so is every mother.

“If you are finding you are having discomfort or pain during the feeds, it is important to focus on your positioning and how the baby is taking your breast,” she says. “You do not hold your baby to breastfeed the way you hold your baby to bottle-feed. When we breastfeed in a bottle-feeding culture, we tend to bring the baby’s head too far to the breastfeeding side of our lap and center the nipple in the baby’s mouth.

“What we want to do is hold our baby more to the center of our lap than we might expect, the way a little girl holds a doll in the center of her lap . . . When we bring the baby to the breast, the nipple should point to the baby’s nose or upper lip depending on how wide the baby opens her mouth. When you do this, the nipple ends up in the roof of the baby’s mouth where there is no friction, therefore no pain.”

Mothers who already have cracked or sore nipples from repeated attempts to get things right might feel pain as the nipple is drawn in. That, alas, is normal. “The baby does not just latch on and the music plays,” Kellams concludes.

WEEKS 1-3

Days Two through Four: I Can’t Be Making Enough

“You are going to have a panic about, ‘is this baby getting enough to eat,’” Kellams warns. “I had it, and I’m a pediatrician!”

Leaving the hospital, most moms expect they should be ready to get that breastfeeding routine going. It rarely works that way. Not only is the learning curve still there (and will be for two to three weeks, Kellams says), but a mother’s milk often takes several days to start filling the ducts of the breasts.

In the meantime, the baby is living off of the colostrum, the thin calorie-rich liquid that is essentially “pre-milk.” As long as a baby is still making several dirty diapers a day, they’re getting enough to eat.

“In the early days, weight loss can be and often is normal,” Keegan adds. “If you are pumping, be aware that pumping small amounts is not an indicator of a low milk supply.”

Days Four through Six: All we have to say is OUCH.

“Your breasts are going to feel like bricks.” When the milk does come in, there’s pain – even with the perfect latch. There can also be pain when the baby’s nowhere nearby.

“The breasts are going to feel rock hard, like bricks,” Kellams says. “It’s tender, but it’s time to celebrate – this means you’re getting over the ‘is he getting enough’ stage.”

You’re going to feel like the last thing you want someone to do is touch your chest, but now’s the time to let the baby nurse . . . and nurse . . . and nurse some more.

When the breasts are fully engorged, gently squeezing to express a little, making it easier for the tiny mouth to latch on, might be necessary. Once latched, they’ll suck out the milk that’s causing all that pain. Each time they nurse, the baby will trigger the body to make more to keep up with his or her eating needs, helping the engorgement phase to pass in a day or two, straight into the ebb and flow of making milk and feeding, then making more.

Related Resources

  • Breastfeeding FAQ and Forums, on La Leche League
  • Breastfeeding Advice, on Berkeley Parents Network
  • Breastfeeding FAQs: Pain on MSN Health
  • Breastfeeding and Growth Spurts, on KellyMom
  • For pain when they’re not on the breast? Try cabbage leaves in your bra, Tylenol (consult your doctor, naturally), cool compresses . . . whatever works.Week Three: You’re Finally Getting It . . . and Now It’s Not EnoughThey’re called growth spurts. Remember when your mom complained you kids always seemed to need a new pair of shoes? Babies grow quickly, and as they grow, they start needing more food to sustain that growth.”Suddenly they’re nursing, nursing, nursing, and you feel like your boobs are going to fall off,” Kellams says with a laugh. “The baby will tell your body how much they want; it’s supply and demand.” If they still seem hungry, let them nurse on an empty breast to stimulate milk production – and keep eating and drinking a lot of fluids to help your body do the job.

    Now’s the time to start introducing the breast pump if you plan to go back to work at the six-week mark – start with one pump a day at a time you know you’ll be at work. Replace the baby’s next feeding with the bottled milk and keep working up from there.

    BACK TO WORK

    Back to Work: Supply’s All Over the Place

    You’re off to the office, and you want to keep them on breastmilk, but you’re still getting the hang of pumping.

    Start back on a Thursday, Kellams suggests, so you have to bank just two days of milk for the baby before you can use the weekend to regulate. Freeze the milk instead of making bottles – it lasts several months frozen.

    Silverman found pumping at work at the time her son would be eating at home helped her body handle the transition.

    Related Resources

    Getting Teeth: Ouch, Again

    It’s one of the pains that passes, almost instantly. So stop sweating the teeth. The first time they bite, pull away immediately. The second time they bite, pull away immediately. They’ll get the picture soon enough – no biting, no losing out on lunch.

    “It’s less of a big deal than people think” Kellams says. “Mom screams, baby freaks out, and that’s it.”

    WEANING

    Weaning Time: Whenever You’re Ready

    There comes a time for every mom when she’s just done. Some do it earlier than others (the AAP, WHO and CDC all recommend you nurse at least a year), some later. Some let the baby decide when to stop, some quit when they feel they’ve had enough or when a new baby’s on the way. The secret is in slowly cutting down the number of feedings at the breast, until there are no more.

    “Nothing every turns out exactly as you think it will,” Silverman says. Some women think they’ll never breastfeed and end up nursing for well past the year mark, others vow never to buy an ounce of formula and end up supplementing throughout infancy.

    Related Resources

    “The same goes for weaning,” she says. “You’ll set an end date. Then, lo and behold, it changes . . . so wean yourself. Wean yourself of all your preconceived notions about breastfeeding. It might be tough. It may even be as challenging as weaning your baby from nursing.”

    What if you tried everything, and breastfeeding still doesn’t work out?

    You’re not alone. According to a CDC look at moms who gave birth in 2005, seventy-four percent initiated breastfeeding, but only forty-three percent were still nursing at six months, and just twenty-one percent still were at one year. Approximately thirty-two percent of infants born in 2005 were exclusively breastfed through three months of age, and twelve percent were exclusively breastfed for six months.

    “Of course, I believe in breastfeeding,” Keegan notes, “but I also understand women who don’t. Sometimes it’s too hard for preventable reasons; sometimes it’s too hard because they just have no support. Breast is best when it’s working for both mom and baby.”

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