Breastfeeding & your baby
Sylvia Zakusilov, RN MSN Certified Family Nurse Practitioner
I love breastfeeding! As a momma who has successfully breastfed four babies beyond their first year, as well as donated breast milk towards multiple babies in need, I have a passion for seeing other mommas succeed in breastfeeding. We all know there are many physical and emotional benefits to breastfeeding, so you’d think it would come completely naturally. But each mother-baby pair is unique, and has to develop their own breastfeeding relationship. Like any relationship, it takes time, effort, energy, and patience, especially in the beginning. But it gets easier, and it usually becomes so enjoyable for them both! I would like to offer some tips and support for breastfeeding mommas.
1. Ensure frequent breastfeeding during the early weeks. The baby's first few weeks are crucial to establishing a good milk supply. Newborn babies should nurse 10-12 times every 24 hours. Choose to have your newborn “room in” at your hospital, and keep her close to your bedside at home. Try to minimize interruptions or the removal of your baby from your side. Wake a sleepy baby up for a feeding at LEAST every 3 hours for the first month. This is especially important if your baby has jaundice, as she may become too sleepy to nurse and allow themselves to get weak or dehydrated. Watch for early “hunger cues” such as the baby rooting, putting her fists in her mouth, or smacking her lips. Crying is a LATE sign of hunger. Try to nurse your baby before she gets to this upset point, or she will be harder to latch.
2. Get a good, deep latch every time. This sounds simple, but correct latching is a big learning curve for every baby and mother. The goal is to have your areola (the dark area around your nipple) mostly covered by the baby’s mouth. Then you should hear him actively swallowing milk, which sounds like soft clicks. While the latch may be uncomfortable at times, it should NOT be painful. Mild nipple soreness in the first week of breastfeeding is common. To help with this, express some breast milk and allow the wet nipples to air dry. You can also try applying a thin layer of lanolin cream to ease the pain. However, continued pain, severe pain when nursing, blisters, cracking and/or bleeding are NOT normal. Often these are caused by a shallow latch, so unlatching and then relatching the baby can fix the problem. Check out this video for some tips on getting an ideal latch. If pain and problems persist, the baby should be checked for a tongue tie which can also cause these issues. Please see a lactation consultant as soon as possible if breastfeeding is painful for you. She can do an assessment and give latching tips, as well as evaluate him for a possible tongue tie.
3. Breastfeed “on cue” for adequate milk supply. Back in the 1950’s, doctors would encourage formula and a strict infant feeding and sleeping schedule. However, science has taught us that breast milk production is a supply/demand process. Emptying the breast frequently tells your body to make more milk. Allowing your breasts to stay full slows down the production of milk. Breast milk digests in 90 minutes, and your infant is growing rapidly. It is completely normal for babies to nurse frequently. Also, each mother's breasts have a unique storage capacity. Some mothers can only store 2 ounces of milk, and some can store 6. The mother with a smaller storage capacity will need to nurse more frequently to ensure good weight gain in her baby. The only way the infant can get more milk is by emptying her mother's breasts more frequently. If a mother’s milk supply seems low, one of the first suggestions is to nurse more frequently. Feeding on cue is essential even in older babies. Following her nursing cues will ensure you make enough milk through your child's growth spurts. Most lactation consultants recommend at least 8 nursing sessions in a 24-hour period for any baby that is exclusively breastfed. Beware of individuals or books advocating 3-4 hour schedules or encouraging any breastfed baby to sleep 12 hours straight without nursing. This advice has been linked to “failure to thrive” in many babies. Frequent breastfeeding is normal, and it is NOT a sign that your baby is not getting enough milk. Focus instead on his urine output and weight gain for signs that she is taking in enough milk.
4. Avoid having your baby circumcised, and instead leave his body as it was designed to be. Several studies have shown, and many lactation experts agree that circumcision CAN negatively impact an infant’s ability to breastfeed. The story often goes like this: Baby is born healthy and is nursing well. He is taken away for a circumcision and comes back so exhausted from fighting through the pain that he doesn't breastfeed for hours and also has difficulty latching. Circumcision often leaves a baby boy traumatized and withdrawn from his external environment due to the pain and suffering. It is common for baby boys to refuse to breastfeed for several hours following their circumcision, and this interruption can negatively affect the mother’s milk supply. Circumcised babies have been found to have a different latch than intact baby boys, so if latching was difficult before the procedure, it will likely be even worse afterward. Circumcisions are commonly done without anesthesia, and the severe pain causes choking and difficulty breathing. Mothers are instructed to not feed their son for an hour before a circumcision is performed to minimize the choking problem, but this may cause her not to get crucial nipple stimulation during the baby's first hours and days. Even if anesthetic is used for the procedure, it does not eliminate all pain, and it wears off within an hour. Every time the child urinates or has a diaper change, he feels excruciating pain which further disrupts breastfeeding. Even the founder of La Leche League warned of the well-known effect circumcision can have on breastfeeding. Babies feel pain just like adults do. Studies have found that babies have an even lower threshold for pain than adults, and that the pain of circumcision impacts a baby negatively for months. Breastfeeding is recommended by every health authority, but routine circumcision is an unnecessary procedure that is not recommended by any medical organization. The USA has one of the lowest rates of breastfeeding in the world, and also the highest rate of infant circumcision. That is no coincidence! In fact, 80% of the world’s men are intact, and the USA is virtually the only country that routinely circumcises newborn boys. All mammals have a foreskin, and all mammals make milk for their young. Leaving a baby intact and whole is natural, healthy, and normal. Foreskin is not a mistake or a defect that needs surgical correction. It has many functions, and God/nature intended for it to be there! If you leave your son perfect and whole, you won’t regret it, and he will thank you later.
5. Do not be alarmed if you have engorged, full breasts at the beginning of breastfeeding. Your milk will greatly increase in volume between days 2-5. Before that, your baby will be swallowing drops of colostrum - a rich liquid high in antibodies which supplies everything she needs until the milk arrives. When your milk comes in, it is normal for your breasts to get much larger, feel firm, and start leaking. Use breast pads under your nursing bra to absorb the leaking milk. Nurse on her cues, "on demand," having your baby finish one side completely before you offer the other side. Do not pump extra milk during the first 2 weeks if you are very engorged, unless you are very tight and sore, then just pump to comfort. If you get a hard sore spot in your breast, you may have a clogged duct. Massage it and apply heat while pumping or nursing. Please note: if you get a painful breast, with redness and/or fever, contact your doctor immediately as this can be a sign of mastitis.
6. Watch for wet/dirty diapers as well as weight gain to verify that your milk supply is good. A baby should have at least 6 wet diapers in a 24-hour period. At this point he should also have at least 3-4 stools a day, the size of a quarter or larger. Weight gain is the BEST way to ensure your baby is getting enough calories. If baby has not regained his birth weight by 10 days, please see a lactation consultant right away, and if he’s not up to birth weight by 14 days, please see his doctor. Also, a breastfed baby should usually double their birth weight by 4-6 months, and should be 2.5-3 times their birth weight by one year of age. Remember, a baby’s weight gain is dependent on how many calories he intakes; genetics don’t tend to play a role in weight gain until two years of age. I have seen this in my personal experience, as I’ve had tiny friends with great milk supply grow chubby babies, and large friends who struggled to produce, with thin babies.
7. Embrace night nursing as both normal and needful. You may be tempted to follow advice of friends to get your baby to “sleep through the night” at a young age, but this can be harmful to breastfeeding. Prolactin, the breast milk hormone, peaks between midnight and 3AM. Most cultures around the world practice co-sleeping, where baby is sleeping in the room with mom, ensuring that the infant gets feedings whenever they need them. You don’t have to share a bed, even being in a crib or portable baby bed near mom’s bed is helpful. Night waking is also protective against SIDS which is why the recommendation to keep baby in mom’s room for at least 6 months is given. I do not recommend any of the “cry it out” methods for various reasons. However, if you do choose to do this, most experts advise to wait until your baby is at least one year old. I offer these helpful tips: Learn to nurse lying down, keep the lights dim when you nurse at night, and try to stay quiet. Your baby will wake up, nurse, and you both will go right back to sleep. It can be rough sometimes, but it is worth it in the end!
8. Understand ways that you can improve your milk supply. Often mothers worry they don’t have enough milk because their baby is nursing frequently. Again, frequent breastfeeding is normal, and most babies are getting enough milk. However, if your baby isn’t gaining weight adequately and is nursing frequently with a good latch, then there are also other ways to improve milk supply. Your first step should be to find a lactation consultant.
Pacifiers can hide early hunger cues, so be cautious about using them especially in the first 2 months. You do not want your baby to be pacified by an artificial nipple, when what she really needs is more nursing. Try pumping after feeding sessions and offering the milk to your baby in a syringe. Drink plenty of fluids, including one full glass every time you sit down to nurse. Ensure that you are taking in enough calories to make quality milk. Approximately half of the calories in breast milk come from fat, an essential nutrient for brain development.. Eggs, nuts, cheese, avocados, and “lactation cookies” are all very nutritious and give your body good fats for making breast milk. Ask your doctor about taking Fenugreek, an herbal supplement available anywhere you can buy vitamins, that you can take to increase milk supply. Avoid supplementing with formula if at all possible, since every time the baby drinks formula instead of nursing, that will be one less feeding of milk that the mother's body will not need to produce. However, if a baby is weak or dehydrated he may not be able to nurse vigorously, and the top priority is to nourish this baby, even if it does mean you need to supplement. See your doctor immediately if your baby seems to be lethargic, isn’t urinating/stooling adequately, or seems to be becoming jaundiced. If you do need to supplement, try to seek out human breast milk from donors. You can also talk to your doctor about potential causes for your low milk supply. Hypothyroidism and Polycystic Ovarian Disease both can affect milk supply. One rare cause for low milk supply which I have seen several times is Insufficient Glandular Tissue/Hypoplastic Breast Syndrome. Signs of this condition are few breast changes during pregnancy, no breast engorgement after birth, and a baby that does not gain weight well no matter what is tried. Even if a mom with this condition cannot fully provide enough breast milk for her infant, she can supplement with donated milk or supplement and nurse at the same time via a supplemental nursing system.
9. Going back to work? Set yourself up for success! Get a high-quality pump, and make the time to take pumping breaks. Double electric pumps are the most useful type, and most health insurances now cover the cost if you ask. Many pumps are built into a discrete and stylish bag that “hides” the pump while you are coming and going from work. They often have a little cooler as part of the bag, or you can bring your own cooler bag to store pumped milk. Proper breast milk storage includes immediately putting milk into a fridge or storing it with cold packs to ensure that it stays fresh. When your baby is a few weeks old, you can start pumping milk to freeze and store for later. Many moms try to have a “stash” built up before they return to work. When you are back at work, try to pump once for every feeding that your baby is missing. My recommendation is that you pump every 3 hours if possible, and 4 hours maximum. Keeping a photo of your baby with your pump and viewing it when you begin will help with your “let down” of milk. Ask your employer if they have a “pumping room” for mothers. If they don’t, please ask if you can have access to a vacant office or spare room where you can have privacy for pumping. Many states have laws requiring that jobs provide a private area for a mother to pump, that is NOT a bathroom. Working mommas may find that “reverse cycling,” meaning that baby nurses more frequently at night, may help keep up their milk supply. It definitely takes even more work and commitment to breastfeeding if you are a working momma, but you can do it!
10. Expect that there will be times when you want to quit. It's ok, wanting to give up is normal, and you are normal. Breastfeeding is a big commitment and a lot of work, so do what you can to get the support you need. See a lactation consultant for any problems or questions. Seek out a breastfeeding support group at your hospital or birth center, or through your local La Leche League which provides free mother-to-mother breastfeeding support. Take whatever help you can from people in your life. If someone offers to bring meals, clean your house, or play with your older children, tell them YES! If they say "let me know if you need anything," come up with something like a meal or a chore right away! Have dad or grandma watch the baby so you can take a nap or go take a walk. Do not be afraid to just ask for help from others when you need it. Many times people are willing to help, but don't want to push, so they don't offer. Make the first move, and make a request. If you have no family or friends available, a postpartum doula would be a terrific help and support to your whole family as you rest and nurse. Clear out your schedule for several months after your due date so that you can make breastfeeding a priority. Wait as long as possible to go back to work. Don’t have expectations for yourself other than caring for your little one. Give yourself lots of grace! All too soon your little one will be independent; it is really such a short time that they are so helpless and needy. Before you know it, your baby will be walking and talking and he won't need you nearly as much. Although breastfeeding and caring for an infant may be tough at times, I promise you will miss those days!