Every once in a while some calls or emails asking for help, suggestions or just wanting to commiserate about breastfeeding. I figured I would go ahead and right out some of my standard responses and thoughts on it. I’m certainly not an expert, but I have a good deal of experience since I have nursed three babies for close to 4 years straight, Greta (2.5 years), Eloise (2 years and counting), Beatrice (2 months and counting). First up, I have nothing against formula or anyone who uses it. Please don’t take any of my thoughts as a dig or that I think YOU didn’t try hard enough or do enough or whatever. Each mother and family gets to decide how to best feed their child. Each situation is totally different and I certainly don’t know how to solve all problems. I am contemplating becoming a lactation consultant one day when my kids are grown, but we shall see if I stick with that or not, so I do tend to read lots about breastfeeding. 🙂
First up, I think you, as a mother, have to decide how important breastfeeding is to you. On a scale of 1 to 10, with 10 “come hell or high water” I will make this work somehow, and 1 being, ah, if it is easy, then why not. Me, I was definitely a 10. In fact, I was much more worried about a successful breastfeeding relationship than I was about labor or really anything else. I think so many of us have heard story after story of breastfeeding not working out for one reason or another, and I knew beyond a doubt that I wanted to make it work. I was scared of all the stories. Sure, it isn’t a cake-walk and many people struggle mightily to make breastfeeding work, but I’m not sure I needed to worry as much as I did. There is definitely a lot of pressure to breastfeed today and although I knew it was for me, it isn’t what everyone wants or even can do.
So, if you are serious about making breastfeeding work for you then I definitely recommend reading as much as possible before the baby is born. There are oodles of books (and millions of mothers stories on the internet) out there and from what I read most of them say the same stuff. There are books dedicated to all different situations, breastfeeding after a reduction, breastfeeding an adopted child (yep, you can do it), breastfeeding and working, breastfeeding special care babies, breastfeeding preemies, or just one of oodles books about breastfeeding. Get your spouse on board and have them be an advocate. I think the education is key for when you are in the hospital and also at the pediatrician’s office. Many times the hospital can really push you to supplement or try formula for a myriad of reasons and if you are educated you can know whether you really ought to go with their suggestions. For example when Greta was born we were sent home from the hospital with instructions from the nurse to nurse her and then follow up with 2 ounces of formula. We promptly ignored this. She was loosing weight, as all babies do, and other than having trouble getting her to latch (which we fought like crazy each and every feeding for the first week or two), she was doing fine, peeing and pooping normally, so there was no real reason to supplement her and my milk had yet to ome in. Honestly the hospital was quite pro-formula, especially compared to the hospital that Eloise and Beatrice were born at, which never once offered or asked me to give my baby formula (I’m sure a little bit is that I was an experienced breastfeeding mother). Also, did you know that doctors get very little breastfeeding training in medical school and residency? Very little. So, don’t assume your pediatrician knows everything. (Nothing against pediatricians at all, in fact my sister is one, but they just don’t receive adequate training in breastfeeding). Our first pediatrician offered numerous times to give us formula samples, even though nothing was wrong at all, Greta was gaining weight fine and I didn’t complain about anything. I can’t even imagine if we were having trouble. So again, be prepared. If you happen to find a pediatrician who has a lactation consultant on staff, awesome! There is a course that the AAP offers that pediatrician’s can take to help them learn more about breastfeeding (it appears that it is only offered in certain residencies, but hopefully it will be come more commonplace). So just be prepared with lots of knowledge in case your hospital or pediatrician is pushy or less than useful. Your education can also help if you have family or friends pushing formula. Thankfully all of my and Matt’s family was very supportive.
Most hospitals these days have on staff lactation consultants and they usually visit new mothers within the first 24 hours. You can certainly request they come sooner if you are having trouble. In my experience, lactation consultants really know their stuff and you should feel free to ask them anything at all about breastfeeding. They can be your greatest advocate. Also, before you leave the hospital, make sure you know how to get in touch with them and what kind of offerings they have. The hospital Greta was born at allowed you to visit their lactation center free of charge if you gave birth there. In San Antonio, there was also another free standing lactation center that was associated with another hospital that anyone could go to for free. Some pediatrician offices have lactation consultants on staff as well. Find out what kind of resources are available in your area. Even if you have to pay, they really are wonderful and can help solve nearly any problem. One of the key things for me was that they offered a scale and suggested that I weigh Greta both before and after a feeding so they could see how much she was getting. This really boosted my confidence as I was now convinced she was definitely getting plenty of milk. This also helped the pediatrician feel better since they knew that she was getting milk and that I didn’t need to supplement since my milk was finally coming in. I think most mothers have the fear that “my baby isn’t getting enough” and this can really help calm that. There is no real other way to know how much the baby is getting unless you are pumping and feeding the baby.
Another great support is La Leche League. La Leche League is run my local trained leaders, they usually offer monthly meetings at which current or soon to be mothers are always welcome. They usually have lots of tips and you can find others who are breastfeeding, which can be especially helpful if you are lacking family and friend support. There are chapters all over the world, so there is bound to be one somewhere nearby. I’ve only actually been to one meeting, but I hope to go to more soon, so that I can share my experience and possibly help others who are looking for help.
So, educate yourself and know your resources ahead of time. Other than a good breastfeeding pillow (I recommend My Brest Friend) and some lanolin for your nipples, there isn’t much you need in the beginning. If you have a pump, bring it to the hospital in case you need or want it. I sent Matt home in the middle of the night to get mine since we were convinced Greta was getting nothing, plus since she wasn’t latching well, I wanted to make sure I was stimulating my breasts so that they were getting the memo to make milk. But, the hospitals have pumps (really powerful ones) you can use if you really need one, so if you don’t have one, don’t worry about it.
In the first 24 hours, the baby might be sleepy and you might have to wake them up a zillion times to try and get them to nurse. Greta was definitely sleepy, but the other two weren’t so much. I’m not sure whether this is due to the epidural or what, but whatever, some babies are sleepy. If so, you will have to fight to get them to nurse in the beginning, but do it. With Greta, we were totally stripping her down to just a diaper and tickling her feet and back to keep her awake to get her to nurse. Both Eloise and Beatrice were quite hungry and at about 18 hours old, nursed for probably FIVE HOURS straight. Sure, there were a few 5-10 minute breaks for diaper changes and bathroom breaks, but they nursed nonstop for a long while. They both nursed much more than the books say until my milk was in. Nursing nonstop helps encourage your milk to come in and comforts a crying baby, so nurse away. Yes, it is tiring, but we all knew that motherhood would be exhausting. Also, don’t necessarily assume the baby isn’t getting anything if they are nursing nonstop. If they are having the correct number of wet and poopy diapers, and you hear them swallowing, they are likely getting enough. I noticed a marked change in all three children, once real milk was flowing rather than colostrum. They were suddenly content for more than a few minutes.
Both Eloise and Greta lost more than 10% of their body weight before beginning to gain again. Beatrice wasn’t weighed before we left the hospital, and wasn’t weighed again until 8 days after birth, so I don’t really know how much she lost, but I would guess less just since my milk arrived much sooner and by 8 days old, she was up 7 ounces from her birth weight. Another thing to keep in mind with weight is that if the mother has an IV during labor (which, if you gave birth in a hospital, you likely did), then the weight loss will most likely be greater. A study published last year recommends that a 24 hour birth weight be used as the baseline, rather than the actual birth weight in cases where the mother had IV fluids during labor. This isn’t to say that you shouldn’t be concerned if your baby is losing weight, but if you baby is losing weight before your milk is in, that is to be expected. Everyone’s milk comes in at different times and the more children you have, the faster the milk comes in, but there are instances in which the milk can take a longer than usual time to come in and in those cases you might need to supplement. To encourage your milk to come in, you should be nursing the baby as often as possible. Nursing the baby helps encourage the breasts to make milk much better than a pump, so make sure the baby is doing a good deal of the work. You can certainly add some pumping in there if baby is sleepy or not latching as it will definitely help. There are also oodles of mother’s milk teas (and cookies) available to help milk supply. Some mothers drink them from the start to help their milk supply get a good start.
Something I just learned the other day from one of my favorite breastfeeeding sites, kellymom, is that most nursing moms can only pump 0.5-2 oz total per pumping session. Holy moly am I glad I don’t have to pump very often! There are lots of things you can do to increase your output. I think in general lots of people, fear they aren’t making enough milk, and here is a great page that talks all about low supply, if you really have it, and what you can do to increase your milk production. Also, did you know that you should be consuming more calories as a breastfeeding mother than a pregnant mother? During pregnancy, you should consume about 200-300 extra calories, while breastfeeding you should consume 300-500 extra calories, so eat up! If you are hungry, eat. If you are thirsty, drink.
My only last piece of advice is to nurse as long as YOU want. If you and baby are still happy nursing, then continue. If either of you is ready to stop, then stop. If this is at a few weeks, months, or years, do what works best for you and your family. So educate yourself and know your local resources and you should have a much greater chance at success.