Breastfeeding: Who knew it could be this hard??

There are literally hundreds of websites that offer breastfeeding information and guidance, many of them excellent. I will list a few of my favorites at the end of this article. My aim here is not to “re-invent the wheel” or offer a comprehensive treatise on the most common breastfeeding challenges – there are entire textbooks devoted to just that – but to briefly share with you the most common concerns expressed to lactation consultants like me from new moms like you.

So let’s start with what I believe is THE most common concern:

#1: “My baby wants to nurse ALL THE TIME! I don’t think I have enough milk!”

A newborn who wants to nurse “all the time” is normal. Before your baby was born, s/he was on a continuous feed, via the umbilical cord, 24/7. After the cord was cut, that continuous feed stopped. Fortunately, babies are hard-wired to seek out the breast. At birth, they are flooded with new sensory experiences, and immediately begin learning about their environment. Ideally, they are placed skin-to-skin on their mother’s belly, then a few seconds later, begin to breathe, and then begin to crawl to the breast. All this serves to organize their nervous system.

The stomach of a newborn is about the size of their fist. Over the next couple of weeks, it will expand to be about the size of a ping-pong ball. But for those first few days, a teaspoon or two of colostrum (the first milk) is all their little tummy can hold. And truly, colostrum is like liquid gold! It only takes a few drops to stabilize the baby’s blood sugar and begin the work of sealing the gut and establishing a healthy bacterial balance.

Some newborns are “born hungry,” and want to nurse right away, and very frequently. Others seem to be more sleepy than hungry. It’s best to offer the breast immediately, and use those first couple of hours after birth for skin-to-skin bonding and breastfeeding. But if, for whatever reason, baby doesn’t feed at that time, get some sleep and try again later. It’s not terribly uncommon for it to take up to twelve hours for baby to get motivated to try again. This is not a reason to panic. Just stay with the skin-to-skin, and keep baby in the “breastaraunt.”

Somewhere between days two and four, your milk volume will increase dramatically. This is when baby NEEDS to be breastfeeding very frequently: every one to three hours. You may find that at certain times of the day, baby wants to “cluster feed,” just taking five to fifteen minute breaks, then going back on. This is fine. It is VERY IMPORTANT that milk moves through your breasts enough that they do not become very hard, or engorged. A frequently nursing baby is the best way to accomplish this.

During these first few days, baby has been passing meconium: the black, tarry stool that accumulated in utero. By day four, this should be noticeably different, becoming brown, then yellow and “seedy,” and much less sticky. If your baby has four or more good-sized stools by day four or five of life, you can rest assured you have enough milk, and your baby is getting it. Nice, huh?

After this, it is normal for babies to continue feeding AT LEAST eight times every 24 hours. Sometimes, it may approach double that. It is ok for baby to have one stretch from one feed to the next of 4-5 hours per 24 hour period, assuming baby is full-term, healthy and at least eight pounds. THIS IS NORMAL NEWBORN BEHAVIOR. As long as baby’s urine is clear or pale (as opposed to yellow), and baby is pooping at least four times a day, you have enough milk.

OK, so what if baby is NOT pooping, and/or your breasts DON’T feel full?

CALL A LACTATION CONSULTANT RIGHT AWAY – and sooner, rather than later! An International Board Certified Lactation Consultant (IBCLC) can do a full assessment on both baby and mom to determine if it’s a milk supply problem or a transfer problem or both, and figure out what to do about it.

The three “cardinal rules” lactation consultants live by are:

  1. Feed the baby.
  2. Protect the milk supply.
  3. Protect the breastfeeding relationship.

Obviously, rule #1 is non-negotiable: the baby MUST be fed. If the baby is unable to get milk from the breast, an IBCLC can find out why, and set a plan in place for feeding until the issues are addressed.

#2: My nipples are cracked and bleeding! Help!

The most common reason for this is a “bad latch.” Most of the time, this is a fairly easy fix. If this is what you’re dealing with right now, please go to my home page and request my video. It’s about seven minutes long, and will give you a thorough description and demonstration on how to get baby on properly. If you feel that you’ve followed those directions, but you’re still in pain, then you need a personal consultation and evaluation by an IBCLC.
While it is normal to be a little tender in the first few days of breastfeeding, it should be mild and temporary – like no more than a couple of days. It is NOT NORMAL for breastfeeding to hurt, or for nipples to be cracked or bleeding. If they are, you need help sooner rather than later! The longer you wait, the more complicated the solution is likely to be.

#3: When will my baby sleep through the night?

First, it’s important that you understand: “through the night” for a baby is no more than five hours, at least until they’re over ten pounds. It’s also important to understand that baby’s brain is developing at a breakneck speed, as is his body. This developing brain and body NEED to be aroused to feed a MINIMUM of eight times every 24 hours. Once they reach the point where breastfeeding is comfortable, weight gain is averaging about an ounce per day, and developmental milestones are being met, if baby sleeps longer at that point, that’s fine. Until then, though, enjoy nighttime parenting: keep baby sleeping near you so it’s easy to bring baby close to feed in bed (well before the crying starts), and treasure the quiet serenity of your sweet, suckling baby. Believe me when I say, those eight-hour nights will return. I just can’t tell you exactly when;-).

#4. “When I pump, hardly any milk comes out (or maybe only a half-ounce). Does this mean I have a low supply?”

Possibly, but probably not, especially if your baby is feeding well at breast, growing well, and pooping and peeing plenty. Some moms just don’t respond well to a pump. I mean, think about it: when you’ve got your sweet, soft baby at breast, it’s pretty easy for that oxytocin (the love hormone) to start flowing. Compare that to a plastic machine with hard, plastic flanges…and sitting up straight, watching every drop come out, maybe worrying, “will I get enough?” That’s kind of like comparing a nice, romantic evening out with your man, topped off with the most amazing lovemaking ever, with going to the doctor for a transvaginal ultrasound. The same parts get touched, but the response will be different. Other moms seem to do fine with a pump. I’ve found that pumping yield can increase as mom pumps more, and gets accustomed to it. Again, the most important thing is a growing, happy baby.

#5. “I really want to breastfeed (or I have mixed feelings about breastfeeding) – but my biggest challenge is my unsupportive (mother, mother-in-law, friends, partner…). They want to feed the baby a bottle. They keep undermining my confidence by saying how hungry the baby is every time s/he cries.”

OK, so here’s the deal: THIS is YOUR BABY, not theirs. (OK, so it’s your partner’s baby, too, but I’ll get to that part in a minute). If they cannot be supportive – and oftentimes, there were clues to their attitude about breastfeeding before the birth – then it will be essential for you to find and surround yourself with a support system. La Leche League is wonderful for that. Also, many cities have breastfeeding support groups that are not part of LLL. Just find a group where you are supported! Seriously, I can’t stress this enough! There is so much practical wisdom that experienced moms are happy to share, and some FABULOUS answers to some of the inane or insulting comments that can come your way.

As far as others wanting to feed the baby (whether your mother, mother-in-law or partner): There are plenty of other ways to bond with a baby that don’t include feeding! Here’s a partial list:

  • Simply hold the baby
  • Sing to the baby
  • Rock the baby
  • Walk the baby
  • Bathe the baby
  • Give baby a massage
  • Play with a fun toy with the baby
  • Get a mirror, and have a BLAST

Seriously. There’s plenty to do that doesn’t include feeding. BREASTFEEDING is the ONE THING that ONLY YOU CAN DO. That’s your superpower! Don’t let anyone forget it!

#6. I have to take a prescription medication. Can I still breastfeed?

Almost certainly, the answer is yes. Unfortunately, much too often, doctors advise moms to suspend breastfeeding and “pump and dump” while taking needed medications. If you get this advice from your doctor, ask that s/he check the reference book for this: “Medications and Mothers’ Milk” by Thomas Hale, PhD. Some medications are not ideal for breastfeeding, and for most of those, there is a better alternative – suggested in the book.

I have sat in many workshops offered by Dr. Hale, whose entire career is dedicated to researching the effects of medications on mothers’ milk. The bottom line is, there are very few medications that are absolutely contraindicated for breastfeeding. Most of those would include radioactive isotopes (used in cancer treatments) and illegal street drugs. For about everything else, the benefits of continuing to breastfeed despite the potential presence of a clinically significant amount of medication in the milk outweighs the risk of introducing formula, with its potential for gut damage and/or sensitization to cow proteins.

#7. What happens when my baby gets teeth? What if my baby bites me?

Babies nursing after teething is VERY common. Mom shouldn’t feel any difference, because the tongue is what comes into contact with the breast, not the gums. (Although, you might feel a little sore just before the first tooth breaks through, due to a chemical change in baby’s saliva. This is temporary.) If baby bites, understand: it’s not done on purpose to hurt you. Baby has no idea clamping down is a bad thing; s/he is probably just seeking out comfort for sore gums. I don’t recommend moms inject any emotion into that situation by reacting with a sharp “no,” or anything like that. Rather, if baby bites, simply – and silently – pinch baby’s heel, toe, or fleshy part of the thigh, just enough to cause discomfort, so baby releases his jaw. After that happens two or three times, baby will figure out, “hmmm…when I bite, my leg (or foot) hurts…I guess I won’t do that any more.” Problem solved. And, there will be no negative emotion around it.

Closing Thoughts

Those are some of the most common questions I – and most lactation consultants – get from new moms. I hope you’ve found my answers helpful. I have offered my answers just like I would if I were face-to-face with you. That means without the academic jargon or references. So before I close out here, I want to offer, by way of encouragement to the stressed-out mom who may be wondering if it’s worth it, a little bit of RESEARCH, complete with references, on the health benefits of breastfeeding, for both mom and baby:

This list includes results from studies where all types of breastfeeding (including partial breastfeeding), not just exclusive breastfeeding, are included. For all of the following, there is a dose-response relationship between breastfeeding and the health outcome, meaning that the less breastfeeding that occurs, the higher the risks.

For the child being breastfed, or being breastfed for longer lengths of time, decreases the risk of:

  • SIDS
  • gastrointestinal infections
  • respiratory infections
  • ear infections
  • necrotising enterocolitis in premature babies
  • sepsis in premature babies
  • overweight and obesity
  • lower IQ.

For the mother, breastfeeding decreases the risk of:

  • breast cancer
  • ovarian cancer
  • type 2 diabetes
  • osteoporosis
  • heart disease

Is it worth it? I’m thinking it is. If you agree, but you need help, please call me, or an IBCLC near you.

Breastfeeding Websites:

www.llli.org

www.drjacknewman.com

www.breastfeeding.com

www.breastfeedingmadesimple.com

www.normalfed.com

www.naturalchild.org

www.kellymom.com

http://www.PositivelyMama.com/

http://www.biologicalnurturing.com/video/bn3clip.html

References

  • Collaborative Group on Hormonal Factors in Breast Cancer 2002, Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease. Lancet 360:187–95.
  • Kramer MS, Matush L, Vanilovich I, Platt RW, Bogdanovich N, Sevkovskaya Z et al 2008, Breastfeeding and child cognitive development. New evidence from a large randomised trial, Archives General Psychiatry 65(5): 578–584.
    Hauck FR, Thompson JM, Tanabe KO, Moon RY, Vennemann MM 2011, Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis, Pediatrics 128(1):103–10.
  • Hornell A, Lagstrom H, Lande B, Thorsdottir I 2013, Breastfeeding, introduction of other foods and effects on health: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food Nutr Res 57:10.3402/fnr.v57i0.20823.
    Horta BL, Victora CG  2013, Long-term effects of breastfeeding: a systematic review, Geneva: World Health Organization.
  • Jordan SJ, Cushing-Haugen KL, Wicklund KG, Doherty JA, Rossing MA 2012, Breastfeeding and risk of epithelial ovarian cancer. Cancer Causes Control 23:919-927.
  • Luan NN, Wu QJ, Gong TT, Vogtmann E, Wang YL, Lin B 2013, Breastfeeding and ovarian cancer risk: a meta-analysis of epidemiologic studies. Am J Clin Nutr doi: 10.3945/ajcn.113.062794
  • Lucas A, Cole TJ 1990, Breast milk and necrotising enterocolitis. Lancet 336(8730):1519–23.
    National Health and Medical Research Council 2012, Infant Feeding Guidelines, Canberra: National Health and Medical Research Council.
  • Rosenblatt KA, Thomas DB 1993, Lactation and the risk of epithelial ovarian cancer – The WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Int J Epidemiol 22:499–503.
  • Su D, Pasalich M, Lee AH, Binns CW 2013, Ovarian cancer risk is reduced by prolonged lactation: a case-control study in southern China. Am J Clin Nutr 97(2):354-9.