Tuesday, December 22, 2009

What Every New Mom Should Know About Breastfeeding

How to establish a good milk supply-
NURSE ON DEMAND. I don't care what any well meaning nurse or the books say about getting your little pumpkin on a schedule or teaching your newborn a routine; for a newborn, you need to be on their schedule! It is super important to establish a good milk supply in the beginning and then you can tone it down a bit as time goes by. This is much easier than starting slow and trying to build it. Breast milk only sits in the stomach for 45 minutes, meaning your baby is going to be hungry a lot. You will probably feel like, 'why even wear a shirt'? That is normal and what you should be feeling. If you feed only every 3 or 4 hours and let your newborn sleep through the night (as they sometimes do if you don't wake them for feeds) you will be doing you and your child a great disservice. Most Dr's tell you to wake your baby every 2-3 hours for feedings after you leave the hospital. The important thing to know about this is that it's not just for your baby but mostly for your boobs. You are establishing supply and demand. The more you demand the more your boobs will supply. I fed Eliana every 1 1/2 -2 hours during the day and often every 3 hours at night for the first few months. She was never too high on the weight charts (she ranged between 25 and 75 percentile) and I never had a supply issue. It is nearly impossible to overfeed a breastfed baby, so err on the side of feeding too often rather than not enough. When in doubt, nurse!

In a nutshell-
1. Offer the breast every time they root, seem fussy and you know it's not a dirty diaper or something else, etc. (Even if it's every 45 minutes! It could be a growth spurt).
2. Wake your infant (generally if they are under 11 lbs) every few hours at night for feedings.
3. Let your infant set the feeding schedule. Their bodies know what they need and they will tell your breasts how much to supply (That being said, babies that are lazy eaters or sleep for long periods of time MUST be woken for feedings for their own sake and your milk supply). Six hours is generally the absolute longest a newborn should be allowed to go between feedings at night.

As time goes on and your newborn becomes a full fledged baby you can work on getting life into more of a schedule for your own sake, but to do that with a newborn is really just going to sabotage your breastfeeding efforts. Many mother's of newborns feel that all they do day and night is nurse their child. This is normal and honestly I think how it is supposed to be. Laundry, dishes, vacuuming, and dinner can always wait (or better yet get Hubby to help!). But your infant and your milk supply should be top priority. This is such a fleeting time in your life, learn to enjoy it. Get a book or a TV series or something you can do while your child is nursing and learn to enjoy the peace and quiet. You will miss this time later on!

Many new mothers seem to want to put their children on a schedule, ie. nursing every 3 hours or every 2 1/2 or every 4, etc. I can't even tell you how many mom's I've heard say, "well it hasn't been 3 hours, I'm not going to nurse yet." And then my thought is, "WHAT THE!"

The 'feed every three hours' rule of thumb really only applies to formula fed babies. Formula is hard to digest and therefore stays in their little belly's longer so they don't need to eat as often. Breast milk is custom made for their specific nutritional needs that day and is easily digested and used by their bodies. They digest it quickly! Feeding your newborn every 3 hours (as in, to a T, on a schedule) will often lead to you not having enough milk and not being able to keep up with the demands of a growing baby. There will be times that your baby will need to eat every 45 minutes (Elly did that a lot!). These are referred to as "cluster feeds". They do this on purpose to tell your boobs to produce more in preparation for a growth spurt. There may also be times that it does end up being every 3 hours or even 4 and they are fine. I want to encourage you to not be afraid to feed often. I have seen so many moms have their children on schedules and end up quitting nursing because they couldn't keep up. This is so sad and completely avoidable- feed more often! I am not advocating overfeeding babies or forcing nursing sessions when they clearly don't want it. Listen to your supply and your baby. Eliana ate very often and has always been in the 25-75% weight range and 95% height range. Definitely not a fat baby, but a healthy one.

Many women end up giving up on nursing because they feel they are not satisfying their baby and that they do not produce enough. Very rarely is that actually true. When I ask a mom why she thinks her baby is getting enough, the answer is commonly, "well s/he is hungry all the time!" My thought- "Good!" A new baby should be a hungry baby. If they fuss and want to eat every hour it does not mean you are doing anything wrong. That being said there are times when it might be a problem. If your baby is suckling for 45 minutes and you're not seeing a good swallow (watch here on Dr. Newman's Breastfeeding Website- it's incredible) AND/OR if your baby is constantly getting a shallow latch (not enough areola in the mouth) and the latch may be hurting you....I then start to think there might be a tongue-tie going on. Your pediatrician or lactation consultant can check for you. I've heard a Dr say, "well it's a small tongue-tie, not a big deal. If your breastfeeding is still having issues in a couple weeks we'll just have you supplement." WHAT!??? Um, hello, this poor mother is going to have to supplement BECAUSE of the tongue-tie! To clip a tongue-tie in an infant is a very easy, quick procedure. Your baby will be able to nurse again within minutes. If you wait til your child is a toddler it will then become a surgical procedure and a much bigger deal. If you choose not to clip a tongue tie you may continue having breastfeeding struggles and your child may have a speech impediment (think Rosie Pope of Pregnant in Heels).

Other items to help milk supply:

Lots of water for mommy! General rule of thumb is when you go pee you shouldn't be able to tell that you just did. So pretty much clear water. That being said, too much water (like gallons and gallons a day) can actually decrease your supply. It's the whole 'everything in moderation' slogan. Let your pee be the guide :)

Fenugreek- Herbal supplement. It has been said that you know you're taking enough if you start to smell like Maple Syrup. According to KellyMom.Com you should take at least 3500mg daily,  KellyMom on Fenugreek , to help with milk production (*note- this is much more than the bottle will tell you to take as that is for it just being a dietary supplement). You can pick up Fenugreek a lot of different places, I recommend Super Supplements.

Rest- Breast milk production really ramps up while you are sleeping. I know you're thinking, "Sleep? What sleep? I'm SO tired!" I know, I get it. But that being said, try to rest whenever you can.

Oatmeal- I have heard this works and it's worth a try. Definitely not going to hurt you. Maybe have oatmeal for breakfast. Babies with sensitive tummies sometimes get gas from mommy eating oatmeal, so just watch out for that.

Lactation Cookies- These are spectacular and yes they really do work! This is the recipe- Oatmeal Chocolate Chip Lactation Cookies . I ate a ton of these (I mean seriously- a TON), ha! The Brewer's Yeast is the magic ingredient among others.

Beer- Yes, most of us have heard, "just drink a beer!" Well sure, I suppose if you really want one you can, but wouldn't you just rather eat some cookies??? As I said, it's the Brewer's Yeast that is the magic ingredient- NOT the alcohol :)

Fenugreek Granola- Central Market carries a lot of different granola in their bulk section that have fenugreek in them. Read the label to find the right one, there's a lot! :)

Pumping- This goes back to the supply and demand scenario. The more you nurse/pump the more milk your breasts should make. I will say, however, that you will not have the same letdown and hormonal interaction with your pump as you do with a nursing baby. Pumping usually takes much longer and you often won't get as much as if your baby nursed. For example, when Eliana would nurse first thing in the morning at around one year old she would gulp for 5-10 minutes and I'd be empty. With a pump it took me 30 minutes and I'd get 7-9 oz and still not feel empty. Babies are magicians at getting milk out of our boobs.The pump is a poor substitute for them, yet really the only other thing we can use. So, keep in mind that while a pump is a great tool for increasing milk supply, it should not replace your baby actually nursing.

Nipple Shield- When the question was asked at LLL how many moms have used one at some point in their nursing journey, over 1/3 of the women raised their hands (me being included!). If you have inverted nipples especially, you may need a shield. And on that note, you may not know you have you inverted nipples. When someone says 'inverted' it's easy to picture a weird looking inverted nipple, but often you cannot tell just by looking. It has to do with the structure of the internal part of your nipple and if your baby will be able to draw it out enough for feeding. If not, your poor baby will be sucking and sucking and getting nothing or next to nothing and you will be in pain! Nipple Shields are easily available at Target, Walmart, etc. They cost around $6 and are clear. You only wear them during the nursing time, not all day. I kept one in the diaper bag and one at home and an extra in the nursery. Hospital lactation consultants will have them available for you also. I do believe that shields can end up being used longer than needed though and then it's hard to get your baby off of it. I recommend seeing a lactation consultant after a couple weeks to get off of it if you are having trouble doing it on your own. I used one for over a year with Eliana and it was a pain. I have not used it even once with Evangeline :)

Other misc items:
Many babies are jaundiced shortly after birth and require treatment for that. Breast milk naturally contains vital nutrient that fight jaundice. I was a little disillusioned to find out that the Bili-light Eliana wore was only supposed to remove 15% of the problem. What a hassle for a small amount of change. Breastfeeding works hand in hand with Bili-lights, so give your babe unlimited time on each breast.

Most hospitals and even counties have lactation consultants available for you and they really do want to help you. You'll want to get your baby on your breasts as soon as you can after birth. If you're getting any resistance from staff, request the lactation consultant asap (be firm!) and she can help fight for you :)
I know that Kitsap County offers a lactation consultant that will come to your home after you've been home a couple days. Take them up on this free help. Often you'll feel fine in the hospital and then you get home and the rubber meets the road and you start to panic. Having someone come to your home can really help. A breastfeeding friend can be a great resource and having a support group like a local La Leche League Chapter is wonderful, too. Don't be afraid to ask for help. I guarantee whatever difficulty you are experiencing, someone else has faced it before! Breastfeeding really takes commitment and a "whatever it takes I'm going to make this work" attitude. The first few months are usually the hardest as your baby, your boobs, and you are getting in the swing of things. Over time it'll be second nature for both of you and you'll learn to really "mother through breastfeeding."

PS. I love this website for finding all sorts of info: La Leche League

For some reason this pic is really unclear on the blog, but it's from Harrison Medical Center late 2009. A friend of mine took this picture showing their advice to feed every 3-4 hours! YIKES! And yes, she had major supply issues following that advice. Things turned around when she started feeding On Demand (yes, it's more than a Comcast remote button).

3 comments:

  1. Thanks Di this was great timing for me :-) Although I've been leaking out the hoo ha the last four days Tiago doesn't seem to be getting enough milk and I'm just now (day 4) starting to realize I need to start trying new things and see what will work. First up has been feeding whenever he seems to want it (more like every 45min) and if he isn't pooping today I'm thinking the nipple shield may be a good next thing to try. I also gave in and pumped some and let him have that from a bottle which is really scary as I'm afraid he won't latch on after using a bottle. Thanks again for the tips :-)

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  2. You are doing so great Mariena! Your first reaction to feed more often is right on the money. It'll get your supply way up and he'll have plenty of milk to drink. If you wake up in the morning and you're pretty engorged, then you know your supply is increasing :) Also remember that if for whatever reason he's not gaining enough weight or something you can always have the hospital lactation consultant meet with you (or find the LLL chapter near you). Breastfeeding is a journey, you'll get there! So proud of you!

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  3. I'm adding a couple more tips to successful bfing....don't be afraid to ask questions of your experienced mom friends who have nursed, take advantage of the health dept. lactation nurse who will come out to your home for free, and use that nipple shield if needed! (I used it for 5 months. It saved me from excrutiating pain...) Those are the things that worked for me. If not, I would not have been successful at bfing!

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