I often tell patients that breastfeeding was the most challenging thing I have ever done -- more challenging than residency, fellowships and exams. My oldest son was colicky and irritable and wanted milk in large volumes and quickly! My body was hard-pressed to keep up. It was a struggle initially but we persisted and it became the thing I most valued in my early parenting life.
Starting out right ensures that breastfeeding is a pleasant experience for you and your baby. People often don't speak about their breastfeeding challenges, which only adds to the stigma. In my clinical experience, about 90 per cent of women have some difficulty with breastfeeding. Many of these issues are easily remedied, and some require months of work. But at the end of the day, if you can make it work, it will be immeasurably valuable for both of you.
Skin to skin: Try to place baby at the breast as soon as you are able after delivery. Delay can hamper feeding. Keeping the baby near the breast often may mitigate some breastfeeding issues.
Latch: Seek guidance in latching your baby. Many mothers do not find latching the baby on to be natural and easy. If baby isn't latched well, he will not be able to transfer milk well, and your body will not respond by making more milk. This downward spiral is the reason many women feel they are unable to breastfeed. If you are having lots of nipple pain when feeding, please ask a lactation consultant or physician to examine your latch.
Supply and demand: The more milk that comes out, the more milk you'll produce. How to increase milk supply? Feed! Your body should make enough milk to feed your baby. Trust in that. If you are concerned that you don't have enough, you can try pumping or hand expressing after feeds. This will stimulate a greater supply.
Compress: I recommend that moms compress the breast when baby stops sucking to stimulate the baby to start sucking again. This also seems to calm babies like mine that want it fast!
Breast milk pump use: As I mentioned above, the more milk that comes out, the more milk you will likely produce. Some women respond well to pumping after each breastfeed to increase supply. However, if this decreases how much you have available for baby at the next feed, hold off.
Feed on one breast fully, then switch: Personally I recommend that moms fully drain one breast before offering the other. One breast is the meal and the other is dessert. By completely draining one breast the body will make more milk to refill this breast.
Stop timing feeds: Many parents watch the clock and assume that by 15 or 30 or 45 minutes the baby should be full. Some babies who feed vigorously and with an excellent latch are full in 10 minutes, others take an hour. The trick is to watch how the baby is sucking. What I look for is strong suck, suck, suck, suck, ... pause. This is the baby stimulating the let down and then pausing to swallow. If the baby is merely softly sucking with no pausing, they are likely pacifying and getting no milk transfer.
Feed eight-10 times a day to start: Some babies need more feeds, some less, but this is a good starting point. If your baby wants to feed more during the day, and less at night, and they are gaining weight well, then I'd take it! As long as weight gain is steady, I think babies should tell you when they want to eat.
Drinking and breastfeeding: To have lots of milk for baby you need to drink a lot of fluid yourself. Drinking at least two litres a day can make a big difference. I would sit with a water bottle beside me and sip throughout feeds as well.
Avoid artificial nipples early on: Once babies are stable at the breast and gaining a consistent amount of weight, artificial nipples (bottle, soother) can be OK. Babies like a fast flow and minimal work. Breastfeeding is harder and often slower than feeding by bottle. I find babies that get the bottle early start to get frustrated by the slower flow of milk from the breast. If baby requires supplementation, I suggest using a lactation aid (essentially a straw at the breast, where baby gets pumped milk or formula as supplement, while also breastfeeding, thus stimulating the breast to make more milk), cup or syringe.
What to eat when breastfeeding: Some lactation consultants swear by Guinness beer and oatmeal. There is some evidence that these may help increase your supply. Oatmeal you can eat any time of the day, though the beer I would save for after a feed, as drinking alcohol when breastfeeding should be limited to at least an hour before a feeding.
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Dr. Ann Borders, an OB-GYN who works with NorthShore University HealthSystem, recommends that her patients and their partners go to a breastfeeding class before Baby is born. In class, they don't just focus on why breastfeeding matters, but what you can actually expect in those daunting first few days. And Borders doesn't just recommend this for newbie families, but also moms who may have tried breastfeeding before and found it difficult.
"You're not going to know everything from taking the class, but it gives you a groundwork that you can build on at the hospital once you have the nurses helping you," Borders said.
Most OB-GYNs will be able to give you a referral to a breastfeeding class nearby, but if for some reason yours doesn't have any suggestions, a quick online search should bring up options in your area.
When you're in the hospital or birthing center, or while you've still got your midwife with you after a home birth, make sure you speak up and ask for help getting started.
"Every health care person should know the basic mechanics of breastfeeding," said Mary Ryngaert, a board certified lactation consultant with the University of Florida's Center for Breastfeeding and Newborns. "I joke that the person who empties the trash [in labor and delivery] should be able to help someone latch on."
Even Borders, whose professional life and research centers around breastfeeding, said that when her first baby was born, she had to ask for guidance. Women should feel 100 percent empowered to ask their care provider to help them start breastfeeding within the first hour after a vaginal birth or two hours after a C-section if the circumstances allow for it, she said. Don't leave the hospital until you've gotten the help you need.
There's a reason why hospitals hoping to earn the coveted "baby friendly"
designation for breastfeeding support stress the importance of skin-to-skin: It works. Research shows that essential contact helps relax both the mom and baby, stimulates feeding behaviors and triggers the release of certain hormones that spur breastfeeding. Experts say it's important to do it both early -- ideally right after birth -- and often.
"Keeping the baby skin-to-skin as much as possible in the early days after birth is very important," Ryngaert said. "If the mother is 'touched out,' then the partner can hold the baby skin-to-skin. It still helps the baby move instinctually to what [he or she] is supposed to do."
If you're not in a "baby friendly" hospital with policies in place to promote skin-to-skin, don't be discouraged. Tell your doctors and nurses that it's important to you, Borders said. As long as your baby is stable, there's no reason why they shouldn't let you hold him or her close.
Engorgement, or a feeling of heavy fullness in the breasts that can be very painful, is common several days after delivery, but Borders said a lot of women don't know to expect it because no one talks to them about it. Having a game plan in place can help curb the pain and keep women from throwing in the towel when they're sore and freaked out.
She suggests an over-the-counter pain medication, like Motrin, and ice. Two bags of frozen peas can also work, Borders said, and -- bonus! -- they tend to fit nicely into nursing bras. Some women may also want to take a hot shower to express some of their milk.
Susan Burger, president of the New York Lactation Consultant Association, finds few things as irksome as telling women that they need to try specific holds. Moms hear those tips and get "all twisted up with finding the perfect position," she said.
What matters most in her book is that breastfeeding mothers get comfortable, which often means leaning back a bit and putting their feet up. "If she's comfortable, it's so much easier to get the baby into a comfortable position," Burger explained. This is one area where partners can really step in, looking at moms to spot any ways in which they might be uncomfortable, then helping by giving them a pillow, a shoulder rub ... whatever.
Your partner, or your mom or friend can also help by agreeing to sit with you while you breastfeed. Why? Since moms are often extremely relaxed and drowsy while they're breast-feeding, your partner can agree to be on "alert" -- maybe quietly reading a book or checking e-mails -- while you get some sleep. "Invite her to take a cat nap while breast-feeding," Ryngaert said.
It may sound like a simple trick, but Ryngaert said it's such an easy, often-overlooked way for women to fully relax while breast-feeding, which only increases bonding and enjoyment, and also, possibly, catch up on some much-needed sleep.
Drop your mouth down to your chest, then open your mouth. A bit tricky, no? Now tilt your head back slightly and open it again. See how much easier that is? Burger said that one of the biggest ways to help babies drink is to make sure their heads are tilted back a bit. You can help support them in that position by putting a forearm under the baby's neck, or even a rolled-up receiving blanket.
"There are a lot of different ways to achieve it," she said.
While experts may not poo-poo specific holds, at least ones a professional hasn't personally recommended for you and your baby, they do offer broader positioning advice: "I like to see the baby and mother have almost no space between them," Ryngaert said.
"You're not just putting your breast in their mouth, you're really bringing your bodies together," she said. That helps babies bring a big, wide open mouth to the breast, giving them the deep attachment that they need. If you're not sure what that means, a good first place to look is the internet: There are videos online that demonstrate the concept, Ryngaert said, and places like La Leche League
have helpful illustrations as well.
Burger said that one of the mistakes women can make is to focus too much on duration and not enough on the frequency of pumping. Often they're too hard on themselves, sitting there for long stretches and pumping away in an attempt to produce more milk, when really, they'd be better served by just a few minutes here and there throughout the day.
Burger likened it to training for a marathon: "You wouldn't just go out and run 13 miles," she said. "If you're just starting out, you'd try a mile or two and do that three or four times a week. That's a much better approach." In the same vein, if you can work it into your schedule, frequent, brief bouts of pumping help build milk supply better than sitting there, rather helplessly, and pumping for one long stretch.
Borders said that women shouldn't just write off sore nipples -- which can sometimes become so bad they don't want to breast-feed at all. She recommends something called Newman's all-purpose ointment, which your pharmacist can mix for you. For women who don't have thrush (a generally harmless yeast infection) La Leche League also recommends
applying freshly expressed breast milk to your nipples, which can help them heal. The bottom line? If your nipples hurt, don't just accept it. Talk to your doctor about what might be causing it and what you can do.
"Make sure you leave the hospital with the number for someone you can call with questions," Borders said. Many pediatricians offices now have lactation consultants on staff, which makes it easier for women to find someone who can offer guidance when you're they're in for one of those many new baby visits that happen after birth.
In many cases, lactation consultants are covered by insurance, Ryngaert said, but places like La Leche League also have a call system where you can speak to someone for free
. Many nurses and pediatricians are also board certified lactation consultants, which can help with insurance coverage.
Women shouldn't feel pressure to figure everything out in the first week, Ryngaert said. "If a baby needs to go on formula for a time while the mother's milk supply is being established, that doesn't mean the baby's not going to be breastfed," she added. "I've seen babies that didn't latch on until eight weeks."
But new moms should never, ever hesitate to ask for help.
"If a mother is having more than a little tenderness, she should not just tough it out. She should get some help" Burger said. "And if that person says, 'Oh, it's normal, suck it up,' that's not a good person to get help from, and they should see someone else."