[Written by Kristin Lloyd, Photo: Max at 3 months, Copyright by Guenter Knop 2010]
When our son was born I knew that I planned to breastfeed, but I never anticipated what an incredibly fulfilling experience it would be, or how long we would end up nursing. Looking at his delicate features and tiny body, I was constantly filled with the desire to protect him and give him the best of everything. Knowing that breastmilk is the purest food I could offer him, and experiencing the complete satisfaction and comfort it brought the both of us, I quickly converted to a co-sleeping, feeding-on-demand, solid-delaying, full-term breastfeeding mom. I'm happy to say that after 17 months I am still nursing. I never had to give him a sip of formula, and we are still loving every minute of it. Below is a summary of some of the things I've learned so far, from the basics to baby-led weaning. Hopefully it will help answer some of your questions and help to guide you on this special journey.
Before Delivery
Starting Out
Latching On
Nursing Pillows & Positions
Nursing at Night
Increasing Your Milk Supply
Returning to Work
Breastfeeding in Public
Delaying Solids
Full-Term Breasfeeding, Child-Led Weaning, and Night Weaning
During the last few months of pregnancy, take some time to read about breastfeeding so that you will know what to expect. The La Leche League website is a great resource. You can also search for a La Leche League chapter near you for assistance in person. It is a good idea to have contact info for a lactation consultant on hand before you go into labor. That way if you encounter feeding problems once your baby arrives you will be prepared.
During pregnancy and for a few days after, your breasts are filled with a sticky clear yellowish liquid called colostrum. Colostrum is a nutrient dense early milk that is extremely valuable for your newborn. It is packed with antibodies that will help protect your newborn from disease. Although you will only produce a few teaspoons of colostrum before your mature milk arrives, it is a custom made perfect first food for your baby.
It is important to nurse your baby as soon as possible during the first hour after birth. Not only is it relaxing and comforting for you and your baby, it will stimulate the release of oxytocin which causes the uterus to contract, pushing the placenta out and eventually returning the uterus to its original size. Shortly after birth, gently introduce the baby to the breast. Don't be surprised if you see a pattern of pauses between suckling. This is normal during the first few weeks. Some babies will latch right on, while others require more time and assistance to get the hang of things.
Most hospitals and birth centers provide lactation support, including on-staff lactation consultants and breastfeeding classes that you can drop into during your postpartum stay. They will teach you and your baby proper latching on and positioning and can help you to overcome obstacles such as inverted or sore nipples.
In the beginning breastfeeding can be overwhelming. In the first couple of weeks you may find that baby wants to nurse every 40 minutes. Feedings may even be back to back or overlapping, but feeding on demand is the preferred method for many families because it helps to establish your milk supply and relieves you of the impossible task of trying to set a schedule with a newborn. The frequency, combined with nipple pain, and sleep deprivation can make nursing a challenge in the beginning, however by month 2 or 3 feedings will decrease, nipple soreness will subside and you and baby will likely hit your nursing stride.
A few days after birth, when your mature milk comes in you may experience engorgement. There are a number of engorgement remedies, but you may also find (like me) that it comes and goes without much to do. In addition to frequent nursing, while you establish your milk supply it can be helpful to have a manual or electric breast pump on hand to relieve engorgement pressure and begin a stash of frozen milk. It can also be nice to pump a bottle so that dad can feed baby while you take a much needed shower break!
[Photo by Guenter Knop]
To achieve the proper latch, brush your baby's cheek with your nipple and wait for him to open wide. Then quickly pull him towards the nipple so that his mouth covers as much of the center and bottom section of the nipple as possible. When he is positioned properly, his top and bottom lip should be turned out. If he is improperly latched on or you need to break the latch for any reason, insert a finger at the side of his mouth to break the suction and then reposition him. If you are having trouble achieving the proper latch, following baby's cues can help decipher the problem. My son had no problem latching onto the left, but could not latch onto the right. It turned out that although it looked normal, my right nipple was slightly inverted and needed one session with an electric pump to get things going.
During the first few weeks, while your nipples adjust to their new role, it is normal to experience intense discomfort during the latch on and for 2 or so minutes after. If the "seeing stars" part of the discomfort continues beyond 2 minutes, contact a lactation consultant for help with latching techniques or to diagnose problems such as thrush or mastitis. While baby is latching on it can help to take sips of ice water as a sensory distraction or practice some of the deep breathing you learned in your child-birthing classes. It also helps to apply nipple cream after each feeding. Nipple cream soothes, sore cracked nipples and provides a nice layer of lubrication for the next feeding. My favorite is First Years Lanolin Free Nipple Butter which is made from shea butter, olive oil, and other edible organic ingredients. It also helped me to remember that it's normal and temporary. Eventually latch on pain should completely subside. For me it took about 5 weeks.
Many a baby gear item will lay around unused until it is shuffled off to charity or an expecting friend. A nursing pillow however is not one of them. My nursing pillow from My Brest Friend, could not have had a more appropriate name! Until my son grew too long for it (at 6 or 7 months) I wore it day and night. It is a firm pillow that provides back support and attaches around your waist to help you carry baby as you nurse. You might think, as I did, "Why on earth would I try to walk around while nursing?" But trust me, you will be nursing A LOT and you will definitely find yourself needing to do other things at the same time.
Though you may find nursing to be a bit awkward at first, like anything you do 10 times a day, it will soon become effortless. Experiment with different positions until you find the ones that suit you and your baby best. The traditional cradle hold is most common. It allows you a free hand for other tasks, like reading, typing or sipping water. Then there is the football hold which, when alternated with cradle hold, helps vary the angle of friction on the nipple, which can help prevent cracking and soreness. Lastly but not least is the side-lying position which is a favorite of tired moms or moms recovering from a c-section. Whichever position you try it is important to make sure baby's neck is straight and in line with his back and torso. A crooked neck can be uncomfortable for baby and can put additional pressure on your nipple.
We've found that the best way for us all to have a pleasant night is to have baby bedshare or at the very least sleep in a co-sleeper basinet. That way you can nurse baby in the side lying position as soon as he wakes, before his whimpers turn to screams that wake up the whole house. And mom can remain in bed and return to sleep quickly. Safely bedsharing with a small baby requires a few adjustments, including switching to a firm mattress, removing blankets and pillows, and using a night light to keep an eye on baby's positioning. If you do choose to co-sleep, please follow these safe co-sleeping recommendations.
Many women experience a dip in their milk supply, sometimes in the beginning and often around three months postpartum. Generally baby will increase your milk supply naturally by nursing frequently or even back to back but if you feel your supply is not enough for baby, there are several things you can do to increase it. Whenever I felt the need to increase my milk supply I followed all of the suggestions below and have been able to avoid any supplementation with formula.
Pump & Nurse as frequently as possible. Set aside two or three days in which you nurse or pump every 30-60 minutes. Gently massage your breast, sliding your fingers gently towards the nipple, towards the end of each nursing or pumping session. This will help empty the breast more completely and stimulate production.
Drink Water day and night. Make sure to drink 8-10 glasses of water a day. If you find it hard to drink that much water in a day, it helps to mix a few tablespoons of unsweetened juice into each glass for flavor. But don't go overboard because to much sugar, even fruit sugar, can be dehydrating. And don't drink more than 8-10 glasses of water each day since too much water can also have an adverse effect on your milk supply.
Eat Well and continue to take your prenatal vitamins while you are nursing. My favorite food-based organic prenatal vitamin is New Chapter Organic's Perfect Prenatal which is sold at Whole Foods. In addition to your prenatal, you can take an algae-based DHA supplement such as Spectrum's Prenatal DHA, also available at Whole Foods. Make sure that your diet contains rich sources of calcium (yogurt, spinach, kale, cow or goat milk, fortified soy milk, cheese and blackstrap molasses) and protein (salmon, lean chicken and turkey, lentils, beans, and quinoa). Also keep in mind that nursing moms burn through an extra 500 calories a day, so make sure to snack nutritiously between meals, especially once you have shed any leftover pregnancy weight.
Drink Nursing Tea containing fenugreek, Nettle, lavender and other herbs that promote relaxation and stimulate milk production. I use Yogi's Nursing Support. If you drink a cup or two in the evening, you may find that morning brings an extra few ounces of milk.
Rest may be the toughest item to conquer on your to do list when you have a new baby. But even when you can't get more than an hour or two of sleep at a time, try to take 10 minutes a day to lie down, calm your mind and take some deep breaths. Just a few minutes of relaxation can send your body the message that "all is okay" and the resulting decrease in stress will have a positive impact on milk production.
Working away from your baby can present difficulties on many levels, but with a little patience, perseverance and a good electric breast pump, you will likely find that your career and your commitment to breastfeed can peacefully coexist. Continuing to breastfeed once you have returned to work is a special way to stay connected to your baby when you are apart.
If you will be away from your baby for more than four hours at a time each day, you will need an electric breast pump. Electric breast pumps are designed to extract all of the milk in your breasts in a short period of time which makes it easier to mix pumping into a hectic workday. Like baby, it takes an electric pump only 10-15 minutes to empty the breast completely. Besides beside being fast, an electric pump is a must for a working mom because it produces a suction that is strong enough to mimic baby's suck, which is imperative for the continued stimulation of milk production. Studies also show that double pumping (pumping both breast simultaneously) increases prolactin levels and stimulates milk production, moreso than pumping one breast at a time.
I've had great success with the Medela InStyle. It empties both breasts within 15 minutes and it is easy to disassemble to clean between pumping sessions. After pumping, wash all of the parts in hot water, while allowing the pump to run (to clear out condensation inside of the tubes). Then wrap the washed parts loosely in a paper towel and stash them inside the pump bag for the next session. The pump comes with a cooling pack in which you can store the milk for several hours if you do not have fridge access at work.
Freezing milk destroys some of its immune properties, so its best if you can give baby milk you pumped the previous day that has only been refrigerated, and save the frozen milk for emergencies. Find out how many ounces your baby drinks a day. Try to pump that amount or more each day and refrigerate it for the following day. In this way you can avoid ever having to give him frozen milk.
It is a good idea to pump every 3 hours to encourage milk production. Try to pump at the same times each day. This way your body will anticipate these "feedings" and ready milk for the occasion. If you do not have a private office or ladies lounge, you can pump in an empty conference room, a restroom, (or in my case the HVAC room!) The bathroom may feel like a last resort but it is actually fairly manageable. Most pumps come in their own backpack or shoulder bag which you can hang on the back of a stall door. The milk goes straight from your nipple into the bottle, so you can avoid germ contamination.
Keep a picture of your baby in the pocket of your pump bag. Looking at the picture each time you pump is not only a welcome vacation in the middle of your day, it will help you remember to focus on what's most important and will help stimulate your milk letdown.
If you can visit your little one's daycare or arrange for your babysitter or spouse to bring the baby to you for a lunchtime feeding, I highly recommend it. This valuable time spent refocusing on your little one will help the second half of the day go faster and it will eliminate one pumping session.
"Breastfeeding is the most elemental form of parental care. It is a communion between mother and child that, like marriage, is intimate to the degree of being sacred," Griswold v. Connecticut, 381 U.S. at 486, 85 S. Ct. at 1682, 14 L. Ed. 2d at 516
In many countries a mother does not think twice about breastfeeding her child openly in public. Unfortunately, in the United States many women encounter (or fear they will encounter) disapproving glances, oglers or, worst of all, attempts at disciplinary action. First, know that breastfeeding in public is legal in every state in the union. When it comes to looks of disdain or ogling, I handle it in the same way I handle most uneducated idiots and that is by simply ignore them.
Most states have specific laws detailing a woman's right to breastfeed in public and protecting her from any indecent exposure laws. If some unfortunate person asks you to stop feeding your child, kindly direct them to your state's legislation on the subject.
That said, I've nursed my son on trains, escalators, subway platforms, in checkout lines and upscale restaurants and no one ever even once said anything (aside from an enthusiastic "Breast is best!" from a Babies R Us employee). I had always pictured nursing exclusively in a rocking chair in a dimly lit room while singing a gentle lullaby, but in reality baby gets hungry in banks, grocery stores, and pretty much anywhere else you can imagine! And as baby's cries turn from whiney to desperate and those tiny hands begin to frantically grab at your shirt, any inhibitions you may have had about nursing in public will likely fizzle.
In terms of "equipment", since I like to wear different types of tops, which are not always suited for discreet nursing, I always carry a large wrap from Aden + Anais, which provides plenty of coverage and can also be used as an impromptu picnic blanket or to keep baby (and mom!) warm.
The American Association of Pediatrics, UNICEF, and World Health Organization all agree that babies should be exclusively breastfed for the first 6 months of life. Prior to 6 months, and for some, prior to 8 or 9 months, your baby's digestive tract will not be ready to handle the introduction of solid foods.
I felt six months was too early to introduce solids and my son seemed to agree. So after a couple failed attempts to get him excited about fortified rice cereal I read an article or two and opted to delay solids until around 8 months.
In addition to helping prevent the development of certain food allergies, according to a 1995 study by Pisacane, delaying solids until 7 months actually reduced the risk of anemia, when compared to babies who had received iron supplementation prior to seven months. The researchers concluded that early iron supplementation reduced the efficacy of baby's iron absorption, and that children exclusively breastfed for 7 months maintained normal hemoglobin levels. The amount of iron in breast milk may be smaller than that found in supplements, but it is has a 49% absorption rate as opposed to the 4% in fortified formula.
Once solids are introduced they should simply compliment breast milk, which should remain the main source of calories and nutrients. From about one year on, breast milk takes on the complimentary role, and solids takeover the role of providing the bulk of nutrients and calories.
Full-Term Breastfeeding, Child-Led Weaning, and Night Weaning
Click here to read about our experience with breastfeeding beyond one year, baby-led weaning, and night weaning.
