I’m a new mom, again. This is our third baby in four years, and I’m a pediatrician, so I feel like I have the ‘mom thing’ down pat. Of course, it is never easy dealing with the repetitive and seemingly hourly wake-ups, battling fatigue, hormone fluctuations, and chasing around the older siblings. This I haven’t gotten used to.
For me - and many other moms - the hardest part of having a newborn can be breastfeeding. I think popular culture has lead many to assume you deliver the baby, pop the baby on the boob and it’s all good. Baby feeds well, gains weight and all is right in the world. NOT SO for so many moms, myself included. In my experience at least 90% of new moms have some difficulty with breast-feeding. For me and the many moms I speak with this leads to feelings of failure, inadequacy, and often guilt when formula is introduced. People often don’t speak about their breastfeeding challenges, which only adds to the stigma.
Breastfeeding was the most challenging thing I have ever done - more challenging than residency, fellowships, and exams. Our oldest son was colicky and irritable and wanted milk in large volumes and quickly! My body was hard pressed to produce enough milk let alone keep up with rate at which he wanted it. We tried it all – pumping, not pumping, tube feeding, cup feeding, formula… In the first two months of his life I spent upwards of 15 hours a day preparing to feed, feeding, or cleaning up after a feed, not to mention the every other day visits to the pediatrician’s office for weight checks. It was PAINFUL, EXHAUSTING, STRESSFUL and HARD. No one prepared me for that. But I was obsessed with making it work, and we did. By four months he settled (and was on solids to help fill him up) and I continued to nurse him until he was 13 months old. All good things are worth fighting for, and it became the thing I most valued in my early parenting life.
So what have I learned from this less-than-ideal experience? A whole bunch of tips:
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.
Seek guidance in latching your baby. Many mothers do not find latching baby on to be natural and easy. If baby isn’t latched well, they 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.
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.
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!
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.
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.
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.
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 the extra sleep! As long as weight gain is steady, I think babies should tell you when they want to eat. I don’t wake my son if he is sleeping more than 3 hours. I relax.
Some additional tips:
Drinking and breastfeeding: To have lots of milk for baby you need to drink a lot of fluid yourself. Drinking at least 2 liters a day can make a big difference. I sit with a water bottle beside me and sip throughout breast feeds.
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 okay. Babies like a fast flow and minimal work. Breastfeeding is harder and slower than feeding by bottle. I find babies that get the bottle in the first few weeks of life tend 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.
Natural and prescription treatments: I took fenugreek and blessed thistle pills along with a prescription, Domperidone, for the duration of my breastfeeding time with my eldest. I simply didn’t have enough milk otherwise. Discuss these with your doctor or midwife.
Bottom line: If you decide to breast feed, know you are not alone if you have struggles. There are a lot of things you can do to remedy any difficulties and you are not alone!