Breastfeeding 101
The most common questions I get from new moms are about BREASTFEEDING. In all capitals because it really is a big deal. And it’s hard. We are told that it comes easily and naturally and that it shouldn’t hurt. When, in fact, it doesn’t always come easily and it OFTEN hurts in the beginning. None of those things mean you will not have a successful breastfeeding relationship with your baby -- meaning that you will breastfeed your child for as long as it works for you.
Since, let’s not forget, breastfeeding has to work for the dyad -- meaning the two people involved: the baby and the breastfeeding parent. So, if it’s not the best route for you (which could even be because you don’t want to do it), then it doesn’t work for the dyad! Some new moms feel pressured into breastfeeding and “less than” if they decide that breastfeeding isn’t the best route for them. Breastmilk is 100% the best food for babies. But that does NOT mean you have to sacrifice your well-being to provide it. You get to make that informed decision because -- guess what -- you matter too!
That being said, breastfeeding can be an incredibly nourishing, bonding, beautiful experience that can last years (if you want it to), and running into obstacles or difficulties early on does not mean you won’t get to have the breastfeeding relationship you want. Most women run into difficulties breastfeeding, since, though it is definitely natural, it doesn’t come naturally when we haven’t grown up surrounded by the totally normal sight of breastfeeding. In this country, breastfeeding is often hidden in bedrooms, under covers and just generally out of the line of vision and full acceptance. Which is one of the reasons that normalizing breastfeeding really is impactful and important.
Additionally, we are just in our heads so much of the time and for so much of our lives that it can be a real challenge to get into our bodies, which is what breastfeeding requires. “Overthinking” can be a real obstacle to getting into the flow of things (pun intended).
Addressing all early breastfeeding challenges would fill an entire textbook, so I’ll just share the information that I have found to be the most helpful and supportive when I work with new parents.
The golden hour (the first hour after childbirth): Get baby skin to skin and to breast as early as it is safely possible to do so after birth. Don’t stress if it doesn’t or can’t happen, for whatever reason, but do take advantage of this special time, if it is available to you. What you do is simple: get that baby up onto your chest, skin to skin, for as long as you are able and that the situation allows. Put the baby to breast and let them suckle, and then switch breasts. Your ob/gyn, midwife, doula, or lactation consultant are the ideal people to help get you latched, since it is far from intuitive or obvious for most of us at the beginning. (Later, you’ll be able to do it with your eyes closed -- literally. And even farther down the line, the baby will be pulling you to them and be doing all the work!).
A particularly amazing way to do this, if your situation allows, is to allow the baby to crawl to the breast (“the breast crawl”). This provides a real sensory experience for them (and for you!), as they use their sight, smell, touch, hearing, and even taste to find your breasts. What a miracle it all is!
Lactation consultants: Work with the lactation consultant in the hospital as much as you can, and get their contact info for follow up! Ask your friends if they have any lactation consultants they love, and get their phone numbers, too. Some hospital-based lactation consultants don’t do home visits, but some do. Know who you can go to for help when you need it.
Pacifiers: don’t use pacifiers, if at all possible. Not only can you miss your baby’s feeding cues, but baby’s suck is “wasted” on the pacifier nipple, instead of used as stimulation for your milk production! Once breastfeeding and milk supply are well-established, pacifiers are usually ok, but often parents find that their babies don’t need or want them when they’re not introduced in the early newborn period.
Bottles: try not to introduce bottles until baby is 4-6 weeks old. That doesn’t mean you can’t supplement, if necessary, but using a cup (like a little medicine cup) or syringe (like a medicine syringe) to deliver the supplemental breastmilk or formula is preferred. Many people prefer using cups and tipping it to baby’s mouth to allow them to sip “like a tiny kitten,” as a lactation consultant I worked with used to say. (If you haven’t spent much time with lactation consultants before, please do -- they are wonderful human beings!)
Paced bottle feeding: Once you do start using a bottle, use paced bottle feeding, which is sitting the baby up and holding the bottle horizontally to their mouth. This means they will be having to feed (suck) actively in order to get milk, as opposed to passively getting milk, when a bottle is upside down and just pouring into their mouth. In this period, swallowing is a reflex, meaning they will swallow whatever amount of milk you put in their mouth. Meaning that they’re swallowing the milk not because they’re hungry, but just because it’s there.
With paced bottle feeding, they stop eating when they are full. Don’t push them to finish their bottle; let them pace themselves. Feeding “firehose style,” as I like to call it (feeding a baby who is lying down with a bottle that is turned upside down) can sometimes cause babies to prefer bottle feeding to breastfeeding, since they get used to that constant flow, which is not reflective of the flow of breastfeeding. Milk flow from the breast stops and starts and gets stronger and weaker at times. Additionally, use a slow flow nipple and take care to burp baby more often when using paced feeding, as babies sometimes may swallow more air with this technique. You also may have to fill the bottle up more to make sure milk gets to the nipple in this position. But again, don’t push baby to finish the bottle! Watch the baby, not the bottle!
Breast compressions: We sometimes find that baby is “lazy” at the breast, which is not exactly true. Babies aren’t lazy; they just respond to milk flow, so when flow is slower (very common early in breastfeeding), they stop sucking or even fall asleep. One way to help increase flow is to literally grab your breast as close to your body (chest wall) as you can and squeeze it gently (gently!!!!) as you move your hand about halfway to your areola (the dark circular area around your nipple). Then, still squeezing gently, move your hand from that point out near your nipple. You’re literally pushing your milk out towards the nipple. Stop doing the compressions once baby starts sucking.
Sometimes massaging or warming the breast (in a warm shower or with a heating pad) prior to nursing can also help get things moving.
Stimulate a baby who is sleepy during feeds: Another thing that happens frequently is that baby is very sleepy during feeds. The answer to this: wake them up!
-Set yourself up for success by awakening them during REM sleep vs a deeper sleep cycle. You’ll know it’s REM because their mouth, eyes, and fingers and toes may twitch and move (vs the more motionless-ness of deeper sleep cycles).
-Change their diaper upon awakening them.
-Get them completely naked (except for the diaper -- you don’t need any of those kinds of surprises during your feeding session!) and take YOUR shirt off too (it’s probably off already anyway, if you are like most breastfeeding moms in the early weeks after birth).The skin to skin with you can help baby stay alert and awake.
-Tickle baby’s palms and soles, rub their head with a cool compress or wet wipe, put on some loud music, get into the sunshine, talk to them, sing to them, do whatever you can to keep them alert.
-You can also switch breasts as soon as baby starts to get less active on the breast (“switch nursing”). Give them a burp or a back rub in between to shake things up that way as well.
-Use a position that is less cuddly, laid-back and relaxing to optimize alertness. So, instead of cross cradle, where they are nestled against you, you could try football/rugby hold, where baby is more exposed to air, and their body is more straight, instead of curled up and snuggled against you.
Other ways to help baby suck is to
-take a deep breath (the movement can make the baby suck again)
-stroke underneath baby’s chin (from chin to Adam’s apple)
Take care of your nipples! Lanolin cream is amazing, but it does stain clothes and sheets etc. Other (non-lanolin) nipple creams, as well as lanolin “soothies” or even silver nursing cups can help soothe sore nipples. Nipple soreness does not mean you are doing it wrong! It just means your breasts are adjusting not only to their new role but also the hormones coursing through your body. Nipple soreness can last 6-8 weeks after birth , although many people report it goes away much earlier than that. Once nipple soreness does resolve, many people report it goes away “overnight,” and further breastfeeding doesn’t cause any discomfort at all. So don’t despair; it will definitely get much better very soon!
Breastfeeding takes time, and it takes support. So please be gentle and understanding with yourself, and take advantage of any support you have.
With time, patience, and the right advice, breastfeeding really will be like second nature.