We hear a lot about how wonderful breastfeeding is, the health benefits and the bonding. We imagine (well, at least I imagined), this easy and smooth experience. I pictured my baby naturally latching onto my breast and continuing to do so for about a year. But most people face some struggles in the early days: nipple pain, latching issues, birth complications, elimination diets, clogged ducts, structural restrictions, supply issues and more. And then there is the second-guessing: Is he getting enough milk? Do I have an oversupply? Undersupply? Is she getting enough of the fatty hindmilk? Is he gaining enough weight? Rest assured that with time and effort, even the most complicated nursing relationships have a good shot at being successful. Many of the common problems are fixable.
If you go into it without any preparation, education or expectations, there is a decent chance you will be overwhelmed or unprepared. This is not meant to scare you, but just to prepare you so you are not caught off guard.
Here are some breastfeeding lessons I learned and tips that were helpful.
The #1 Rule is: Feed The Baby
More importantly than HOW you feed the baby, is that you FEED the baby. Motherhood is difficult and babies are a lot of work (physically and emotionally), so do what makes you the sanest! Your baby needs to eat and formula is not the devil. You often hear, “breast is best”. But in reality, “fed is best”. The number one rule above all else is to feed your baby. If your breastfeeding struggles are preventing your baby from getting the milk she needs from your breast, feed the baby another way. Pump milk or buy formula and give it to your baby via a syringe or bottle. If you still want to make breastfeeding work, sometimes a tincture of time is needed. During that time, follow these rules given to me by my most favorite IBCLC ever: feed the baby however you can, protect your supply, work on identifying and resolving the problem.
If it becomes too much for you, if you are emotionally struggling, if you are suffering from postpartum depression and this is another weight you do not need on your shoulders… IT IS OKAY TO STOP! You have permission from this internet stranger (me) to not torture yourself. But my advice on this post is for those that really want to breastfeed and feel they are in the right place mentally to work through any struggles.
Set Mini Goals
Breastfeeding is really very difficult at first. A goal of one-year can be very overwhelming when you are struggling to make it through the first week. A friend told me to set mini-goals for myself. For example, say you will do WHATEVER IT TAKES to breastfeed for one month. If you want to continue after the first month, set another goal. My second goal was the end of my maternity leave (3 months), and so on. But the first few weeks can be difficult so if you want to breastfeed, you almost have to tell yourself you will do “whatever it takes” at the beginning, for whatever short period of time you determine.
Don’t Quit On Your Worst Day
If on a good day you still want to quit, it’s totally okay to hang up the towel and switch to formula! But try not to do it on your worst day. One a good day you will have some perspective and be able to make the best decision for yourself. I think that’s a good rule for pretty much anything in life. If and when you do decide to stop breastfeeding, try not to quit cold turkey. That can create other problems so I recommend a gradual process.
Be Patient While You Wait For Your Milk To “Come In”
An exclusively breastfed baby will lose weight between birth and going home. It is totally normal for breastfed babies. Milk typically “comes in” between Days 3-5. Frequent feedings and skin-to-skin contact are key! Put your baby on your breast as often as possible! If you got Pitocin, an epidural or IV fluids during labor, your baby will retain some of those fluids as well and her birth weight will be inflated. The calculated percent of weight lost will be higher than the reality because your baby will be born slightly “heavier”. Some of the weight loss is just self-regulation after all that hydration. My daughter lost 12.5%, my son lost 9.5%. But with both of them, I had many hours of Pitocin, as well as an epidural. They don’t like to see more than 10% weight loss. Many pediatricians will try to get you to supplement with formula if you are getting close to that 10%. They tried with my daughter, but I said I would do whatever to avoid that at first. So, we went back every two days for weight checks until she was over three-weeks-old and had reached her birth weight. It was a pain but I’m glad I didn’t supplement early… not because I’m against formula, but because babies who get the bottle too early often have trouble breastfeeding after that, and giving formula too soon can hurt your breastmilk supply. Having said all that, I want to also say that if you want to give your baby formula because you do not want to breastfeed, GO FOR IT! Do whatever keeps you the most sane. The ideal time to give a baby his or her first bottle of pumped milk is supposedly 4 weeks. If you do it too soon they may struggle with the boob again, if you wait too long they may refuse the bottle. Go to kellymom.com for more.
Meet With a Lactation Consultant Early
An IBCLC (International Board Certified Lactation Consultant) is THE breastfeeding expert. Your insurance should cover you seeing a lactation consultant at the hospital after you give birth. Breastfeeding is usually not easy at first. If you want to have a successful breastfeeding experience, meeting with a consultant is usually important. I didn’t follow my own advice with baby #2. At the hospital, breastfeeding seemed to be going fine, and I had done it before so I thought I was good to go. Soon after, things went downhill and I was too deep in sleep-deprivation and torturous screaming that I didn’t have the energy to find a lactation consultant. Had I met with one at the hospital, they would have caught my son’s lip and tongue ties, we could have had them released much sooner, and it would have saved us some suffering.
Trust Your Gut
Trust your instincts, especially that new mom gut. This is your baby and you do have a say in his or her care. That means you may have to smile and nod your way through a visit to the pediatrician and take what they say home for you to digest with your partner. If they are just giving you vague direction, remember they are generalists and basing that advice on the general population. No one is an expert on YOUR baby. Dr. Ghaheri offered some helpful advice. He said, “Most doctors spend 0% of their residency directly working with lactation consultants. Almost none of the doctors are IBCLCs. If they aren’t IBCLCs, please realize that any breastfeeding advice they’re giving you is likely dogma passed down to them from other doctors who had no training in breastfeeding. The IBCLC is the breastfeeding expert. Period. Do not let your doctor trump what the IBCLC is telling you when it comes to breastfeeding.” Obviously, you should follow any strong medical advice or guidance from a medical professional. I’m just talking about vague direction or advice here. For example, based on my son’s early symptoms, a pediatrician said he likely had a dairy allergy and didn’t appear to have a tongue tie. After eliminating every trace of dairy in my diet for weeks, like I did with my daughter, I learned that didn’t affect him. A second pediatrician said there wasn’t a significant tongue tie and was probably a general intolerance to something dietary. In my gut I know it wasn’t an allergy. Eventually, multiple lactation consultants and a pediatric dentist all diagnosed his tongue and lip tie. Once he had minor surgery to release those, we saw significant improvement in his eating.
Laid-Back and Side-Lying Nursing Are Game Changers
With my second, I was forced to nurse side-lying or laid-back for a few weeks due to my physical recovery. I continued in those positions often because it was so comfortable for me and my baby. Side-lying is especially wonderful for those middle of the night feedings. Do research to make sure you are doing it safely in case you fall asleep. Side note: if you think you will fall asleep, don’t nurse this way!
Eat and Hydrate
You are STARVING during the first few weeks of breastfeeding. Well, actually the entire time, but especially the first few weeks. Be sure to have lots of snacks that you can eat one-handed because sometimes the hunger can’t wait and you’ll need to grab food while holding the baby on your boob. Drink lots of water. You need it to maintain your milk supply.
Ignore the Schedule
So many people will tell you that your newborn should eat every 2 hours, or every 3 hours. Don’t listen to them; listen to your baby! Feed on demand, especially in those first few weeks. I would actually argue that the first couple of months you should try to ignore the schedule — even if you are a person in need of predictability — until your supply regulates. That is for the benefit of keeping your supply on track with your baby’s needs. But it’s important to realize that your baby may not be hungry or thirsty on any sort of regular schedule. Do you only eat or drink every three hours? What if you are thirsty and it has only been an hour since you last had a glass of water? You go have something else to drink! Let your baby do the same! I know that is so much easier said than done. It can be very frustrating having your baby attached to you ALL THE TIME!
If you don’t have a local La Leche League group or another breastfeeding group near you (you probably do), find one online. Facebook, for example, has plenty of breastfeeding groups. A supportive group of women is essential. Breastfeeding moms benefit from talking to each other. At a breastfeeding group, you will meet women struggling with the same things you are, women who you can learn from, and women who can learn from you. I reluctantly went to my first breastfeeding support group. I thought I had everything mostly under control, just had a few questions and expected to feel like most of it was a waste of time. Boy, was I wrong! I ended up going almost weekly for the first year of my son’s life. Search your zip code on International Lactation Consultant Association to find a local IBCLC.
If it Hurts, Seek Help
Discomfort at first can be normal, but it should not be too painful. If it is, meet with a lactation consultant. Don’t wait. She can help with any latching troubles or underlying issues causing the pain.
Some tips to get you through that first week or so of that toe-curling painful nursing:
• Rub an ice cube on your nipple before baby latches, to help numb it a little.
• The first latch is usually the strongest. So, have the nursing session begin on the side that is least sore.
• Nipple creams and cooling gel pads can be helpful.
My Personal Struggles
Like I said, even the most complicated nursing relationships can be successful… if you are prepared and have support! Here are just a few of the struggles I had with my children, and I ended up breastfeeding the first two for the first year (with some formula supplementation), and am currently eight months in to exclusively breastfeeding the third.
Pain • Breastfeeding my daughter was SO PAINFUL! I had ginormous bruises on both nipples and they were bleeding all the time. Fortunately, I had done my research ahead of time and knew this likely a sign of a problem. Within seconds of meeting with a lactation consultant, she identified the problem was with my daughter’s latch. She taught us how to “train” her to latch appropriately. It took a few days but the latch was fixed and the pain was gone! With my son and my second daughter, the pain was caused by a lip and tongue-tie. Once those were released, the latch was no longer painful.
Elimination diet • Two months in, my daughter’s poopy diapers started looking like someone dumped a cup of blood in them. I’m not exaggerating. I said this to the doctor and she seemed to think I was exaggerating. Then my daughter pooped while there and after taking a look she sent us straight to the emergency room. There was so much blood she thought maybe something serious was wrong with her intestines and prepared us for a possible need for blood transfusion. We met with a few specialists and then I started an elimination diet. At first, I cut out all dairy, soy, nuts, eggs, wheat and shellfish. After weeks of slowly phasing ingredients back in, we learned she had a severe allergy to dairy (cow protein) and soy. I couldn’t eat any trace of it or her diaper was bright red. Did you know many english muffins have traces of dairy? I didn’t!
Mastitis • I had mastitis twice with my son. I felt like I was dying. I had a high fever, chills, full-body aches, bright-red painful breasts, and more. Awful! I got it again with my second daughter. I’ve truly never been as sick as I was when I’ve had mastitis.
Supply issues • With my first two babies I had to work very hard to produce just enough milk for my kids. I drank so much water, ate lots of galactagogues and power pumped. By five months I had to supplement with a bottle of formula a day with each of them. There is absolutely nothing wrong with formula, but I was working my butt off to produce enough milk and felt like a failure.
Lip and tongue-ties • This deserves a separate blog post. But in a nutshell, because of my son’s lip and tongue-ties, he was unable to get an efficient latch, he nursed for only a few minutes at a time, but about every twenty minutes, around the clock. He screamed a lot. And by 3-months he started losing weight. I shouldn’t have waited so long to get help with that. Some people claim that lip and tongue ties don’t contribute to major feeding issues. In our case, that is false. Moments after we fixed my son’s ties, he latched correctly and started gaining weight.
Slow weight gain • As I previously mentioned, my babies lost 12.5%, 9.5% and 10% of their weight by the time we left the hospital. I chose not to supplement with formula yet and instead have “Booby Bootcamp” – which basically meant we were constantly doing “skin-to-skin” and I forced my boob in their faces until they got back to their birth weights and the doctors laid off! We had weight checks at our pediatrician every two days until my daughter was over three-weeks-old and had reached her birth weight. It was hard work, but totally worth it for me. So many of my friends gave a bottle in the hospital and the baby never went back to the breast again. Some chose to no longer breastfeed and some exclusively pumped. I really didn’t want to risk that happening to us so I did everything possible to avoid a bottle before four-weeks-old.
Forceful letdown • With my third, I started off with a very forceful letdown. She would gag, cough, spit up, and get very gassy. I worked with a lactation consultant to figure out the best position to breastfeed (leaning back into a reclined position, so gravity would help decrease some of the force). She also said in any given day, I should not pump more than 2 ounces more than my baby will drink in that day. This helps prevent an oversupply, and with an oversupply often comes a forceful letdown.
Check out my list of Breastfeeding Essentials
A great gift idea for a breastfeeding mom is a breastfeeding basket: