1. Breastfeeding is natural, but it doesn’t come naturally! Somewhere along the way moms have gotten the notion that just because breastfeeding is very natural (it’s the way a baby is supposed to be fed), it will be easy from … Continue reading
It makes me sad to read articles/blog posts asking, “Are Baby-Friendly hospitals actually unfriendly?”. I’ve read the comments to these articles and it simply breaks my heart that moms go home from a supposed Baby-Friendly hospital with bad experiences. My hospital became designated a year ago and by following the “rules” (the 10 Steps to Successful Breastfeeding) of the Baby-Friendly Hospital Initiative, this is how we do things:
EDUCATION: Moms simply need to make an INFORMED choice about breastfeeding, supplementing, skin-to-skin, rooming-in, pacifier use, etc. It’s not about MAKING a mom follow these guidelines or steps, it’s about telling them the research-based information that backs them. Then, with this information, mom can make the decision that’s best for her. The nurse then has to DOCUMENT the education that mom received and what her decision was.
SUPPORT: All of the nurses are educated and trained to help moms with basic breastfeeding issues and we are all on “the same page”, giving the same information. In addition, our policies are written to break down the barriers that sabotage a good start to breastfeeding and bonding, such as baby going to the nursery right after delivery, baby routinely taken to the nursery at night, etc.
ENCOURAGEMENT: Simple cheerleading, listening, praising. Sometimes all mom needs to hear from the LC or nurse (who are often viewed as the absolute expert) is, “You are doing great! I’m so proud of you.”
Somewhere along the way some hospitals have gotten lost in the rules (The 10 Steps) and forgotten that all moms/babies are different. Our job is to educate… Not MAKE someone do what we want. Again, it’s about giving mom the correct, up-to-date, research-based information that she needs to make an informed choice. The Baby-Friendly surveyors actually interview the moms who are there at the time, as well as moms who have been discharged. They can tell whether or not the staff has adequately educated and encouraged the recommended practices.
I’m also VERY adamant that our staff presents information in a non-judgemental manner. Moms are under enough pressure in this society – we don’t need to contribute to feelings of unworthiness and guilt. Interestingly enough, Baby-Friendly focuses on mother/infant bonding (STS and rooming-in) and INFANT FEEDING … As in, breast AND formula feeding. We educate moms about breastfeeding (no, it shouldn’t hurt, yes, you can make enough milk for twins, yes, you can feed while taking that medication, yes, it’s possible to continue after going back to work…..) and if their decision is not to breastfeed, then we have to educate them on bottle feeding per cues, not the clock, feeding appropriate amounts and how to properly prepare it. So, the bottom line is BABY- FRIENDLY isn’t unfriendly, but some of the hospitals are unfriendly in how they execute the program.
“While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby.” ~Amy Spangler
Four Steps to Achieving a Good Latch
As a hospital-based lactation consultant, my days are filled with teaching, supporting and encouraging new moms about breastfeeding. While there is so much to be taught, the latch is the MOST important, and probably the most difficult, thing to achieve. Many babies latch great and never look back. If yours did, then stop reading. You don’t need to know this. For the rest of you, read on.
So, how many of YOUR friends and family have negative breastfeeding reviews because they had cracked, bleeding nipples? The number one reason for this is a narrow latch. Period. We need to remember that breastfeeding is learned. Natural? Yes. But, so is crawling, walking, talking … and these, too, have to be learned. Asking for help is key.
Through the ten-plus years I’ve been in this particular role, I’ve tweaked, molded and shaped my latch instruction into a lesson that is well received and well understood by moms and their families. (You have no idea how many dads I’ve crowned junior lactation consultants! They GET this. So have dad read this, too!) The only thing missing is my hands-on presence. I’ve attached some video clips to hopefully close that gap, somewhat.
Step 1: POSITIONING
Positioning is very important. Hold your baby in whatever position is comfortable for YOU. There is no wrong way, but you need to be comfortable and relaxed. Starting out, I find that moms have the most success with either the cross-cradle hold or the football hold. BUT, however you hold your baby, she should be facing the breast. Your baby should not be turning her head to latch. We eat with our food in front of us, right? So should your baby.
Step 2: NOSE-TO-NIPPLE
This is also about positioning. Once your baby is positioned facing you, then you need to make sure that your baby is lying so that her NOSE, not her mouth, is touching your nipple. She should be looking straight ahead at your breast and you need to line her up so that your nipple is touching her nose. This will make it so that she has to reach UP to latch. When any of us look up slightly, we can open our mouths REALLY WIDE. If we look down slightly, that’s cut in half. Try it now and you will see what I mean.
Besides allowing for a wide latch, nose-to-nipple positioning also allows for the nipple to be aimed at, and land on, the roof of the mouth when baby opens wide and latches. I like to say that there’s a “button” or a “sensitive spot” on the roof of the baby’s mouth. If you were to put a finger (clean, of course) in your baby’s mouth and softly rest the pad of your finger on the roof of the mouth, she would close up and start sucking. It’s a reflex that babies are born with. Sometimes you may see your baby shaking her head back and forth when she’s trying to latch …. She’s looking for the “button” to be pushed. So reposition her so that she’s nose-to-nipple and have her reach up. This way the nipple will be pointing to the roof and will touch it once she latches – causing her to suck.
One other benefit of nose-to-nipple positioning ….. once baby is latched and feeding, you will notice that the nose is not buried in the breast. If you are having to hold your breast down so that her nose isn’t covered, you didn’t start out nose-to-nipple. Her nose may be touching the breast, but shouldn’t be buried. This would mean that she is looking down, instead of up. Remember what happens with the mouth when we look down? We can’t open wide.
Step 3: “SANDWICHING” THE BREAST
Think about when you eat a big, fat sandwich. In order to fit it in your mouth, you have to mash it down smaller with your fingers so that you can get your mouth on it, right? You need to do the same thing with your breast AND it needs to be sandwiched in the right direction. How do you know you are sandwiching in the right direction? Your thumb should be right in front of the baby’s nose. So, depending on how you hold her, it may not be the traditional “C-hold”. When holding your baby in the cross-cradle hold, your fingers will actually look like a “U”, rather than a “C”. Also, you need to be far enough back from the nipple so that baby can latch on the breast and not just the nipple. BUT you also have to be close enough so that you are making the sandwich skinny enough for baby to put her mouth around.
Step 4: TUCKING THE BREAST IN THE MOUTH
Again, go back to eating that big, fat sandwich …. After you mash it down, don’t you use the fingers that are in front of your nose to “tuck” a lot of it in your mouth? You need to do the same for the baby, but you will be using your thumb to do that. The baby needs to learn that she needs her WHOLE mouth to be full of breast. This will enable her to get more milk and will keep you from hurting.
Need visuals? The following are great resources.
- ABCs of Breastfeeding shows these four steps perfectly in photos.
- Start at minute 11:00 and watch the steps in action in this video.
Dr. Jack Newman:
WHEW! That’s a lot of info. Read it. Watch it. Practice it. Ask questions. I LOVE questions! You can do this! It just takes practice!!
The Breastfeeding Guru
I see so many moms who come into the hospital claiming that they want to breast and bottlefeed their babies. It seems that many of these declarations come from a standpoint of practicality, but many come from a place of fear.
With the recent surge of not only breastfeeding moms in this country (it’s about time), but also the flood of available evidence-based information and knowledgeable people who can help (it’s way past time), there has also come a fear from mothers that they will be denied formula in the hospital if they want it or that they will be bullied into sticking with exclusive breastfeeding while in the hospital. Their protection is “I want to do both”.
In addition, well over half of the moms with children under the age of three reside in the workforce here in the US. That means that many moms, after their meager 6 or 8-week maternity leave, will be leaving their babies in someone else’s care and, to do this, their babies need to take a bottle. So, I see these moms thinking they should get their babies used to the bottle from the get-go. Good thought … but it won’t work like that.
The bottom line is this: If a mom starts out giving her baby a bottle from the beginning, it’s highly likely that she will be ONLY bottle-feeding in about a week’s time or, even worse, find herself with a low milk supply because of the unnecessary bottles. The breasts will only make enough milk to replace what is removed. The math on that looks like this: If mom feeds her baby, say, 4 bottles of formula a day, her breasts will make 4 bottles-worth LESS of breastmilk. It’s rather simple, really.
Before you panic, this doesn’t mean you can’t EVER give your baby a bottle! Heavens, no! We would really be in a fix, right? Remember all of the working moms out there? Then, add in all of the moms who would like to do something nice for themselves and go to a movie or event … sans baby. The simple answer, or guideline, if you will, is that you need to wait THREE WEEKS before pumping or bottle feeding.
There are two reasons for this. Reason #1: You and your baby need to become pros at breastfeeding. Babies don’t know how to breastfeed when they arrive. Breastfeeding is learned, just like crawling and walking, and you both have to learn to do this together. The vast majority of babies can’t learn to breastfeed while sucking on a bottle. A baby uses approximately 35 muscles to breastfeed. Your typical bottle only takes 4! Okay, you have one of the new fancy “just like the breast bottles”? Great! Here’s the thing – NOTHING is just like the breast, except the breast. Those bottles may require the use of a few more muscles – maybe 6 or 7 total? That’s an honest to goodness guess on my part, but I can promise that it’s nowhere NEAR 35. I see too many moms who didn’t read this wealth-of-information blog, sitting in my office, in tears, with a baby who won’t do anything but sleep at the breast.
Yes, yes, yes … I know there are moms out there who successfully introduced a bottle early and everything was fine. The fact is this: EVERYONE IS DIFFERENT. Mom’s personality, breasts, hormones, stress level, milk supply, baby’s personality, gestational age at birth, latch, suck, tongue ….. the list goes on. Congratulations if it worked for your friend, but I can promise that as a lactation consultant, I don’t hear that it works very often. Last time I checked, no one had a crystal ball available, so we can’t predict who will succeed in introducing a bottle early and who won’t.
Reason #2: Your milk supply needs time to become established. It’s like building a strong foundation for a house. A supply that is built solely on a baby’s demand will be a strong one, indeed! Here’s how it works: the first three days after birth, you will probably wonder every minute of those three days whether you even have any milk. Hopefully, your support system will emphatically reassure you that you have “just the right amount for your baby”! (Trust them. They are correct.) Well, on Day 3 your worries will be over. HELLO! There will be no doubt that you have enough milk …. for the entire neighborhood! Yes, your breasts outdid themselves and you now feel full …. really full. Each time your baby feeds, she removes what she needs. The breasts take note that this amount is only a fraction of what they made. “Let’s make a little less for the next feeding,” they say. You don’t feel like they made less, but they did. Each feeding, the amount of milk produced is slightly adjusted. Around the 3-week mark, moms sometimes feel as though they don’t have enough milk, but they do. They are making just what the baby is taking, plus a small surplus for growth. Giving a baby a bottle during this process can not only affect the process of learning to breastfeed, but can screw up the math being done by the breasts.
What a minute! If I have all of this extra milk from the beginning, you may ask, why can’t I pump and save it? Good question and good thinking! Sounds plausible, right? But this isn’t good either. Remember the whole supply and demand process? If milk is pumped out along with your baby breastfeeding, the breasts will continue to make that much milk ….. even when you decide not to pump after the feeding. Again, I’ve consulted with enough moms who have had this thought and, because they just couldn’t keep up the constant pumping, found themselves with more milk than was needed, which baby can’t remove on a regular basis. They found themselves with plugged ducts, mastitis and, for some, abcesses which needed to be drained. Will this happen to everyone? No. But remember the crystal ball? Or lack thereof? Believe me, you don’t want to take a chance.
The good news here? There’s always good news! You can enjoy your baby for at least three weeks without the pressure of pumping to save milk for work, or learning to use that dang pump (which you will grow to not love). Introduce an occasional bottle between three and six weeks and you will have no trouble. Sleep when your baby sleeps so you aren’t too exhausted. Rest and heal. Your body just went through a lot with pregnancy and delivery of a baby. Just wait for three weeks and, yes, you can breast and bottlefeed your baby! Keep calm and breastfeed on!
Perception of having a low milk supply is one of the number one reasons moms will stop breastfeeding. Have you worried about one, or more, of the following things? If so, read on and, if you are still worried, might I suggest calling a lactation consultant before giving up on breastfeeding altogether?
- “I don’t feel as full as I used to.”
After giving birth, you may have wondered, “Where’s my milk? I don’t feel like there’s any in there”, as you jabbed at, and fondled, your soft breasts. Reassurances of having “just the right amount of colostrum” came from well-meaning friends and probing nurses. You know the nurses I’m talking about … the ones who squeezed your breasts to show you that precious drop of colostrum on your nipple? Yeah, you won’t soon forget that! But, alas, they must have been right because your precious new babe did survive until that blessed, uncomfortable day when , wholly schmolly, you’ve got milk now!! But, here’s the deal …..that’s not forever. Thank goodness, right? For the first 3-4 days, while junior was learning how to breastfeed, he was stimulating the breasts to make more milk! After three days of wondering if you had enough milk, you were then left NOT wondering that at all. During the next three weeks, or so, the breasts adjusted the amount of milk being made by how much was removed. That’s why moms are HIGHLY encouraged not to pump or bottle-feed for the first three weeks. It’s an important time for milk establishment, which will serve you well in the future. However, once the breasts are making what the baby is removing, plus a little more for growth, most moms become concerned that they don’t have enough milk. Oh, the phone calls I receive around that time frame! If your baby’s poop and pee count hasn’t changed, and your baby was back at birth weight by the two-week checkup, chances are that all is well with your milk supply.
- “My breasts don’t leak.”
Know what I have to say to that? Congratulations!!! Good for you! How lucky can you be? So many moms want to compare themselves to their friends and family. Or, better yet, well-meaning friends and family want to give unwarranted advice like, “You must not have enough milk if you aren’t leaking! I went through at least 20 breast pads a day!” Let me ask you a few questions. Did you and your friend start your periods at the same age? Do you have the same color hair? Is your skin the exact same color? Do you both wear the same size bra? I could continue being obnoxious, but I think you get the point. Every mom, every pair of breasts, every baby …… all different. We are all beautifully and wonderfully made, but different. So, congratulations. You’ve just saved money on breast pads … more money for diapers!
- “My baby wants to feed all of the time and doesn’t act satisfied.”
Okay, this one is a bit trickier. Babies go through growth spurts. It’s a fact. The time periods for these food-fests are around three weeks, six weeks, three months, six months and nine months. Some babies graze right through and mom never notices. Most moms, however, will. Instead of your baby feeding every three-ish hours, she starts searching for the buffet at 1-2 hours. Then, to add insult to injury, and panic upon worry, she acts like she ate nothing! Once again, poops and pees can tell us a good bit. Still the same output as before? Check! Does your sweet baby’s age fall within the aforementioned time frames? Check! What do you do? Feed on demand, as you have hopefully been doing thus far. The increased demand will increase your milk supply somewhere in the neighborhood of 2-5 days. I won’t lie to you, it can seem like an eternity. But this process is a sure thing. It will happen and it will end …. Until the next growth spurt.
Many moms think that since breastfeeding is natural, it will come naturally. It doesn’t. It’s learned just like crawling and walking. For most moms it takes good support and help.