Tuesday, December 10, 2013

Breastfeeding 101

Yesterday I was reading through a forum about "stupidest things people say to a breastfeeding/pregnant/postpartum woman" frankly it got me thinking about a particularly irritating experience of my own.

The day after I had my son we were in the recovery wing rooming in with our son.  One of the post partum nurses that came in to check on me told me that I shouldn't let my son use the boob as a pacifier and that I should put him on a feeding schedule.  At the time, I didn't know any better and neither did my husband.  My husband took her advice to heart and insisted that I put him on a schedule, however my gut feeling wouldn't let me do it so I ended up nursing him on demand from the get go.  Once I went home I did a ton of research on breastfeeding and low and behold it turns out that letting baby suckle at the breast is the most important thing to do especially in the first few days because the suckling is what signals my body to produce milk.

Breastfeeding is all supply and demand so therefore it is SO very important that baby is allowed to nurse constantly even if its non-nutritive sucking.  Matter of fact I didn't realize till yesterday the gravity of what the nurses comment could've made on various mothers.  She very well could've destroyed the nursing relationship of other women that had come through that particular ward.

I've been considering filing a complaint to the hospital because her attitude is very unsupportive for a postpartum nurse.

Anyway, I tend to give a whole lot of advice on breastfeeding, especially for women in the beginning stages.  I'm just going to go ahead and give some personal advice and answer some faq that I tend to come across often.

BIRTH
To set yourself up for the best possible breastfeeding relationship it would be ideal to have a natural birth because that way your baby won't be drugged and he/she will be completely alert.  While i'm not going to go into it here, natural childbirth allows a ton of oxytocin to be pumping through mom and baby.  Oxytocin is the "love" hormone and it is also the hormone that surges during "let-down" or when your breast let down milk.

*note: when I refer to natural childbirth I'm referring to a completely unmedicated labor, not only the lack of an epidural.  I mean refusing pitocin, narcotics, epidurals, stripping of the membranes, etc.

It is best after baby is born to have baby put directly on the center of mamas naked chest without being wiped down.  Ideally the cord should be cut after its stopped pulsating unless of course you have   Babies instinctively crawl towards the breast on their own time whether it be a few minutes or an entire hour.  The most important part is to allow baby to latch themselves unto the boob and allow them to suckle for as long as they'd like too.

A common misunderstood thought by many mothers who had given up on breastfeeding is that they were not producing enough milk.  Statistically only 2% of mothers really have a hormonal issue that doesn't allow them to produce milk.  During the first three days or so mama is only producing colostrum which is high nutrients and thick.  There is very little colostrum but baby doesn't need much in the beginning being that his tummy is very very tiny. It is normal for baby to lose a little weight in the first few days before mamas milk comes in, often with engorgement, till 4-7 days later.

For instance my son was born at 6 lbs 12.8 ounces and dropped down to 6 lbs 4  ounces three days after birth.  Once my milk came in he gained weight like crazy, putting on more than a pound a month.  I now have a six month old 20 lbs boy.

THE FIRST EIGHT WEEKS
The first eight weeks of breastfeeding are the hardest but I promise that it gets a whole lot easier once the breastfeeding relationship is established and the milk supply has been regulated.

FEED ON DEMAND
During this time skin-to-skin is very important with both mom and dad.  Babies sleep a whole lot during the first few weeks and it is also important to wake baby every two and a half hours to eat if he/she does not do so on their own.  In between those times it is also quite normal for baby to cluster feed or in other words be on the nipple constantly for hours at a time.  Feed on demand in order to establish your milk supply.  Honestly nothing else is needed other than time and your baby suckling for comfort and nutrition.

NIPPLE PAIN
Also for nipple pain, squeeze out some extra breastmilk, rub it on the entire areola and allow it to air dry.  DO NOT put a shirt or bra on after putting breastmilk on your nipples otherwise the moisture will only make it worse.  Honestly, the first eight weeks or so should be more or less just baby, mama and daddy so shirts can most likely be optional for the whole family.

SUGGESTIONS FOR GETTING SOME SLEEP: COSLEEPING
This is where things can get a little exhausting but one thing that helped for us as a family was cosleeping.  Cosleeping was great because I didn't have to wake up to feed my son, he just put the boob in his mouth and we were golden.  My husband actually got up with my son for all of his diaper changes in the night because I ended up having an emergency c-section (due to a placental abruption.) Cosleeping also just made sense because he grew in me for the last ten months, constantly hearing my heartbeat and snuggling in my warmth. To suddenly put him in a dark quiet place all by himself seemed mean to me and I could understand that he felt alone, scared and wanted to be with his parents.  To this day we still cosleep.  However, never ever sleep with baby if you or your partner are medicated or intoxicated.  Be sure to keep pillows/blankets to a minimum.

PUMPING...OR NOT
I highly highly suggest that in the first eight weeks while you are in the process of establishing a milk supply, to feed only straight from the boob and NOT TO PUMP.  Pumps are not that same as a baby and don't stimulate your breasts the same way in order to produce more milk.  Everyone will always say that pumping is good because it allows dad to bond, I personally don't believe that but even if you do it would be ideal to wait until your supply is steady before pumping.  Besides, there are many other ways for dad to bond with baby.  Also, the amount of milk that you are able to express from a pump DOES NOT REFLECT how much milk you are supplying.  Once again the pump is not a baby.  A baby is a million times more efficient than the pump and as long as he/she has enough poopie (at least 3) and peepee diapers (5-7) they are getting enough to eat!  When your baby comes home their stomachs are only the size of a marble, by the time they are a couple of months old they are still on the size of a small egg.
(I only pumped a few times ever and each time I only got a few ounces but I exclusively breastfeed my chubby boy)

BREASTFEEDING POSITIONS
Always let baby latch himself/herself.  Every single time they eat in the first few weeks place naked baby (only wearing diaper) on the center of mamas naked chest and allow the baby to do a breast crawl every time.  They will get a correct latch every time when you allow them to do it on their own.  Shoving your boob in their mouth is what leads to incorrect placement and painful nipple, so don't do it.  Honestly, if your baby latches correctly there should be NO pain at all during breastfeeding.  Pain means that baby is incorrectly on the boob.

DEALING WITH ENGORGEMENT 
I recommend using warm compresses and manually expressing a little bit of milk with your hands but more or less always try and have baby drain the boob.  If the engorgement is to the point where the nipple is flat and the baby is unable to latch than hand expressing some milk or pumping a little is probably necessary. However, pumping an engorged boob often makes the problem worse because it puts in another "order" of milk and tells your body to produce even more.  On the side note though, if you're trying to build up a frozen milk supply (for instance if you're planning on returning to work) than by all means take advantage of the engorgement and pump away.

I personally did some block feeding with my son in the beginning because I was engorged all the time.  Meaning that I would feed only one boob at a time and continue feeding said boob till it was empty. All in all within a three hour period he would only get one boob.  I'd switch to the next boob and only feed that boob till it was empty.  This decreases supply a bit because you end up putting in less "orders" of milk.

HOW LONG SHOULD MY BABY BE EATING?
I read a whole lot about how babies are supposed to spend a certain number of minutes on each boob and ladadadadada.  Honestly, in the beginning my babe nursed only for a few minutes on one boob at a time and was done.  The important thing to count is diaper out put.  There should be at least 3 dirty diapers and 5-7 wet diapers a day.  As baby gets older they will get more efficient at the boob and will often nurse for shorter spans of time.  Personality of the baby also goes into play here in that some babies eat quickly and some take their time, same as adults.  I used to worry that he wasn't getting enough because he only spend a few minutes at a time at the boob but he pooped and peed more than enough and was gaining weight consistently.  Now at six months he eats for twenty minute periods three times a day, when he wakes up, before each of his two naps and than one fourty minute to an hour long session before he goes to sleep for the night.  Between his "meals" he snacks whenever but never more than a couple minutes at a time.

As a side note i'd like to point out that after the first four to six weeks, ebf babies can go as long as a  week without a bowel movement.  Everything is simply absorbed into babies system.  On that note, it is very rare for breastfed babies to be constipated, but they still may cry to poop because their systems are immature yet.

HOW DO YOU KNOW YOUR BABE IS HUNGRY?
Crying is actually a really late sign of hunger.  Look for signs such as smacking of the tongue or lips, nuzzling your chest, so on and so forth.

JUST A SUGGESTION AND SIDE NOTES
I also recommend holding off on a pacifier while you're trying to establish the breastfeeding relationship.  All sucking that baby wants to do can go to benefit your milk supply.

Once the first eight weeks are over, you'll find that engorgement is rare unless you miss feedings and that you'll hardly ever feel "full."  At this point breastfeeding will be a breeze and you'll delight in the fact that you can nurse without having to wash bottles and knowing that your baby is getting the best possible start in life thanks to you and your dedication.

Overview key points:
Feed-on-demand even if it is constantly but don't allow more than 2 1/2 hours between nursing sessions
Breastmilk for nipple pain, landolin is unnecessary.
Skin-to-skin always, cosleeping is helpful
No pumping in the first eight weeks.
Count diapers not ounces!
Let baby latch himself/herself always, if baby latches themselves they will latch correctly every time.
There really isn't an ideal amount of time it should take a baby to nurse


*This post was written off of my own personal experience because I feel that there isn't much support for breastfeeding mothers especially here in Hawaii.  I'm not saying breastfeeding is the only way to go or that by doing it, your any "less than."  I know its not for everyone but its what works for me and my family.  I just feel as if society makes breastfeeding seem like an impossible unattainable fairy tale goal and it really doesn't have to be.  The only thing that mothers need is some SUPPORT.  At the end of the day that right there is the make it or break it part for most people.  My husband had to support me fully in breastfeeding for me to be able to accomplish it gracefully and he had to have my back when people would constantly ask/tell me to pump (which I obviously didn't.)