Breastfeeding is something that seems like it should be natural, but nursing can be very challenging, especially in the beginning. Remember that line from the “Summer of ’69,” by Bryan Adams—“I played it till my fingers bled….”? Unfortunately, first-time breastfeeding can feel a lot like learning to play the guitar. A new Mom’s nipples frequently become irritated and cracked. They may bleed, which can lead to the baby swallowing and then vomiting blood. If your baby spits up and you see blood, don’t panic—it’s probably your blood, not the baby’s. At the hospital, nurses and lactation specialists will assist you and the baby with achieving a good latch.
Here are a few quick tips for protecting your breasts while nursing:
One. Don’t let the baby nurse unless he/she opens the mouth wide, like a big yawn. Otherwise your baby might clamp down on the nipple. In addition to being extremely painful, this will damage the skin and potentially cause bleeding.
Two. Vary position to avoid traumatizing the breast. Feel free to use a breast shield if you need one.
Three. Make sure to keep the baby’s tongue is DOWN when offering the breast. This important step is often neglected.
Four. If a baby tries to pull her head away from the breast after latching, don’t allow her to do so. Supporting the head against the breast is important for preventing damage to the nipple.
Five. If you’re struggling to get a good latch, try placing your nipple upon the baby’s lower lip. This will cause the baby to open the mouth in a more downward direction, allowing you to slide more of the areola into the baby’s mouth.
Six. Practice using a breast pump before you leave the hospital. Remember, babies receive all the benefits of breast milk whether it’s pumped into a bottle or taken directly from the breast. The mode of administration doesn’t matter.
Seven. If a baby is tongue-tied (ie. there is a tight connection between the tongue and the base of the mouth), consider getting the baby checked by a pediatric ENT doctor. In cases of significant ankyloglossia, a quick procedure can be done to release the tongue and make nursing easier.
Eight. Ask the lactation consultants and nurses at the hospital for help if you need it. Medical providers can help you achieve a successful breastfeeding experience.
It may be challenging to know whether your baby is doing well with breastfeeding, since the amount of breast milk the baby is taking can’t be measured. However, numerous signs may be used to determine whether you’re headed for quick success or challenges.
Here are some signs that breastfeeding is going well:
One. Two to three days after delivery, your breasts become engorged with milk.
Two. Instead of wailing like a banshee constantly, your baby starts to seem happy and satisfied after feedings. A baby who is never satisfied and won’t stop crying is likely hungry and may need supplementation.
Bear in mind that after delivery, a mother’s breasts produce a small volume of colostrum. Though loaded with antibodies to protect the baby from infection, the colostrum may not completely satisfy the baby, leading to constant crying and frequent feedings (i.e. cluster feeding every 20 minutes). If it wasn’t so exhausting, this wouldn’t necessarily be a bad thing. Frequent episodes of nursing help stimulate the milk to come in. Sometimes supplementing with a small amount of formula (which can be given by a spouse or partner through a feeding syringe) or using a pacifier is helpful to avoid exhaustion related to frequent feedings. “Baby friendly” hospitals that deny nursing families pacifiers should be spanked (corporal punishment in any other setting is a bad idea), as studies have shown that early pacifier use can increase the success of breastfeeding by giving exhausted mothers a break. No one likes being used as a human pacifier all the time.
FYI, the human pacifier phenomenon is very common. In the beginning, many nursing mothers observe that the instant the baby latches on, she falls asleep. Why does this happen? Snuggling up and breastfeeding is incredibly relaxing—at least for the baby. If an infant is using a mother like a pacifier, nibbling on the breast but not sucking and swallowing vigorously, then getting the baby off the breast—and potentially offering a pacifier—after a maximum of 20 minutes per side can be helpful. Techniques like undressing a baby and blowing on his fingers and toes to wake him up before feeding can help to maximize the success of breastfeeding episodes. If a baby isn’t latching or feeding well, stroking the side of the cheek can also be useful, because this action stimulates a sucking reflex.
Three. The time between feedings stretches to two to three hours.
Four. You can hear your baby sucking and swallowing while feeding.
Five. Your baby’s mouth is filled with milk after nursing.
Six. Your baby is making plenty of wet diapers—at least four to five in 24 hours. BM’s can be all over the map; the rule of sevens applies to newborns: BM’s can occur once every seven days, or seven times daily; this and everything in between is NORMAL.
Seven. Your baby does NOT look jaundiced (the skin does not have a yellow tinge).
Eight. Your baby is sometimes alert between feedings. Note that babies sleep A LOT when they are first born, often more than 18 hours in a 24-hour period.
Nine. Your baby is gaining weight. Weight gain is the single most objective sign that a baby is doing well with breastfeeding. Keep in mind that weight loss at the beginning is normal. A breastfed baby may take up to two weeks to completely regain her birth weight, especially because it takes three to four days for breast milk to come in.
Conversely, here are some signs that breastfeeding is not going well:
One. Your breasts never become engorged. If your milk isn’t coming in, notify your pediatrician and obstetrician right away. You will probably need to supplement with formula.
Two. Your baby is always crying. Unremitting crying can be a sign that your baby is getting dehydrated and will need supplementation.
Three. You don’t hear the baby sucking/swallowing or see milk in his mouth.
Four. Your baby is losing weight, continuously. Weight loss that doesn’t turn around within a week or two is an ominous sign. It can be related to insufficient milk supply or other medical problems, such as infections or heart disease. Unrelenting weight loss always warrants a careful medical evaluation.
Five. Your newborn is glowing from head to toe, evoking memories of the “glow worm” toy that was popular in the eighties (this is a sign of clinically significant dehydration and jaundice).
Six. Your baby seems lethargic and isn’t waking spontaneously for feedings.
Seven. You can’t remember the last time you changed a wet diaper—another sign of dehydration.
Eight. Your baby constantly wants to nurse and never seems satisfied.
How to maximize breast milk supply:
The single most important factor for maximizing breast milk supply is emptying the breast. The more frequently the breast is emptied, and the more completely, the greater the milk production. For mothers who are struggling with producing enough breast milk for their babies, simple steps can be taken to improve supply.
After a baby has finished an episode of nursing, a mother can pump to further empty the breast. Because an electric breast pump doesn’t completely empty the ducts, the remaining milk can be obtained through hand expression. These steps can be repeated each time a baby nurses. The key is pumping after the baby nurses, not before. If a baby is taking an extra-long nap, a mother can pump midway through the nap; but she should avoid pumping close to the time at which a baby will be nursing again.
Fenugreek is an OTC vitamin sold in health food stores that women frequently take to augment their milk supply. However, no controlled studies have evaluated either the efficacy or side effects of fenugreek.
Breastfeeding and vitamin supplementation:
Although breast milk is, by far, the healthiest thing a mother can feed her baby, it is low in two essential nutrients—vitamin D and iron. Iron supplementation doesn’t become important until four months of age, when in utero iron stores begin to diminish. Vitamin D, however, is essential right from the beginning.
To prevent rickets, or vitamin D deficiency, nursing mothers should supplement their infants with 400 IU of vitamin D daily. Concentrated “D drops” can be placed on the breast or directly onto a baby’s tongue. Less concentrated vitamin D formulations can be measured with a dropper and squirted into the baby’s mouth. Be sure to follow the instructions on the box, as some formulations are more concentrated than others.
When infants are four months old, they can obtain iron in two different ways—either with a liquid vitamin, like Poly-vi-sol, or from solid food. Infant cereals are fortified with iron, and pureed meat is another excellent, highly bioavailable source of iron. If a mother chooses to exclusively breast feed beyond the age of four months, then I usually recommend switching from D drops to Poly-vi-sol. Providing the baby with some form of iron is important, because iron-deficiency anemia can be associated with cognitive delays.