The First 100 Hours – Getting Breastfeeding Off the Ground

Research shows that the number one reason for moms not meeting their breastfeeding goals is low supply. Research shows that milk supply is heavily dependent on what happens in the first 3 days.  Here are a few tips that will protect your supply and ease baby’s transition from womb to world.

What To Know:

  1. Babies are not born knowing that sucking is related to hunger satiation. Sucking is a reflex that brings comfort first, food second. Babies do not know hunger before birth.
  2. Caring for babies skin to skin provides warmth, moisture and transfer of protective good bacteria from mom to baby. Research has shown that babies cared for this way have less jaundice, better sugar levels, better temperature maintenance and fewer infections than those cared for away from mom’s skin.
  3. Most babies, when placed on mom’s chest immediately after birth, will begin crawling, searching and rooting activities within the first hour after delivery. Interestingly, mother’s milk is most readily available at that time due to birth hormones. Babies who get this early dose of colostrum are protected from low blood sugar and the gut is provided a protective layer of mother’s helpful bacteria. This early latch also starts the milk production process and helps prevent delays in milk coming in.
  4. Baby’s first sucking experiences help develop baby’s sucking behavior. Finding the breast for herself while crawling on her belly encourages a wide-open mouth and tongue forward. Repeated practice sessions – offering the breast with early feeding cues whenever baby demonstrates those – helps the imprinting process.
  5. Frequent feedings in the first 100 hours (10-12 per 24 hours) encourages a more rapid transition from colostrum to milk production.
  6. Feeding both breasts, and repeating as necessary, helps a baby associate sucking with obtaining milk.
  7. IV fluids, blood pressure issues etc. can cause the areola around the nipple to be firm and make latching more difficult for the baby. Reverse pressure softening and areolar expression can remedy this and make latching easier.
  8. When babies are latched well, you should be able to hear a few swallows, even in the first day of nursing.
  9. What goes in must come out: that means a baby who is getting milk from the breast will have wet diapers and poop. This starts at one a day and increases by an additional wet and poop for each day of life. By 5 days, a baby should be wetting 6-8 times and pooping 3-5 times per day.
  10. Nipple tenderness should be resolved by day 5.

What To Expect:

First 24 Hours: Baby should nurse within two hours, if placed skin to skin with mom and allowed to remain there.  Some babies will sleep 4-6 hours and then begin nursing every 1.5-3 hours.  Some babies do not take the recovery sleep. Babies may nurse for a few minutes, others for half an hour.

Second 24 Hours: Babies should start waking up more, nursing for longer periods. During the second night of life, babies may nurse more frequently and seem hungrier, wanting to nurse off and on all night. Milk often comes in after this frequent nursing period. Switching breasts frequently and breast compression helps protect nipples and improves supply.

Third 24 Hours:  Milk volumes increase, breasts become firmer. Nursing sessions should last 10-30 minutes. Be sure to nurse both breasts, changing breasts whenever baby starts to fall asleep.

What To Do:

  1. Keep mother and baby together, 24 hours a day. Do not separate unless medically necessary.
  2. Put baby on mom’s chest immediately after birth. Mom’s head should be raised so she can see and follow her instincts to help baby with latch.
  3. If mom’s areola is firm or nipple appears flattened, perform Reverse Pressure Softening and/or Areolar Expression to help baby draw nipple far back onto his tongue. http://hopebreastfeedingsupport.com/video-resources/
  4. Use breast compression to keep milk flowing if baby seems to fall asleep quickly after latching. This is a firm but gentle squeezing of the breast a few inches back from the nipple. Squeeze and hold while baby is drinking; release while he rests and repeat until baby is not swallowing.
  5. Change breasts every few minutes when baby slows down on sucking and swallowing. Repeat breasts until baby is satisfied and asleep.
  6. If your baby is too sleepy to latch (this can happen from medications mom is given during labor), express directly into baby’s mouth or hand-express colostrum and syringe or spoon feed to baby. This will help prevent low blood sugar for the baby and prevent unnecessary formula supplementation. Breast milk is more effective at increasing baby’s blood sugar than formula because it is self-digesting. Do this every 2 hours until baby shows interest and starts latching by himself.
  7. If your baby has not started latching by 12 hours after birth, ask for a hospital breast pump and begin pumping as well as manual expression to give your supply a jump start. If your baby begins latching but is still having difficulty after 24 hours (causing nipple pain, no swallowing), start pumping. Pump 10 times/day the first three days, then 8 times/day after that until baby is doing well.  Research shows that moms who begin hand-expressing AND pumping in the first two hours when baby is unable to nurse well, have twice as much milk at 10 days as those who delay.  WATCH THIS VIDEO: http://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
  8. Avoid pacifiers and bottles until baby is latching well. It usually takes about 2 weeks for babies to imprint at the breast.
  9. Keep track of baby’s output. The My Medela App is free and will help you keep track of feedings and baby’s wets and poops.
  10. If you are still having trouble with latch or have nipple damage after the 5th day or you have cracked or bleeding nipples, get hands-on individual help.

If you have time and resources, please take a comprehensive prenatal breastfeeding class. Prenatal Classes help get the whole family on the same page and reduce stress. Classes are offered in many locales, including Nova Birth Services at (615) 669-6399 and most Maternity Hospitals. 

 

When It’s Time to Wean – Mothering After Breastfeeding

All babies wean eventually.  Some have to be weaned early because of circumstances beyond control. Some wean by themselves. In cultures where breastfeeding is the normal way of feeding a baby, many children nurse until 3 or 4.  Some tandem nurse when a new baby is born. Different circumstances may bring up different issues for mom or baby.

Sudden Weaning

When baby weans or must wean suddenly, and mom still has milk, the goal is to reduce milk supply comfortably and safely. Some measures are well known such as wearing a supportive but non-binding bra, using cool packs such as disposable diapers that have been wet and then frozen, cabbage leaves that have been crushed and placed on the skin of the breasts and changed out when limp. Hand-expression or very short pump sessions can be used to gradually reduce milk supply. This may take a week or more. When in the shower, stand with your back to the shower. Only express milk if absolutely necessary. Herbal remedies for drying up milk include peppermint, sage, oregano, lemon balm, chickweed and black walnut. Sudafed is an over the counter medication that has been shown to decrease milk production in mothers 6 weeks or more past delivery. It can take months for breasts to completely involute. Once breasts are comfortable, avoid hand-expressing “just to see”, as this may stimulate additional milk production for some women.

If baby did not choose to wean, but weaning is necessary, and she is 6 months or under, consider paced or baby-led bottlefeeding to allow him or her to be in control of the feeding as much as possible. See my printable baby-led-bottlefeeding for instructions on this method of feeding. For older babies, try a sippy cup without the spill-proof valve, a straw cup etc,  These may be preferred. If you are using formula, see my printable preparing-infant-formula-2016 for safe handling of formula.

Gradual Weaning

If your baby is older and you are preparing for weaning at a later date, start by limiting your feeding locations to a special area or chair. If you are nursing your baby to sleep at night, begin to develop a bedtime ritual that can be continued after weaning. Turn on white noise, rub his back and rock after you take him off the breast. If possible, as you get closer to planned weaning date, start the back rubbing and take him off the breast but hold him close as he falls asleep. Trust your instincts. The biggest hurdle is to have clear in your mind why you want to wean and when you want to wean. Start a bedtime ritual that can be transitioned to not include breastfeeding as soon as you feel it is helpful.  Every child is different.

The Relationship Goes On

The close relationship you have started with breastfeeding can easily transfer to other activities that will provide comfort through your child’s senses.  Touch, warmth, soothing sounds can all happen with you, even when breastfeeding is over. And the benefits of a strong immune system will last as long as he lives!

 

For Helpful Information on Introducing Solids –

Check out this website:  http://www.babyledweaning.com/

 

 

 

Employment and Breastfeeding – Continuing the Breastfeeding Relationship When Separation Must Happen

So you made it to the 6 weeks mark. You’ve overcome the breastfeeding learning hurdles and are starting to feel a little more confident about this new relationship. Your healthcare provider has released you from care and you are feeling better physically. But now comes the challenge of dealing with the realities of your life. You have to go back to work. Many women, and especially first time moms, fear this pending separation.

Some of the questions that may run through your mind include:  What if my baby won’t take a bottle while I’m gone? What if my baby likes the bottle better than me? What if I don’t have enough milk? What if my boss won’t allow me time to pump? Can I juggle my work and all the responsibilities of being a mother? And what about my other relationships – partner, family and friends – can I fit all of this into my life?

Let’s take these questions one at a time.

  1. Baby won’t take a bottle? See my post on how to bottle-feed a baby.
  2. Wondering about pumps and choosing the right bottle?  See my post on pacifiers, pumps and choosing bottles.
  3. What about the workplace that doesn’t support breastfeeding?  See this article on Federal law and the workplace. Here is an article that you can use to talk to your employer about supporting breastfeeding.  http://www.cdc.gov/breastfeeding/pdf/BF_guide_2.pdf
  4. Start saving milk for your “stash” early. Most moms have more milk than babies require by the 3rd to 4th week after birth. Get your pump and learn how to use it and start saving. Many moms find they have an abundance of milk in the morning. Nurse first, then express the remaining milk and freeze. This will serve as your back up supply for any emergencies and when you first return to work.  After you start back to work, what you pump one day will be the feeding for the next day to work. Freeze what you pump on the last day before a stretch off work and use some of your stash on your first day back.
  5. If you haven’t learned to nurse in bed, it’s time to learn. By the time a baby is 6 weeks old, she should have enough head control so you don’t have to hold her head and her latch should be secure. Check out side-lying positions. Put your co-sleeper crib next to your bed so it’s easy to transfer her into her own bed once she has nursed to sleep. Keep things simple so nighttime feedings are short and uncomplicated. Unless absolutely necessary to maintain your milk supply, do not pump in the middle of the night.
  6. If your baby starts sleeping longer than 5 hours at night, pump right before you go to bed to keep your breasts from getting uncomfortably full during the night. You will rest better and the extra milk goes to your stash.
  7. Try to make life simpler at home. Crockpots and quick meals will save time in the kitchen. Simplify clean up and household duties and of course, enlist help from anyone available to you. There are lots of websites out there that have suggestions for this.
  8. Make sure you continue recommended vitamins for yourself, including adequate Vitamin D. Here’s a technical article supporting the recommendation for nursing mothers to get an extra 6000 IU of vitamin D daily for improving their own and their baby’s health.  https://www.ncbi.nlm.nih.gov/pubmed/17661565
  9. Most importantly, try to take some time for refreshment for yourself. Eat healthy as you can. Take naps. Put baby in a front carrier and get outside when the weather permits. And take lots of selfies! This time will pass quickly!
  10. Remember that breastfeeding is not just about the milk you provide your baby. It’s about the special closeness that comes when your baby looks in your eyes while you are nursing her and she begins to realize that YOU are her source of life and nourishment, when she smiles at you and then buries her head in your breast as if to say, “I’m home!”

Breastfeeding Confidence: Are you gaining or giving it away?

Entering Motherhood Unsupported

Let’s face it.  Our culture has totally undermined our confidence and security in ourselves as being dearly loved children, created lovingly and capably by a gracious God. What does that have to do with breastfeeding? Many women have bought into the idea that they are not good enough physically, mentally or emotionally just as they are, to be a woman, a wife or a mother. First, we feel the need to mold ourselves to the Victoria Secret models’ shapes and appearances. We feel a need to use whatever femininity we have to attract a mate. Then, when it’s time to have children, instead of being empowered through education to guide us in doing what we were created to do, birth becomes a maze and we are taught we can’t birth without medical technology. Even when this technology is needed, the way it’s administered can leave us feeling more like victims instead of capable mothers.  Finally, once the baby has been “delivered” (notice the disempowering language of  delivered instead of the mother who partners with God in giving birth!),  we are then expected to produce the life-giving, unduplicatable fluid that the baby needs, on demand, in time and in sufficient quantity.

Every new phase of womanhood is just that–new, uncharted territory!  Everyone’s experience is unique, so despite the best education possible, or no education at all, we venture into the breastfeeding relationship as rookies.

Mixed Messages

In today’s world, the internet, social media and television/radio broadcasts have informed us dramatically that breastfeeding can fail us and the baby. But we are also confronted with the growing body of evidence that breastfeeding is essential and necessary. What to do? Many moms are trying to be preemptive in their preparation. They research all the best herbs for increasing milk supply. They search for the best breast pumps. They look into special diets and techniques. When their babies are born, they are quick to assess and intervene for any perceived difficulty. For other moms, however, the possibility of failure is so daunting, that they never even begin the journey. They opt to formula-feed from the beginning. Better safe than sorry!

Imagine a Better Way: Birth, Breastfeeding and Beginning Again

What if?

But imagine with me for a moment what the world could be like if we could breach the chasm between flying and the fear of failing.  What if moms could find a middle way that empowers women from birth to breastfeeding? That way might include research to identify the best environment for birth for their newborns and themselves. It might include education about the normal progress for mothers and babies during the early time after birth and making plans and contingency plans should unexpected difficulties occur.  But, above and beyond all this planning, let’s include trust. Trust in the birth caregivers she has chosen. Trust in her partner to protect and support her desires. Trust in her family to honor her decisions.

What if moms could develop relationships with other mothers who have journeyed and reached the goal desired? What if they could find supportive professionals to answer questions and guide the journey when needed? What if we treated the breastfeeding relationship as normal and necessary, but respected it as so important that we celebrated the RELATIONSHIP part of it as much as we did the milk-making (FOOD PRODUCTION) part of it? Those who have gone before us could celebrate the choices made, whatever they are, for what they are worth, choices made in the best interests of mother and baby? We could stop blaming ourselves and each other for the past mistakes and sins and move forward from here, learning from the stories of life and love that we each bring to the table.

One Team

I am so tired of hearing about “mommy wars” and “breastfeeding Nazis” and “need for more research before pushing breastfeeding on mothers.” What would happen if we took out the word “breastfeeding” and replaced it with “sex”? No one would stand for a war on sex to make it only used for reproduction!  No one would shame a woman (or man) for seeking professional help if there were issues on either the relationship or reproductive front. Then why is there so much shaming of something just as natural and essential to producing and maintaining life as feeding our children? We need to re-prioritize and support women trying to navigate motherhood and breastfeeding.

Love, Not Fear

Let’s change this paradigm and create an environment that is normal, helpful, supportive and non-shaming to mothers no matter how they feed their babies, while continuing to educate and celebrate what has sustained humanity up until the 20th century.

Let’s start now.  If you are reading this and you didn’t breastfeed your child, or you didn’t breastfeed “properly”, let me be the conduit of forgiveness.  You operated within the knowledge and barriers of your time.  Yes, you had responsibility.  It’s OK to own that and say, “I wish I had known better” or “I wish I had had better support” or “I wish I had made better choices.”  It’s OK to own it.  Then give yourself grace and forgiveness.  When you own something, you are then able to use it for good. Perhaps you will help someone by supporting them or offering to find them the support they need. You don’t have to be in denial or defense, you just move forward.

If you are reading this and in the middle of a feeding struggle, then get the help or accept the help you need, but cherish what you already have. If your issue is low milk supply or latch, don’t give up the breastfeeding relationship, the cuddling and skin-to-skin and eye-to-eye language without words. If you have plenty of milk, but a baby who can’t or won’t latch, take off the pressure. Make bottle-feeding as much like breastfeeding as possible with positioning, allowing baby control etc. Take as much of the stress away as possible by taking each day as it comes. Pray blessings over your baby.

In summary, loss of confidence comes when we allow fear to take control of our actions and thoughts. Fear is paralyzing but it can’t be overcome by will. Perfect love casts out fear (1John 4:1) F.E.A.R. equals False Expectations Appearing Real. Let those who love you understand what your desires are and accept acts of love that are truly loving and supportive. Let love be your guide, knowing that love is the antidote to fear. As you make small steps, your confidence will grow and you can then help others along the way.

 

Milk Donation

I have heard many questions from moms over the years about what to use in a situation where they don’t have enough milk to feed their babies. I do not support formula companies.  However, I don’t support homemade formulas either.  Neither can come up to the specificity of human milk for human babies.

What I DO support is milk banking.  This can be done for your own child or for others.  Proper handling, labeling and storage of the milk makes this process more useful.  Here are a few helpful hints.

  1. Set out to have an excellent supply.  That means the first hour after birth is critical for baby getting the most volume – and studies are now beginning to show that moms whose babies nurse well in the first hour (or who start pumping and hand-expressing right away if baby can’t nurse) have more abundant supplies and are less vulnerable to negative events later on in their lactation. Make sure your support person is on the same page with you in helping you achieve that early stimulation and milk removal. Mothers who get 30 sessions of effective breastfeeding or hands-on pumping within the first 3 days of birth have twice as much milk at 10 days after birth as those who have less breast stimulation and removal of milk. This has been found in more than one study.
  2. Pay close attention to your baby’s effectiveness in the first four weeks. If baby is not removing milk well during this period of time, the breast will reduce milk production capacity and possibly storage capacity as well. If your baby is not removing milk well, using a breast pump after morning feedings and before bedtime can help protect your supply.  If your baby is not nursing effectively, please see a skilled lactation consultant for assessment.   Medical-grade rental breast pumps (such as the Symphony) are generally more effective in setting up a high supply than personal pumps, which are designed to maintain supply once lactation is established and a healthy baby is nursing.
  3. Store your precious milk carefully. Most women use plastic bags for storage. Use bags that are thick enough and have wide enough seams to reduce breaking and leaking during thawing. Don’t over-fill bags. Get as much air out as possible and lay bags flat for freezing. Label with at least the date of pumping. Use a sharpie on part of the bag that is not in contact with the milk (on the edges) or use a piece of tape for the label. Ink written directly on plastic will leach into the milk inside. Once bags are frozen solid, they can be stacked vertically in a plastic shoe box to keep in order in the freezer. Caution: plastic milk bags that are over-filled or have thin seams can break during freezing or when transporting in the frozen state. When stacking horizontally, put a layer of paper or plastic between rows of bags. If you are shipping milk through Fedex, contact them for information. Styrofoam lined shipping boxes with dry ice can be used to ship milk overnight. Layers of bags should be separated by cardboard or thick paper to prevent puncturing each other during transport.
  4. Think about how much to store and when to share. To avoid wasting milk, don’t put too much in a bag – a maximum of 5 ounces. If you are pumping a couple of ounces at a time, you can add to a previous amount until you get your desired amount, as long as it is all obtained within 48 hours and kept refrigerated until frozen. The best place to store milk is in a separate deep freezer that is not opened frequently. Regular freezers should be turned as low as possible, to the point that ice cream is frozen solid. Do not store your milk in the door of the freezer. Some moms start out storing a lot of milk because they have babies with nursing difficulties. Once those babies have overcome their difficulties, moms find they don’t need the extra stored. At that point, sharing becomes a possibility, and sometimes even a necessity when freezer space becomes low!
  5. What about formal versus informal milk donation? Milk banks have requirements for moms since their customers are NICU’s with very tiny, vulnerable infants whose very survival depends on milk donation.  Milk sharing done between healthy moms with healthy babies can be a little more relaxed. Some medications that are OK for nursing moms may be acceptable for another nursing mom – but unacceptable for a tiny medically vulnerable baby. Eats on Feets, Human Milk for Human Babies and other mother-to-mother sharing sites can help re-distribute milk from moms who are not eligible for milk bank donation to moms whose babies are not eligible for receiving banked donor milk. Tennessee is establishing it’s very first Mother’s Milk Bank. Here’s a link to find out more about how to donate and how to help. UPDATE: 2 Local donation sites are now available – in Nashville at Meharry General Hospital and in Memphis at Regional One. More donation sites are expected to come on line. Check the Mother’s Milk Bank site for more info. http://mothersmilkbankoftn.org/

Alyssa Milano and Breastfeeding Shaming

As if moms don’t have enough to worry about – we have a continued attack on public breastfeeding. This is a first world problem – a USA problem. Like so many other “issues,” those trying to build their ratings find something to project their biases and ignorance upon and try to get some controversy going. EVERYONE knows that if we were in a developing nation where Western marketing machinery had not yet ruined the culture and economy, breastfeeding in public would not even be a topic of conversation. Babies do not have any sense of propriety (as some would define it). They just know when they are uncomfortable and want their needs met. A young baby cannot understand that someone’s guilt might be stirred up by their need to be tended to in the same general vicinity as the casual observer.
The idea expressed in this commercial needs to be distributed.

If we are to help mothers reach recommended goals of breastfeeding to at least a year and hopefully to two, we must first help them reach their OWN goals – whatever that length might be! And currently, 80% of moms do NOT meet their own goals – whether to breastfeed 6 weeks or 2 years! Baby-Friendly Breastfeeding Initiatives and other similar programs are a first step to getting moms off right. But beyond that, the community must be engaged to support these moms. Breastfeeding should be welcome wherever it is safe for a mom and baby to be. Workplace and social accommodations must be championed. Ignorance can be cured with education. Disappointment when goals are not met must be met with determination to help the next mom – not try to downplay the goal!

If you are a friend or relative of a breastfeeding mom, do what you can to encourage and support her. Educate yourself and your community. The babies of the world will appreciate your efforts!

Adoptive Breastfeeding

I have a particular heart for adoption. I came from a large family where other children were welcomed. My brothers, sisters and extended family have adopted and now I have an adopted grandchild. If adoption is part of your journey and you would like the experience of breastfeeding, I am here to help. Breastfeeding is a normal part of comforting as well as feeding a baby. There are protocols available on the internet to help with bringing in milk prior to anticipated arrival of your child. My part in helping adoptive moms is to coach, encourage, make adaptions to the plan as needed throughout the process.