Strategies for Moms Anticipating Breastfeeding Difficulties

This page is designed for moms who have previously experienced breastfeeding difficulties or have been informed by a skilled provider that they MIGHT have difficulty breastfeeding. These strategies do NOT guarantee that mom will avoid these problems, but serve as a sample of actions that moms have taken that have proven successful in their breastfeeding journey.

Flat or Inverted Nipples

A flat nipple is one that, when the areola is compressed about an inch behind the nipple, flattens out and appears level with the surround areola or becomes thick and barely protrudes past the surface.  An inverted nipple pulls behind the surface of the areola and may pull inward into the breast.

Prenatally:  Try Supple cups starting at least 8 weeks before delivery. Check out supplecups.com for product information. Begin using these as per instructions. Consider purchasing softshells for inverted nipples http://www.medelabreastfeedingus.com/products/103/softshells-for-inverted-nipples to wear over the supple cups to allow longer periods of wearing to help correct the condition prior to delivery.

After Delivery: Try Latch Assistant by Lansinoh. This can be used on the nipple itself or placed over a nipple shield (if needed) to draw the nipple out or to pull inside the shield before latching.

 

Supple cups can also to be used in the same way.

History of Latch difficulties with delayed or slow onset of Stage 2 of lactogenesis.

Research has shown that optimal breast stimulation and expression of colostrum during the first 72 hours after delivery can double milk output at 10 days.

  1. Initiate breastfeeding within the first hour after delivery with mom in laid-back position, using biological nurturing approach. See: http://hopebreastfeedingsupport.com/the-first-100-hours-getting-breastfeeding-off-the-ground/ for more basic tips.  If areola is tight (feels like your chin or the end of your nose), use reverse pressure softening and areolar expression to increase nipple availability before baby latches.  See:  http://hopebreastfeedingsupport.com/video-resources/.   Once baby has latched, remain reclined throughout the feeding. Switch breasts when baby starts to pause a lot (usually every 5 minutes or so). At 24 hours, begin softening and expression before every feed, even if you don’t think your areola is firm.
  2. Ask for a hospital breast pump to be brought to you right away, along with syringes for milk collection. If your baby is not latching well by 12 hours, begin using breast pump in addition to hand-expressing. 
  3. Offer the breast every 2 hours until 10:00 at night, and then every 3 hours during the night. If baby is too sleepy to latch, hand express about 10 minutes and then pump for 15 minutes. Give any colostrum to the baby by finger-feeding. This is for first 3 days of life.
  4. If your baby cannot latch to the breast or stops latching, ask for a small and a large nipple shield. Try both to see if baby can latch to either. Ask for demonstration from your care provider.  If you have not started pumping yet, begin doing so. Pumping in the first 3 days should be about 15 minutes using the Symphony initiation program. Once your milk starts coming in, use the maintenance program and move the vacuum up to about 10 bars on the screen.  Ask for written instructions for pump use. Plan on taking a rental pump home from hospital if needed. Remember milk does not start squirting until Day 7 after delivery.
  5. Check baby’s suck using your thumb to see if baby is drawing your thumb back to the back of her tongue or is only “peanut butter sucking” on the tip of your thumb. Sometimes a little suck training before latch can correct what is just a habit baby has at birth.
  6. If no comfortable latch, strong latch is obtained, plan to see a lactation consultant around 4th-5th day (optimal time when milk surge normally begins and baby is more alert).
  7. Monitor baby’s weight loss. If mom’s milk is not coming in quickly, have donor milk or ready to feed formula available for early supplementation as needed. Many organizations recommend hydrolyzed formula if human milk is not available.  If supplementation is needed in the hospital after the first day, ask for oral syringes and a feeding tube for easier finger feeding or at breast supplementation. If long-term supplementation is required, a Dr. Brown’s bottle and side-lying baby-led bottlefeeding technique can be used.  See information and videos http://hopebreastfeedingsupport.com/video-resources/.  

Breastfeeding Assistive Devices 

(available from walmart.com, amazon.com and target.com)

  • Latchassist by Lansinoh
  • Hydrogels by Medela (2 pkgs)
  • Nipple shields 20 and 24 (if not obtained from hospital)
  • Bacitracin
  • Medela Harmony manual pump
  • Haaka milk collector
  • Tube top – makes a comfortable holder for nursing pads, can be used as a pumping bra
  • Dr. Brown’s 4 oz regular newborn bottle (not glass, not wide mouth)
  • Microwave sterilizer bag (if you have a microwave)

From Hospital

  • Oral syringes
  • Pump kit
  • Rental pump
  • Feeding tube (used for finger-feeding or at breast supplementation)

A Word of Encouragement

DID YOU KNOW?

In a study conducted with moms with history of breastfeeding difficulties, that 95% of them had success with following births – even if the previous breastfeeding experience was not what was expected or planned? This just validates that every breastfeeding experience is unique with a unique baby and a mom with a different (and growing) skill set! It’s just like childbirth – each birth, each mother-child relationship is different, but all are valuable!

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Fitting Baby In

When you have a baby, everything about life changes. The love of your child may hit you like a ton of bricks. Or, like other love relationships, it may creep up on you slowly. Some parents take the coming baby experience with a laissez faire attitude. They trust they will get through childbirth and child raising by the seat of their pants. Others plan everything, like a military expedition, trying to think of every possibility and plan for every outcome. Others take a middle of the road attitude. Whatever the personal style of the parents, they will be bombarded with all sorts of advice and warnings. Some of it will be useful, and a lot of it, not.

If the parents are “researchers,” they may discover many opposing viewpoints on almost every issue. The “planners” may find this frustrating and overwhelming and make a firm commitment to adopt a viewpoint that causes issues within their relationship with each other and the baby. The “flyers” may find themselves validated when everything goes smoothly or be able to adjust to any bumps in the road they encounter. The key is having two parents on the same wave length – which often doesn’t happen! It’s a good idea for parents to discuss these things before baby comes and be prepared to change strategies if they find that the planned one is not working for them and their baby.

The truth is, babies need love, comfort, security, food, and warmth. Breastfeeding provides that very first connection that simultaneously provides all of a baby’s needs with one activity. The challenge comes in providing those needs for the baby while caring for the mother and father. Here is where family and community support becomes vital.

If you are a laissez faire sort of person, consider the possibility that childbirth may not go in a predictable pattern. It helps to have supportive folks in the wings ready to step in and give a hand if you need it. Have the conversation with family and friends so they understand your point of view, but can plan to be available in case you need a little help with coping in the first days. If you are a researcher or a planner, try to accept that there unforeseen events may occur and contingency plans may be required. Give yourself room to breathe and try not to set impossible goals as a measure of success.

Babies are non-stop needy. They go from having their needs supplied without any effort on their part before birth to a world that is cold, bright, hard and must be engaged to get anything that they need. Babies have massive brains (compared to other animals) but few connections established. Everything must be learned from scratch. Primitive reflexes such as suck, swallow, breathe that are essential to survival are present but baby must associate those with actions that bring food and satiation together. Those associations build over time. Connections between the brain and mouth and neck become more secure by 5-8 weeks. This becomes obvious to parents when baby begins to smile in response to interaction with other humans. In these early days, babies need to be near their mothers, enjoying skin to skin contact and free access to mother’s breasts for nourishment and comfort. Interestingly, this time when baby is mainly reflex-driven is also the time when mother’s milk supply is built and established. Frequent and unrestricted access to breastfeeding has been shown to increase milk supply better than scheduled and limited feeds. Frequent breastfeeding helps to increase hormone levels and sensitivity of lactation tissue to hormones of milk production. For mom to be available, it helps to have household and toddler assistance (if needed) during this early period. Slings and wraps that keep baby close to mom can help reduce stress.

Sometimes parents are tempted to use artificial carriers such as car seats, Rock ‘n Plays, swings and other devices that put baby in a semi-upright position and provide movement and/or noise like the uterine environment. The thought is that these devices will give parents a break and are harmless. Studies, however, show that babies who spend too much time in these are more likely to develop acquired torticollis, reflux and plagiocephaly. Here’s an article that gives more information about one product. By age 3 months, babies have progressed and gained more head and neck control and can use these products without some of the side effects. Heres’ an article about use of containers: https://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=53d90264-1846-4b86-891f-0facc63db3e8

As babies grow and mature, they become more sociable. Stomachs grow and babies can take more milk in at a session and sometimes go longer between feedings. Feedings can also be shorter at times. The unique personality of your baby becomes more obvious as time goes on. Your relationship grows and develops. Most moms find that after 3 months, breastfeeding becomes easy – and so much easier than all the work it takes to bottle-feed a baby. Breastfeeding becomes more than just a way of transferring nourishment to your child – it is a communication tool, a way of comforting, and a way of teaching about relationship.

In most non-Western cultures, breastfeeding to 2 years and beyond is the normal pattern. Of course, older babies do not nurse as frequently as newborns and some sessions may last only a couple of minutes. Extended breastfeeding (breastfeeding exclusively for the first 6 months and thereafter as long as the child desires) is associated with better development of facial structures, reducing the need for orthodontics in children nursed over 18 months. Family-friendly solid foods can be introduced starting at 6 months of age. For more information on introducing solid foods to older babies, check out this website:

Whatever your parenting style, know that it is possible to grow and adapt as time goes by. You are not committed to one style of parenting forever. You can compromise and change as you need to. Love, after all, is the most important gift that you will ever give your child.

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Tools for Breastfeeding

I often get asked this question by pregnant women: “What are the essential tools I need for breastfeeding?” My answer is almost always this: At least one breast and at least one healthy term baby. That’s it! Provided everything goes well with birthing, you are able to avoid mother and baby separation and you are able to keep your baby skin to skin, things should go well.

Sometimes they will follow with this question: “But what things do I need to know or know how to do?” My answer is this: Get comfortable with handling your breasts and nipples. Review reverse pressure softening and hand-expression, especially areolar expression. Review breast massage. Watch some YouTube videos on baby-led latch. Talk to your partner about protecting you and your baby so that you have the private time you will need for learning.
Breastfeeding is a relationship between mom and baby. All relationships require one on one time to foster closeness and confidence. Pregnancy is like a Facebook romance where you communicate only with pictures – and the other party can’t speak back to you! You make a commitment to that person before you ever meet face to face, know what they really look like or anything substantive about their personalities. You sign the marriage contract (like an arranged marriage) with a vast unknown before you. You consummate the marriage – and then you begin to learn about your partner.

The next question I may get is this: “But what if there are issues? Are there any products or supplies you would recommend to have on hand, just in case?” Here is my list:

1. Breast pump – double electric. If your baby has some issue that makes it difficult for her to attach and draw milk from your breasts AND you need to establish your milk supply, I strongly recommend temporarily renting a Symphony from your local rental agency. You can use your breast flanges and attachments from a Medela personal pump, but will need to purchase a conversion kit if you have not received one from the hospital. Breast milk supply potential is established in the first four weeks of breastfeeding. Failure to remove milk from the breasts signals lactocytes to shut down production. It is easier to protect your supply from the beginning than to try to rebuild a supply later on. Medela Pump In Styles are my favorite personal pump, but I will admit prejudice. Your insurance company may provide you with this. This style of pump was designed for helping moms transition back to work and for occasional use when you have a healthy nursing baby.

2. Tendercare Hydrogel Pads by Medela. These are sold online, by Target, Baby’s R Us and hospital boutiques. For sore nipples. There are other brands but Medela pads can be cut in half to go further, if needed.

3. Microwave sterilizer bags. These save a ton of time if you need to sterilize/clean breast pump parts, pacifiers, bottles etc. You may never need these for your baby. They make great bags for steaming broccoli and other vegetables if you don’t need them for baby supplies. And they’re reusable!

4. Nursing pads – disposable or re-washable. Soft cotton pads are very comforting especially if your nipples are sensitive but not sore.

5. Bacitracin. A great topical antibiotic for scrapes and cuts and useful, should you need it, for treating nipple trauma.

6. Ice diapers. Make these yourself. Take 4 disposable diapers. Open them out and wet them. Drape them over a cup in the freezer. These are great for soothing tight breasts throughout the engorgement period.

7. Nursing support pillow. There are lots of styles and brands. One of my favorite is the Boston Billow. This can be found on-line and in stores (check with the website). Additional pillows, some firm, some more adjustable, may be needed. Make your own wrist support. This can be made from a long tube sock filled with rice and tied off. The wrist support can be placed strategically to help support your hands, arms and the baby during the first few weeks while baby is unable to support his own head.
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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.

 

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5 Reasons Breastfeeding is better than Formula

 

You’ve heard it all over the place: breastfeeding is best for your baby. I’m going to disagree. Breastfeeding is the NORMAL way for babies to be nurtured and nourished.  Here’s why.

  1. It’s the normal diet of newborns.  All substitutes for mother’s milk are simply imitations of the original.  But when you try to imitate something – don’t you want the perfect example to start with? That’s hard when it comes to mother’s milk. Why? Because every mother’s milk is custom-made for her individual baby! And it changes according to the baby’s needs, age and environment. Breast milk composition is affected by direct breastfeeding. That’s because the mother’s breast vacuums up little bits of the baby’s saliva which contains information about baby’s system. The mother’s antibody manufacturing system then creates what baby needs and drops it back into mother’s milk for the next feedings. Breast milk is dynamic – not a static substance. As the baby gets older, content changes also with more fat for older babies who tend to spend less time at the breast and need their meal to be “on the go”.
  2. It’s the normal function of breasts. Breasts were designed to make milk. A mother stores some fats during pregnancy that are meant to provide nutrition for the coming baby. These fats are moved out of mom’s body during breastfeeding. Breast milk proteins, sugars, vitamins and minerals are consistent. Mother’s body produces the right type of milk for the baby – even when her diet varies! Failure to breastfeed may result in retained pregnancy weight. Mothers who do not breastfeed are at higher risk of metabolic syndrome, Type 2 diabetes, breast and ovarian cancer, etc. This is an area of research that has only just begun.
  3. It’s the normal location of babies. Babies are not just fed at the breasts. They learn to enjoy closeness to another human being. They listen to mother’s voice, hear her heartbeat as they did in the womb, and associate the feeding experience with comfort and security. Held close to mom, they observe the world and its newness in a safe location. Skin to skin care (the kind that happens naturally in natural breastfeeding) allows baby to use his energy resources for feeding as mother supplies warmth and support through her body.  Not only that, but the mom’s skin transfers healthy bacteria to baby’s skin which forms a first-line defense against stranger bacteria.  This benefit has been identified as one factor in reducing allergies and asthma in later life. This is important for all babies, but particularly those who have been born by Cesarean section or separated from their moms at birth for medical care.
  4. It requires a minimal amount of financial resources. Breastfeeding is less expensive. The extra food mom requires to breastfeed is much cheaper than buying formula. Even if moms need help learning and getting through rough patches in the beginning, the cost of formula is not declining. And there are hidden costs of formula that do not occur with breastfeeding – such as bottles and cleaning utensils, energy for water and cleaning, use of materials for making formula and bottles etc. Someone pays somewhere – whether it be through working a job to earn the money or through tax money supporting the “free” formula available through WIC programs. A standard-sized container of powdered formula will last about 1/2 a week and may cost up to $30. Babies under 2 months should only be given ready-to-feed formula because of the chance of contamination of powdered formulas. This is even more expensive. Babies who are breastfed have fewer infections and this also results in fewer doctor visits with co-pays, etc.
  5. It provides baby with a normal immune system. More and more research is being done to link “gut” health and overall health. Breast milk provides epigenetic factors that help a baby recognize what is “normal” and what is not. This helps reduce allergies, asthma, and many other auto-immune diseases as well as providing protection from casual infections in the baby’s environment. It is now believed that continued breastfeeding while introducing family foods during the second half of the first year helps to reduce the incidence of food allergies.  In addition, when babies who are breastfeeding receive their immunizations, the breast milk helps baby’s immune system have improved results from the immunizations. IQ, dental health and many other factors in a baby’s general health are affected by breastfeeding. When breastfeeding continues through toddler-hood, maximum benefits of breastfeeding are extended.

In summary, breastfeeding is the normal way by which babies move from the world of the womb where they are protected and fed by the placenta. As baby grows, he moves from being a totally dependent individual to an independently functioning individual. Breastfeeding provides that first step that takes this new little human being from the womb to the world.Continue reading

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