9 Important Things To Know About Breastfeeding

mom and doula with yoga ball

While you can’t predict or plan for most things in your birth, there are nine important principles that will keep you breastfeeding through nearly any problem.

Here is a cautionary tale from one of my clients who did not follow any of these principles. Their names have been changed.

Jackie’s body hurt everywhere.

Her back hurt, her bottom hurt, her nipples and breasts hurt. She was in the hospital being observed for pre-eclampsia, because she had a slight headache and elevated blood pressure. Hopefully they would let her go home soon.

Jackie and her partner, Adam had labored for three days at home and two more in the hospital. She had pushed for 3 hours before Ava emerged, blue blushing into pink, covered in vernix. Their little warrior was perfect and she breastfed right away. Ava had looked at Adam and Jackie with interest, and she was surprisingly quiet. For the past two days, she nursed regularly receiving colostrum, waiting for Jackie’s milk to change and increase. The change was happening.

Three day old Ava suckled blissfully and fell asleep.

She was milk drunk with dribbles in the corner of her mouth. Her long lashes fluttered slightly and her arms lay open, limp, a slight smile on her lips. Jackie gazed in awe. She loved her so much. She didn’t know at the time, but they would never breastfeed again.

Her husband Adam tucked Ava into the bassinette and Jackie leaned back in her bed, exhausted. She fell into a deep sleep. She barely noticed the night nurses checking on her and Ava. Adam watched his tiny family sleeping for awhile, before he too fell asleep.

Early in the morning, her breasts were firm as melons.

She tried breastfeeding Ava, but Ava was super sleepy. She would root and suckle, and then fall back asleep. The nurse brought them ice packs, hot packs and a breast pump. The ice felt great! She pumped a small amount of milk and felt a little better. The nurse instructed Jackie to pump every 3 hours.

The pediatrician came to check on them. She explained that Ava had jaundice and this was causing her to be so sleepy. Ava would need to go under bilirubin lights for a few hours to bring down her bilirubin levels. They would check her again, after. The doctor also recommended a formula feed or two, to reduce Ava’s bilirubin.

Things get better and more complicated.

Over the next 24 hours, Ava’s bilirubin levels decreased, and she was more awake, but at each feed, Ava would latch, and then she would either pop off and scream, or fall asleep. Jackie pumped milk to fill a bottle and Adam fed her. In between, they had conferences with their nurse, filled out paperwork, and got their final clearances to leave the hospital. They drove the 40 minutes home, stopping twice to soothe Ava with a bottle.

Jackie cried at the chaos they had left nearly a week before.

Their bed needed fresh sheets. There was a mountain of laundry. Week-old dishes cluttered the sink and counter. The dog-sitter brought their dog home. Their dog was very happy to see them and very interested in Ava. Adam changed their sheets and started on the dishes.

Jackie once again tried to nurse Ava, who refused. She started pumping just before Adam’s parents arrived with flowers, champagne, bags of gifts for Ava, Chinese takeout and bagfuls of food to put away. They happily held Ava, chatted and fed her. Jackie moved to her bedroom so she could cry some more, and kept pumping. Adam tried to answer his parent’s questions while taking care of Jackie and putting things away.

He finally flopped on their bed, exhausted.

Jackie and Adam looked at each other. They felt lost. This was not how they thought it would be.

Late that night, Adam’s parents passed Ava over to Adam and left for their hotel. Ava cried and then screamed, when Jackie held her. Adam brought her a bottle and Jackie fed Ava and Adam walked her until she fell asleep.

Jackie continued pumping.

She fed Ava all her milk and supplemented with bottles of formula, because Ava seemed insatiable. This went on day after day. Days drifted into weeks. She stopped trying to nurse. Then she stopped holding Ava skin-to-skin. The amount of milk Jackie made decreased, and at four weeks, she stopped pumping. She felt defeated and sad. She wondered if it could have gone a different way.

Could this have gone a different way?

I believe that if Jackie had followed these important ideas, she would still be breastfeeding.

1. Breastfeed first

Before you do anything that isn’t breastfeeding, breastfeed your baby. If you and your baby are separated, hold them skin to skin until they breastfeed. If you need to sign papers, breastfeed first. If you need to supplement, breastfeed first. Before changing a diaper, going to sleep, eating your meal, answering the phone, or taking a shower, breastfeed first, even if it’s just for a few sucks. If your baby won’t breastfeed, hold them skin to skin until they do. If they don’t, get help.

Breastfeeding takes practice for you, and for your baby.

All these tiny, short sessions give the both of you time to practice without getting tired, and hopefully, without getting frustrated. The more you practice breastfeeding, the sooner you will be successful. Your body responds to your baby by relaxing and making more milk. When you relax, your baby can relax and breastfeed. Breastfeeding feeds, calms and relaxes babies. When your baby is relaxed, you can relax and breastfeeding becomes more comfortable. When you figure out how to comfortably nurse, breastfeeding then becomes relaxing for both of you.

2. Remove milk to make more milk.

During the first few months, your breasts fill up, and your baby empties them. You may be tempted to wait for your breasts to fill up before you nurse or pump. But, when your breasts are full, your body slows down your milk production. Waiting actually causes your milk production to decrease.

If you exclusively breastfeed, your body will usually make the right amount of milk your baby needs– not too much, and not too little–though it takes a few weeks for production to be “just right.” If you breastfeed and pump frequently, your body will make more milk.

Your breasts make milk two ways: ‘continuously’ and ‘on-demand’. In the early months, continuous production gives you full breasts so your baby doesn’t feel frustrated and give up. By six months postpartum, milk is mostly produced on demand while your baby nurses. Your everyday fullness decreases, and each time your infant or toddler nurses, your body will make 2 to 6 ounces of milk in the time that they are breastfeeding.

3. Breastfeeding should be comfortable.

If you aren’t comfortable, there are three things to explore..

First and most important, is positioning. Support your baby with your body, not your hands. Align their ear, shoulder and hip with their belly flat against you. You should be leaning back, in a comfortable supported position.

A safe and comfortable chair is a worthwhile investment.

Some people like gliders or rocking chairs, but many more prefer a reclining and/or rocking armchair. You should feel supported, and your feet should rest on the floor. Choose a chair with firm cushions, and smooth surfaces, to minimize risk of suffocation. Fill crevices with foam blocks to reduce chances of your baby becoming entrapped.

Second, invest in some kind of bodywork to unwind and balance your baby’s scrunched up body.

A baby can compress your nipple when their body is twisted or scrunched. Torticollis (wryneck) is a common example of this, but even mild misalignment can cause nipple pain.

Your baby spent the last couple months curled up in one position, without moving much. This can cause molding in their skull and asymmetry in their body. They probably were not handled gently as they pushed or were pulled through the birth canal. This can cause them to lock into a twisted body posture. Cranial-sacral therapy, chiropractic, physical therapy, and massage are all gentle, non-invasive therapies that can help a baby release tension in their body.

Third, your baby may have a tongue tie, or other attachment, in their mouth.

This can cause them to move their tongue and clench their mouth in ways that hurt your nipple. A pediatric dentist or ENT can release or revise tongue ties.

4. There is only one number that matters and it’s not how much you can pump.

The biggest worry new mothers have is not having enough milk.

When a baby isn’t gaining well, many pediatricians suggest the mother pump her milk, “to see how much she has.” This is useless advice, and often upsetting. When you pump, it shows how much milk you are able to pump, not how much you can make. Many mothers won’t have good results the first few times because pumping is a learned skill.

A mother can have plenty of milk, but if her baby isn’t able to nurse well, they aren’t drinking enough milk. Because her milk is not being removed, it will start to dry up.

Many mothers decide to pump and bottle feed, so they know exactly how much milk baby is getting.

This is a bizarre idea. Pumping and bottle feeding is the most time-consuming way to feed a baby.

How do you know how many calories your milk has? How do you know how many calories your baby needs? How do you know when your baby has eaten enough? How do you provide for their comfort when they are full but still need to suck? Why take a chance on setting them up for weight and eating problems later in life?

There are some very good reasons to pump and bottle feed, but “knowing how much” is not one of them.

Measure the baby’s weight. It’s the only number that shows they are getting the right amount of food.

When a baby breastfeeds, they know when they are full, and they stop eating.

When they are hungry, they ask to nurse. They can’t overeat by nursing all the time, because they control the milk flow by slowing down suckling when they are full. Suckling for comfort gives comfort and very little milk.

Breastfed babies do the same thing when they start eating solid food. They stop eating when they are full. Research backs this up. Babies who breastfeed on demand generally don’t have weight issues when they grow up.

It’s hard to shift into this thinking!

It stirs up all kinds of anxiety because American women are body shamed in childhood with unrealistic images of women touting endless dieting, and working out. Because we learn unconsciously, it feels normal. But it’s not normal and it’s not healthy.

5. Receiving the right support, at the right time, is crucial.

You may wonder what “support” is and why you need it.

Support is education, encouragement, medical care, laws and policies that help women breastfeed with confidence. Research shows that mothers who have the support of family, medical and peers, continue breastfeeding through their challenges. They nurse longer and are more satisfied with their experience than women who are unsupported.

Support starts with your parents and your partner.

Pregnancy is a great time to educate your family and friends about why you and your baby are going to breastfeed. If they don’t know why you are breastfeeding, their doubt can infect your thinking, and you will wean earlier than you want to.

Maybe you want closeness, or protection from allergies? Maybe you want the protection from reproductive cancers and heart disease? Maybe financial concerns are at the top.

All the medical associations in the USA have breastfeeding goals and protocols.

Your medical team should be fully educated and supportive of your breastfeeding. Sadly, this is not the case. Pharmaceutical companies spend a lot of time and money educating them on the benefits of formula feeding. In addition, many perinatal professionals have no breastfeeding education, and no personal experience nursing their children.

As a result, when your breastfeeding starts to go off the rails, they will offer you non-breastfeeding work-arounds, instead of breastfeeding solutions. You may be:

  • Advised to pump, instead of scheduling a lactation consultation.
  • Prescribed a nipple shield, instead of learning better positioning.
  • Told to give a bottle of formula, instead of your expressed milk, or milk from a licensed human milk bank.

6. Search for answers from trusted sources.

The most trusted source of support is often breastfeeding communities. Whether it’s an online community, a Facebook group, a La Leche League group, or another. Mother-to-mother support is a way to find out how utterly normal your situation is.

A support group is the best way to effortlessly learn what is on the horizon with your breastfeeding. Others in your group are also dealing with episiotomy stitches, milk production, teething, sex, day care, first foods, and weaning. You will absorb tiny doses of knowledge, as you need it.

Examine where your online information comes from.

How can you tell a trusted source from predatory marketing? An International Board Certified Lactation Consultant (IBCLC) is the highest level of breastfeeding consultant and signs a commitment to practice ethically.

Organizations whose goals are evidence-based are La Leche League, Breastfeeding USA, the Academy of Breastfeeding Medicine, and WIC. Accurate up-to-date, evidence-based websites are LLLI.org, LLLUSA.org, KellyMom.com, and InfantRisk.com.

Avoid breastfeeding information and advice online when you see advertisements for formula, teats and bottle-feeding next to them. When mothers see images like this, research shows they stop breastfeeding earlier than when they don’t see them. Websites with ads showing bottle-fed babies are not promoting breastfeeding. A worldwide initiative called The WHO Code bans this types of predatory marketing.

7. Keep a good breastfeeding manual nearby.

A good breastfeeding handbook on hand is always useful. The best breastfeeding manual is The Womanly Art of Breastfeeding published by La Leche League International. It’s now in its 8th edition and still under $20.

This book has taught millions of mothers how to breastfeed, and answered their many, many, questions along the way. Unlike the internet, you can find good answers easily and comfort, as well.

8. Have some benchmarks on when to get help.

Sometimes “powering through” works, but usually it makes things worse. Don’t wait. The sooner you get the right help, the sooner you will be enjoying breastfeeding your baby.

While you are pregnant, look up IBCLCs near you. Call and introduce yourself. Ask how to make an appointment. How long does it take to be seen? How do they work with clients? Why did they become a Lactation Consultant? It makes it easier to connect for help after the baby comes.

Most hospitals have lactation consultants on staff, and many nurses have breastfeeding training. And, they all have opinions, which can be confusing. Pick a nurse that you like and try to follow only one set of suggestions when you start.

9. Set small goals for big results.

Over and over again, successful breastfeeding mothers say they succeeded by setting small goals, and no goal seemed too small. “Today, I will nurse until lunch, and then decide if I want to continue.” “Just for today” and “Two weeks” are the most popular goals. Make this your mantra: “Don’t quit on your worst day.”

If you do quit, think of it as a breather. Try to get your feet back under you.

Breastfeeding often goes awry. It does not mean you can’t start again. When you and your baby can be together again, undress and hold your naked baby on your naked chest, and relax together. If baby doesn’t start breastfeeding on their own after a few days of this, make an appointment with an IBCLC. Keep trying with their suggestions. The window to re-start breastfeeding closes around 3-4 months. That’s not to say, you can’t succeed, but the longer you wait, the more unlikely that breastfeeding will resume.

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