Crucial Breastfeeding Advice for Expectant and New Mamas
Let me preface this note with this: when it comes to feeding your baby, you have to do what is right for you. If breastfeeding works for you, Great! If formula feeding works for you, Great! There is no shame in doing what you feel right for your baby.
If you are not sure breastfeeding is for you, or you want more information on breastfeeding after birth, please please please check out the rest of this post. I have been a member of different breastfeeding groups since before Chulengo was born and a lot of the same questions come up. These were the same questions I had when I first started out. So, there is information in this post that will pave the way for a successful nursing journey.
Because Chulengo and I just celebrated one year of nursing, I want to discuss our breastfeeding journey and the one key to our success. If you are pregnant or newly postpartum, this post is for you!
So, over this past year of nursing, Chulengo and I have had our ups and downs. There were days when we nursed without skipping a beat and other days when we both ended up in tears, frustrated with our nursing journey. Some of my highest highs and lowest lows of life revolve around this past year of nursing. Lying in bed two-weeks postpartum shivering with a painful breast due to mastitis was a very humbling moment for me. Holding my breath and counting to 10 as he painfully latched on during the first couple weeks, was difficult to endure. But, seeing my son grow before my eyes from the nourishment I could give him was incredible. Having many opportunities during each day to cuddle and have skin to skin time while nursing cultivated a strong bond with Chulengo.
When Chulengo latched on for the first time, I remember thinking, ohmygosh I’m breastfeeding. It was just happening. Holy cow. Took my breath away a bit. Do you remember the scene from Anchorman, with Will Farrell? When he says “Hey everyone, come and see how good I look!” Well, picture Chulengo latched on for the first time, and I am wanting to say “Hey everyone, come and see us breastfeeding!” Haha!
Breastfeeding was one of those things I never really thought about until Chulengo was literally latched onto my breast immediately after he was born. I had participated in discussions and also read up a little bit on nursing information, but I never really mentally pictured myself doing it. I had no clue what to expect. I quickly learned that when it came to breastfeeding, there was no more accurate saying than “You don’t know what you don’t know.”
I have surpassed my goal to nurse for at least a year, even though it wasn’t always pretty. I owe our successful nursing journey to one thing… regular contact with a qualified Lactation Consultant.
I met Summer Friedmann, my Lactation Consultant, at our first Bradley Method class when I was five months pregnant. When we showed up for our first class, Summer introduced herself as our teacher and mentioned she also was an International Board Certified Lactation Consultant. During our course, we discussed all the different aspects of prenatal care, labor & birth, and even touched based on the postpartum life, including breastfeeding. Over the 12 week course, I had developed a fondness for Summer, as she approached everything with a very relaxed attitude. She supported her statements with research. Which, if you know me, I research everything!
Once Chulengo was born, Summer transitioned from my Bradley teacher to my Lactation Consultant. She came to our home when Chulengo was just a week old. She took a look at our nursing mechanics and offered advice on how to make it better and more efficient. Nursing was very painful during the first week, and I wanted her to help me become more comfortable with breastfeeding. Summer spent a couple of hours with Chulengo and me. She looked at his latch, taught me new positions to nurse comfortably, and gave me invaluable insight on how to continue nursing successfully. That night, as I nursed Chulengo, there was a feeling of peace that had come over me. Chulengo was latching more comfortably. Summer had instilled a confidence in my nursing that I was lacking. I knew I had an ally, a truly educated and properly credentialed professional to reach out to when needed.
Now, I would be joking if I were to say that nursing was all rainbows and butterflies after our consultation with Summer. She was able to help me build a solid foundation for nursing, but there were many days and nights that I reached out to Summer desperate for answers to my nursing questions. Each time she responded to my questions with a calm, logical answer. Honestly, I don’t think I would have made it this long if it weren’t for Summer’s guidance. There were plenty of times I thought I couldn’t continue or Chulengo was self-weaning or I wasn’t producing enough milk. Regular contact with Summer is the only reason I have been nursing for over a year now.
So after my long winded history on my nursing journey, I want to get to the point of this article. Looking back on this past year, I have realized there is a lot of misinformation and lack of support out there regarding breastfeeding, especially in the first few weeks postpartum. Yes, we can read books and articles, but having a face to face meeting with a lactation consultant can be life-changing. Imagine if you were trying to learn how to perform CPR. You could wing it and see how you do on your own, but how much more successful would you be if you were to reach out to a professional for advice, tips, and coaching. The same should be with breastfeeding — a lifeline for your baby.
When you become a young lady, you start seeing a gynecologist. When you are healing from a back injury, you see a specialist. When you start nursing, you should work with a qualified Lactation Consultant. It’s very easy as a new mom to question your body and lack the confidence to continue nursing. I was so lucky to have met Summer when I did.
So, I want to pass on the knowledge that Summer has taught me. This past week I asked Summer to re-answer the questions that I had during my initial weeks of nursing. Please enjoy and share her priceless, extensive, thoughtful, and extremely informative message below:
To answer Lisa’s questions, one has to understand the very basics of milk-making. Many people have heard “supply and demand,” but they don’t often truly understand what this means. I’m going to help you. Who am I? My name is Summer J Friedmann, and I am a Board-Certified Lactation Consultant (IBCLC), a La Leche League Leader, and formerly (14 years) a Certified Bradley Educator in the Bradley Method of Natural Childbirth. I have worked with several thousands of families over the last 14 years. For the last nine years, you can find me in the postpartum unit or the NICU in one of Kansas City’s largest teaching hospitals working as a Lactation Consultant, or in my private practice visiting with moms in their homes. I am a mom to three (of course breastfed!) boys, who are now surpassing my own height and that freaks me out! As you may expect, I am an extremely passionate woman who loves to help other women find the joy in breastfeeding, as I did. So that is who I am! Let’s get to talking about some of the stuff I love to talk about and get you to reach your own breastfeeding or breastmilk-feeding goals! You can find more information on me and my practices on my website here: www.donenaturally.com
The baby is the smartest one out of us, and we have to trust the baby, AND trust our body! Those of you that know me hear me say that a lot! Babies know what they are doing, and often, our adult minds can get into our own way, which can create many of the concerns listed above.
I will start by explaining how our body produces milk. Around 24 weeks pregnancy gestation, our body makes colostrum, the first milk. It isn’t until after the birth when the placenta detaches from the uterus, that our body’s drop in hormones signal to produce, what I call, the BIG milk, others call mature milk. This mature milk arrives somewhere between day three to five, depending on if this is your first child or a subsequent child. Everyone makes colostrum. It is impossible to be pregnant and not produce colostrum. How much mature milk a mother will have depends on one thing, the baby! This is where supply and demand come into play, or what I call, milk removal. The more milk we take out, the more milk we will produce. Who takes the milk out? The baby; either by nursing or if not, by a mother pumping.
Here is the kicker I want you to know; our milk supply is determined within the first 2-3 weeks after birth. However much milk we will make FOREVER, is figured out within that first VERY important 2-3 weeks. I explain it like building a house, a house of milk! When you build a house, you have to build the foundation first, before anything else. That foundation will support the size of how big that house will be. Each foundation needs to be a different size for a 4-bedroom, or 6-bedroom house, or 1-bedroom house. For the house to work, we have to know that information in the beginning as we are building the foundation. If someone builds the foundation, starts building the house, and months down the road decides to add a bedroom or a bathroom, it can’t happen. We’ve passed that point, and it won’t work because the support for that addition wasn’t built from the start.
Why is my baby drinking so often? Is he not getting enough?
So let’s return to breastfeeding. In the early days and weeks, it is imperative that a mom allow the baby to nurse ANYTIME and EVERY TIME they cue or desire because every one of those nursing sessions is laying down a brick in the foundation of her house of milk. Even just comfort nursing is laying down the groundwork for her milk supply. This usually means a baby will be nursing about 20 hours out of the 24 hours of the day. I am not exaggerating! They do this by instinct! They know the more they nurse, the more milk they will have made for themselves. And they want a large milk house to live in forever! Keep in mind, it is impossible to overfeed a breastfed baby, so truly, when in doubt, breastfeed them. Once we pass the 2-3 weeks window of time, we cannot increase our milk supply. It is set. The house is built. So relax, follow every one of your baby’s cues, lay back, and just allow the baby unrestricted time at the breast. It will do you both good.
Someone may ask, what is a breastfeeding cue? A feeding cue is anytime they place their hand, fist, finger into their mouth, or when they play with their tongue, sticking it out, swirling it around or just opening their mouth and rooting; turning their head from side to side in search for a nipple. When you see ANY of these, it is time to breastfeed NOW. And yes, you’ll see your baby doing that all of the time, and yes every time it is time to breastfeed. Remember, you are laying down your foundation for your house of milk! So don’t doubt it, just do it!
Now someone will ask, do they always nurse 20 hours out of 24 hours? Of course not. Phew! They will eventually fall into a pattern that will be more predictable and allow for more rest and non-nursing time. But that will be up to the baby. They will naturally fall into that pattern; it should not be directed by parents. And normally that is going to be somewhere around the 8-12 week mark, and many much sooner.
When do I need to stop waking my baby to nurse?
Now the always asked question, do you wake the baby to nurse. The answer is yes and no. In the first 24 hours, when they are naturally sleepy, yes. If it has been a few hours and they haven’t cued or nursed, then you attempt to wake them and offer a breastfeeding. It doesn’t mean they will. Maybe they won’t; they may still be too sleepy, and that is ok. If you can’t wake them after spending 5-10 minutes trying, then stop and re-try in a few hours. But waking a baby for feeding is a very short-lived problem. There are exceptions like premature babies or early term babies; under 38 weeks, jaundice, or weight loss, and those are another discussion for later.
Healthy full-term babies wake up a lot, so it is usually us wishing they would sleep longer, than the opposite. Eventually, your milk will come in, and if they do sleep longer, your breasts will become so full and engorged, and uncomfortable. At this point, you will have every selfish reason to want to wake them up and breastfeed. So usually this “problem” takes care of itself very quickly. And you have a baby who is very interested in building your house of milk by nursing every hour or for hours long, or even cluster feeding back-to-back. And all of those are really good things that get us what we want. We get a baby who is growing, gaining weight, and a mom who has a super milk supply that will help her baby grow for at least the 1st year of life or longer.
So hopefully this answers many of those above questions. The problem again is our adult brain, not the baby. If your baby is fussy, and they just nursed, put them back to the breast. Adults have the idea in their head that babies nurse every 2-3 hours. Which to an adult means: 12:00, 3:00, 6:00, 9:00 and 12:00. Or 12:00, 2:00, 4:00, 6:00, 8:00 etc. This is not how babies function. They do not know math. They are not predictable at these early few weeks of age. They are instinctive. So trash those adult brain ideas, and just expect that your baby will cue and then you will nurse until they fall off the breast and are done until they cue again.
In fact, not looking at the clock, may do you some good. But you can see the misunderstanding how milk making works, and the misunderstanding of how the early days of production work, can push moms into unnecessary worry. I hear things like, “Why is my baby rooting, we just finished feeding 15 minutes ago?” Or “She’s been nursing for 45 minutes, she has to be full, can’t I take her off?!” Or “I’m just going to give her a pacifier because she nursed an hour ago and she shouldn’t be hungry yet.” Or “My baby is greedy, never seems satisfied, and that must mean I don’t have enough milk since they always want to nurse.” These are all comments made by our adult brain and made from a base misunderstanding.
Now that you know about the house of milk, doesn’t it make sense why the baby is doing what they are doing, and why it is vital to follow their lead? Isn’t it neat to see how the baby is smarter than we are, and they teach US? Trust them!
Speaking of pacifiers, why do we want to avoid them? Because they interrupt the building of your foundation for your house of milk. More time spent sucking on a pacifier means less time spent at the breast sucking. The pacifier doesn’t make any milk, so the baby is sucking on the pacifier trying to tell the pacifier to make milk, which it won’t; Instead of sucking on the breast where it does tell the body to make more milk. See where the trouble begins and how this can lead a mom to have a low milk supply? Not to mention it wastes precious energy of the baby, and can contribute to more weight loss, more jaundice, and possible trouble with latching.
How do I know if my baby is getting enough milk? He never seems satisfied. How do I know how much milk my baby is getting?
Now onto the next most common concern mothers have; how do I know how much milk the baby is getting, or if they are getting enough…I can’t see the milk go in! We can tell, and we can even count, but with breastfeeding, we count what comes out, not what goes in. Diapers, diapers, diapers! That is the answer! If enough milk is going in, enough diapers will be coming out. Super simple ladies! In the first 4- 5 days, they need to pee and poop as many days old that they are. If they are 1 day old, they need 1 wet and 1 poop; if they are 3 days old, they need 3 wets and 3 poops. 4 days old means 4 poops and 4 pees. And in these first 5 days, it moves from dark sticky black meconium to a bright and runny/watery yellow color. And the colostrum makes that happen.
A mother’s colostrum is a laxative, so the more a baby nurses, the more a baby will poop and the faster it will transition from dark sticky black to runny yellow. By day 5 of life, a baby should have 5-6 wets every day (24 hours), and about 4 quarter-sized yellow poops every day (24 hours). And that doesn’t change. It stays that way as they age. Now that’s a lot to remember, so I would like to explain a shortcut. Four quarters is one-dollar, right? Right! So, once you’ve reached day 5 and yellow poop, your baby will need to poop one-dollar every day! And it doesn’t have to be 4 separate poops. It can be one poop that is the size of 4 quarters all-together. So even if they poop once a day, as long as it is as big as one- dollar, it is enough! Now saying that most breastfed babies will poop like $20-$30 per day. Parents seem to be always changing a diaper with poop that spilled out of the diaper and up the back. That’s a healthy, well-fed and growing baby!
So again, how do you know if your baby is getting enough milk? If they are pooping at least one-dollar per day, and wetting at least 5-6 diapers per day, they are getting enough milk. That it! Isn’t that wonderfully simple?!!!!
My baby is fussy when he nurses, does that mean I am not giving him enough milk?
And I need to say, getting enough milk has nothing to with a baby’s behavior. What do I mean? I mean, you can have a fussy baby, and still, the baby is getting enough milk. Remember count the diapers! Fussy is just annoying, and no one wants that, but it has nothing to do with how much milk a baby is getting. Babies are born with a temperament, and sometimes that temperament is more stubborn, or needy, or loud. Many parents with elementary-aged or teen children, can now look back at the baby stages with that child and recognize that the way the child acted like as a baby makes a lot of sense with their personality as an older kid. Just trust those diapers! They are the proof you need!
Should I give my baby a bottle if it doesn’t seem like he is getting enough milk?
Every situation is different. If your baby needs more milk, then a way to get that milk into him is by a bottle. But many moms think they don’t make enough milk, when really they are, and it is just misunderstanding that leads them to this (incorrect) thought. Anytime you give your baby a bottle; the mom has to be pumping at the same time. We call this matched pumpings. If your baby is away from you, or someone else is feeding them even while you are home, you have to pump at the very same time. You and your baby are channeled together. Your body needs never to know the baby is away from you. It cannot know the difference between a day with your baby and a day without your baby.
You can’t ever go longer without nursing or pumping without risking reduction in your milk supply. Even those sweet gestures from dad to feed the baby a bottle of pumped milk at 3:00 am to let you sleep longer, you should not accept. If your body skips a feeding (or pumping), you will become full, engorged, get a plugged duct, or worse mastitis. Each one of those things is a signal that you don’t need that milk anymore (since you didn’t take it out), and it will reduce your milk supply. So, yes, anytime your baby gets a bottle, you are pumping too, girls! Protect your milk supply!
Now ideally, we are not giving any bottles until both our milk supply and latching are well established. I tell moms to wait at least 4-6 weeks before introducing any nipples other than moms. After that, any point it is fine, just make sure you are pumping too. And if we are giving bottles during the foundation phase of milk supply, in that first 2-3 weeks, that is riskier, especially if that mom isn’t pumping in place of the feeding. If she gives the baby a bottle just because he wants to nurse too much, or “isn’t ever satisfied,” then that is where we’re in trouble. Her body will not produce the milk the baby needs, and it can be a slippery slope from there, and closer to weaning.
Someone once told me a good way to think of it is: during the first 2-3 weeks, every ounce of formula that the baby drinks, is 1 ounce of breastmilk the mom will never make. UNLESS she is pumping and matching feedings with pumpings. Then she is saving, protecting and prioritizing her milk supply.
Why is my baby spitting up so much? Is my milk bad for him?
Some babies spit up, and some babies don’t. Neither is a concern unless the baby is losing weight. Otherwise, if they are gaining weight, have enough diapers, and otherwise well, spitting up is merely a laundry problem, as Dr. William Sears would say. It is annoying, but certainly not a medical problem nor reason for concern. Some babies may get a little more than they bargained for, especially if a mom has a healthy let-down reflex, or if she has had other children before and therefore has a much larger milk supply. Sometimes a little milk comes up with some gusto just because it came up at the same time as a burp. But really, not a concern.
How do I know if my baby has a tongue tie or lip tie? When should I see a lactation consultant?
If breastfeeding is painful or latching seems irregular — this is an appropriate time to see a Lactation Consultant. She can observe a feeding, perform an oral evaluation for the baby, and discuss your specific situation with you. I will tell you that breastfeeding should never hurt. But it is a very new sensation. When a baby is latched on properly, a mom should be able to breathe normally and speak normally, and she should feel tugs, pulls, pressure, suction, stretching or yanking. She should not ever feel anything sharp or pinching or slicing or cutting, or anything that makes her hold her breath or resent feeding time. If she is feeling this, something is not quite right. It could be the anatomy of the baby, it could be the anatomy of the mom, or positioning could be incorrect. But this is definitely a time to see a Lactation Consultant, and she may refer you to an oral surgeon or ENT who can diagnose and possibly perform the release.
Tongue Tie, aka ankyloglossia, is seen when the tongue cannot make the proper movement to latch properly and properly remove milk because the frenulum underneath the tongue is holding it down, restricting it. If a baby is gaining weight, a mother is pain-free, and her nipples are healthy and intact, and the baby has enough wet and poopy diapers, nothing is wrong. I repeat, nothing is wrong, and things are working.
If the baby weren’t latching on properly due to a tongue tie, the mother’s nipples would be bleeding, cracked, and worrisome. If the baby wasn’t latching properly due to a tongue tie, the baby also wouldn’t be getting enough milk, and wouldn’t be having enough diapers. I will say, it is not always about what the tongue and frenulum look like. Babies can have a frenulum that appears to be restrictive but does not get in the way with proper latch nor proper milk removal, and mom’s nipples are happy. That is ok and may not need to be released. But anytime we have a mother’s nipples that are unhappy, a baby with weight loss, and a baby without enough diapers, that is the time to see a Lactation Consultant. She can then evaluate and see what the problem(s) may be and help move you down the right path.
May I also say, lip tie does not usually interfere with breastfeeding. It can be a cosmetic concern when, later, eventually teeth come in with or without a space between. But physically is not usually problematic for breastfeeding. Why? The upper lip and gum have nothing to do with sucking. The tongue does the movement to remove milk. But there is nothing that goes between the upper lip and the upper gum. Nothing. No nipple goes there, nothing. So if a lip is tied, it will not have anything to do with nipple pain at all. The only time it can interfere with breastfeeding is if it is tied to a degree where the baby cannot seal onto the breast for latching. In this case, we would have a baby who can never stay latched on and is constantly on and off after a few seconds. Simply because it can’t perform a seal. But a lip tie does not cause nipple pain at all. So if you hear that, it is incorrect. And to have a lip tie that is severe enough to interfere with the seal, would be very rare.
Can I have a glass of wine when I nurse?
Now onto another common question. Is drinking while breastfeeding safe? Yes, yes, it is. The concern has never been about the alcohol in the milk; the concern is can you care for your baby? The amount of alcohol in your milk is considered sub-clinical, immeasurable, clinically irrelevant even with large amounts of drinking. But when you drink large amounts, you shouldn’t be with your baby, and you should still be pumping at the same pattern to maintain your milk production. Pumping and dumping milk is a long-standing myth. It is so very rare ever to need to discard breastmilk.
Healthy and moderate drinking is healthiest for everyone, non-breastfeeding mothers included. But yes, you can drink as you normally would, and breastfeed your baby as you normally would, without doing anything different, special or any waiting and certainly not any pumping and throwing away! Many moms have heard me say, you should be able to be a mom who happens to be breastfeeding, not a breastfeeding mom who has to do certain things, or not do certain things. You can be normal and just happen to be a breastfeeding mom. Isn’t that great! That’s what everyone around the world does and so can you! For a more detailed response to alcohol and breastfeeding, read on here at my website: Alcohol & Breastfeeding Article – DoneNaturally.com
Why is my baby biting when I nurse? Is my supply low?
Some babies bite when they nurse because they are teething and using mom to gum on. Some babies bite because they are bored. Sometimes they bite because the fast initial let-down that every mom has, went away, and they want it back, and they are assertive talkers about that. But biting definitely does not mean a milk supply is low. If you’re wondering about your milk supply, count those diapers!!!! Babies can bite for many different reasons, and for some reasons we may never figure out. So save your worries for something that really matters, not this.
What books do you recommend for the breastfeeding mama?
I have lots of great book ideas for the breastfeeding mama.
Breastfeeding Made Simple by Kathleen Kendall-Tackett & Nancy Mohrbacher
Working and Breastfeeding Made Simple (by the same prior listed authors)
Hirkani’s Daughters by Jennifer Hicks
Nursing Mother, Working Mother by Gale Pryor and Katherine Huggins
Bestfeeding by Chloe Fisher, Mary Renfew and Suzanne Arms
The Breastfeeding Book by Dr. William Sears
***Happiest Baby on the Block by Harvey Karp
No-Cry Sleep Solutions (book series) by Elizabeth Pantley
The Baby Book by Dr. William Sears
Nighttime Parenting by Dr. Sears
The Attachment Parenting Book by Dr. Sears
***Baby- Led Weaning by Gill Rapley and Tracey Murkett
…and the list could go on and on.
***Also recommended by Move Mama Move