better beginnings

Wednesday, April 4, 2012

Breastfeeding: The Elusive “Good Start”

Just a few hours old, showing hunger cues, ready to nurse some more.

Pregnant women are bombarded with one clear message about feeding their baby: Breastfeeding is the way to go.  The known risks of formula feeding  are many and continue to grow in number. So, it’s really no surprise that most pregnant mothers plan to breastfeed their baby.  While many of those mothers attempt to breastfeed, very few babies are getting any breastmilk by the time they are 6 months old (in Mississippi, just 10.5%).  What happens?  Why are mothers who want to breastfeed not able to keep it up?

I admit it, I would like for all children to be blissfully breastfed for at least two years.  And, I would like this to happen in a world full of rainbows, kittens, and lollipops.  

Since that is highly unlikely, let me share what I would really love to see: I want moms to breastfeed as long as they would like to.  Let me just say that one more time.  I want you to breastfeed your baby as long as you want to.   I do not want moms to feel like they somehow failed, wonder what they “should” have done differently, or to suffer heartache over the end of breastfeeding. Empowerment is a running theme for us at better beginnings and breastfeeding shall be no different.  I want the decision to breastfeed AND the decision to wean to both be just that, decisions.  As a mom who has decided to breastfeed, does that sound like a worthwhile goal?  That you will breastfeed until you actively decide that you no longer want to. 

If you are pregnant, you have undoubtedly had friends tell you why they were unable to breastfeed. She was not able to make enough milk, her baby was crying for more, her baby started teething, she needed medication, her baby was sick, her baby was a preemie, she had to go back to work.  We are saying goodbye to all those reasons (and many more) moms feel like they “have to” quit. We are letting that go right here and now. Instead, we are creating a plan that puts all the decisions in your hands.  As the mother of your sweet bundle of love, you will decide if you will breastfeed and when you will wean.

I am going to assume if you are still reading, you are pregnant and want to breastfeed your child for a few weeks or longer.  In case you haven’t figured it out, there is a whole heck of a lot of information about breastfeeding out there, some good and some not so good.  In terms of scientific understanding and advice, we have learned a lot in recent years, and what your mother was taught about breastfeeding isn’t necessarily best. (Breastfeeding was at a low point in the 70s)  I’m going to give you the 3 steps that will help you to make that good start less elusive and more realistic:

STEP 1:  Prepare During Pregnancy
When your child is older, you will probably put a great deal of effort into developing a plan to provide a great education, develop his spirituality, provide good nutrition and fitness, or instill values.  Right now, you have just one thing that fills all his needs: breastfeeding. For the first days/weeks/months of life, Breastfeeding is Mothering.   It is important enough to prepare ahead of time. 
  •  Find a great breastfeeding book and mark pages for future reference when baby arrives. Take the book with you to your baby’s birth place. You don’t need to read the entire book, but read the parts about the early days and skim the rest. There is no need to memorize the best options for dealing with every possible road block that you may or may not encounter.  better beginnings clients have access to our library of books. Take a look at our favorites, and then buy the one that works best for you. My personal favorite is The Womanly Art of Breastfeeding, 8thEdition.  Love it!! 
  •  Take a breastfeeding class at your birth place. Most hospitals offer a free breastfeeding class. We’ve heard mixed reviews, but you will no doubt learn something in the class.  Maybe more importantly, you will gain insight into what resources your birth place offers.  Do they have a board certified lactation consultant on staff (IBCLC)?  Can you call or visit someone for help after discharge?  Take a look at this CDC document to learn more about what a hospital can do to support breastfeeding.
  • Attend a breastfeeding support meeting.  On the Mississippi coast, we have 2 La Leche League groups that meet monthly.  Find them and attend a meeting.  La Leche League Leaders are trained volunteers who want to help breastfeeding mothers.  By attending a meeting while pregnant, you will meet the Leaders and may feel more comfortable calling if and when you do need help. 
  • Build your support network, literally.  Don’t just make a mental note of breastfeeding resources; make an actual written list (perhaps in the cover of your beloved breastfeeding book). This may seem silly now, but those first weeks can be pretty hazy.  Having a written list that you or your support person can locate easily is important.  Include the names and contact info of good friends or family who were successful at breastfeeding (hopefully for at least a year), hospital lactation consultants, La Leche League Leaders, Breastfeeding Helpline (877.452.5324), your doula, your childbirth educator, WIC Breastfeeding Peer Counselor, Mississippi Breastfeeding Medicine Clinic  (check out their awesome “Notes” section of facebook) and anyone else who would provide you with excellent support and encouragement.

STEP 2: When In Doubt, Ask For Help
Let’s imagine for a moment that we live in that utopia I mentioned earlier.  All babies would be breastfed, mothers would work side by side and care for each other, the sun would be shining, and the little dew drops would reflect tiny rainbows everywhere you look.  You would have seen countless babies breastfed. You wouldn’t even have to think about how to hold the baby, how often to offer your breast, how to assess that she is getting enough milk or what to do when it hurts.  You would have seen all of this first hand your entire life. Breastfeeding would come natural to you. 

Well….ummm….let’s get back to modern day Mississippi.  You may have never seen a baby breastfed, but you have seen countless babies bottlefed and probably even fed a baby yourself.  In our culture, bottle feeding is more likely to “come naturally.”  The good news is you have a network of women that care about you, care about your baby, and want to help you breastfeed (remember, your wrote them down in Step 1).   Since you don’t live in a tight knit community with these women, they won’t know when you need help.  You have to ask for help when you need it.

When do you need help?  I can’t (and certainly don’t want to) list all the possible indications of a breastfeeding problem that needs help.  Instead, I will suggest you pay attention to yourself and your baby. Use your fantastic breastfeeding book so you know what is normal. (Step 1), and when in doubt ask for help. Even if you can’t describe a problem, but you feel unsure, overwhelmed or concerned, you can ask for help. As a person who helps breastfeeding mothers myself, I have never once thought that a mother didn’t need to call me.  If she called, then she needed to.  I have thought on many occasions, when a mother has shared with me how sad she felt when she “had to stop breastfeeding” because of X, Y or Z, “I wish she had called me.” 


STEP 3: Relax
Assume that breastfeeding will go well, but be prepared to act (by asking for help) if problems arise on the first day or many months later.  The vast majority of women can make enough milk to nourish her children.  The vast majority of babies are able to breastfeed successfully.  So, relax. 

Full term, healthy babies are born with enough fat to sustain them for a few days.  Your body produces highly concentrated colostrum for the first few days.  After a few days, you and your baby are more coordinated and able to latch on for longer periods, just as your milk changes to adapt to your babies unique needs.   This is a winning combination.  Both of you are designed to have a few days to “figure things out.”  So, Relax.

Nurse your baby whenever he likes, for as long as he likes.  For the healthy nursing pair, mom’s milk making capacity is being calibrated (particularly in the first few days and weeks) to make the amount of milk her baby needs.  That system works when your baby is able to “send the message” by nursing whenever he likes, for as long as he wants. So, relax.

Babies nurse better when you are relaxed.  Literally, get in a laid back position where your body can relax and put your baby skin-to-skin, tummy-to-tummy so he can relax.  Here is a website with photos and a video of relaxed breastfeeding moms.  

If breastfeeding isn’t working, remember the “3 Keeps.”  By doing these 3 simple things, you will be taking care of yourself, take care of your baby, and keep the system working so that your will be able to breastfeed when your baby is ready. So, relax. 


Breastfeeding mothers have a range of experiences.  Sometimes it hurts, sometimes it doesn’t.  Sometimes it starts off difficult and gets easier.  Sometimes it starts off easy, but gets more difficult.  Some moms don’t like breastfeeding all that much and some just love it.  Some have lots of support, some feel alone. Some challenges can be worked through and some cannot (no matter how much help your get).

Whatever happens, it is the unique story of you and your baby, a relationship that exists just between the two of you.  You are the mother of your child and you make the decisions that are best for you and your family.

- Bianca Wooden

The 3 Keeps

This is such great information, it deserves it's own page.

If breastfeeding isn’t working, remember the “3 Keeps.”  By doing these 3 simple things, you will be taking care of yourself, take care of your baby, and keep the system working so that your will be able to breastfeed when your baby is ready. So, relax.
  • Keep Your Baby Fed – If breastfeeding isn’t working, you may need to supplement.  There are methods to supplement in a breastfeeding supportive way.  Just because breastfeeding isn’t working out as planned, there is no need to give up completely.  It’s not an all or nothing kind of deal.
  • Keep Your Milk Flowing – The amount of milk removed from your breasts tells your body how much milk to make.  If your baby can not remove milk himself, you will need to pump to keep the milk flowing.  There are lots of great tips for effective pumping.  By the way, a pump is not a necessity for every breastfeeding mom.  Many moms never use a pump.  If you encounter a problem or need to be away from your baby, then you may benefit from a pump.  Even then, there are some moms who prefer hand expression.
  • Keep Your Baby Close – Keeping your baby skin-to-skin on your chest encourages him to breastfeed and helps you both to feel relaxed, which encourages milk production.
Adapted from The Womanly Art of Breastfeeding, 8th Edition.