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Breastfeeding Through The First Few Weeks

This article is for the woman who has decided to breastfeed. Because there are many excellent sources on the subject, I have limited the coverage of this topic to what I feel is essential to help you through the first few weeks. In addition, I have presented information I feel is inadequately covered elsewhere. I have purposely omitted advice on breastfeeding techniques, manual expression of breast milk, etc., because I feel this material is well presented in other sources. I believe that every nursing woman should purchase one or more of the books that cover every aspect of breastfeeding to use as a ready source of reference if questions arise.

Breastfeeding can be one of the most beautiful aspects of motherhood. There is a special, quiet joy in knowing that your body nourishes your child and that the close physical interrelationship between you was not abruptly terminated at birth, but will end more gradually, more gently, more naturally. Unfortunately, however, in our society the most natural way to feed a baby is not the most common way, and in the early weeks of physical and emotional adjustment to new motherhood the breastfeeding woman especially needs all the support she can get. During this time she must learn how to breastfeed - possibly never having seen another nursing mother, possibly under pressure to bottle feed, possibly questioning somewhat her ability to successfully nurse her child, and having few ways to measure how well she's succeeding. After all, she doesn't know how many ounces the baby drinks. Until her first visit to the pediatrician, she is never quite sure he or she is gaining weight. If she's lucky, her baby sleeps between feedings and that indicates he or she is satisfied, but not all babies sleep all the time - and if the baby is the wakeful type, what reassurance does she have that the crying is not from hunger? In addition, during the early weeks the baby must also learn how to nurse - how to grasp the nipple, how to hold the head. Only the sucking and rooting (nipple locating) reflexes are instinctual.

While you and your baby are learning together, your breasts are undergoing an adjustment process. The nipples “toughen” to meet the new demands placed upon them by the baby's tongue, lips, and gums. The milk-producing glands adjust their output to suit the baby's needs and the letdown reflex establishes itself. As a result of these adaptations, some women experience temporary physical discomfort.

In The Hospital

Not all hospital personnel are supportive of breastfeeding and some hospitals still routinely administer an antilactogenic hormone by injection or pill to women “to dry up the milk” if they do not plan to breastfeed. Be sure to tell all medical personnel you encounter from the moment you enter the hospital that you plan to breastfeed and do not want this injection. If your mate or another individual will be with you in the delivery room, ask him to keep an eye out for anyone preparing to administer an injection and question its content and purpose before it is given. (Under any circumstances you have the right to know what medication you are being given.) The hormones most frequently given for this purpose are estradiol valerate and testosterone emanthate (Deladumone). Forms of stilbestrol (currently under scrutiny for possible cancer-causing effects) may be given in pill form over a period of days to suppress lactation (question the content of any medication given orally before you swallow it). If you had not planned to breastfeed, received antilactogen, and then changed you mind, or if you received one by error, don’t panic. You can still nurse because the baby's sucking will stimulate your breasts to produce milk. However, before you go into the hospital, discuss your breastfeeding with your obstetrician or certified nurse-midwife and remind him or her of it during labor and delivery. He or she can also help you avoid unnecessary hormonal injections, and if you do require any medication for any purpose during your hospital stay, he or she can, if at all possible, prescribe something that will not be harmful to the baby. Remember that most medication you take will pass through your milk to the baby. In many cases this is not harmful, but it is imperative that you remind hospital personnel that you are breastfeeding before you take any pills offered. In some hospitals, sleeping pills and painkillers are routinely prescribed for all patients. If you require any medication for any purpose for as long as you are breastfeeding, always check with your pediatrician, obstetrician or certified nurse-midwife, or both. If you must temporarily take a drug that would be harmful consider hand expressing your milk or using a breast pump, discarding the milk, and formula-feeding your baby for the time involved.

It is a good idea to tell your obstetrician in advance that you'd like to breastfeed immediately after the baby is born or as soon as possible thereafter, and prefer not to wait the three, four, six, ten, or twelve hours which some hospital rules still impose. Immediate breastfeeding is good for both you and your baby. The newborn is welcomed into the world with warm, loving arms and a healthy start in life from the colustrum he or she gets from your breasts. Sucking will cause oxytocin to be released, which will stimulate your uterus to contract, help deliver the placenta, and prevent hemorrhaging. Know, however, that if you have taken any medication during labor and delivery, including Demerol (a narcotic), the baby's sucking instinct may be temporarily suppressed or the child may be groggy. Even if you have taken no medication, some babies are just not interested m breastfeeding right after being born and prefer to sleep. If at all possible, you can try again in the recovery room.

Guidelines During Your Hospital Stay

Contrary to standard advice given in many hospitals, it is unnecessary to wash your nipples and areola with soap and water before each nursing. Your breasts produce their own natural cleansing substance. Rinsing is fine, but stay away from soap and pads saturated with alcohol. Both are drying. Do wash your hands with soap and water however, before handling your breasts.

I recommend you breastfeed the baby at all feedings, including the 2 A.M. one. This is important to establish your milk supply to meet the baby's needs. This will help you avoid engorgement and can help relieve it if it does occur. Another point to remember is that if the bottle is offered often enough, the baby may prefer getting food from the bottle, because it takes less work to get it. Sucking at your breast is what stimulates your milk supply. Remember, breastfeeding is a supply-demand process. The baby signals his or her requirements to the breasts by the duration and intensity of sucking.

It is not necessary for your baby to be given a bottle of glucose and water “for energy,” or “to clean the digestive tract” - a practice which is routine in many hospitals. This will cut down his or her appetite for the next feeding. If the nurses are insistent and want to give your baby some liquid between breast feedings, you can insist on plain boiled water, although even this is not necessary. Ask your pediatrician to leave instructions that your baby is to have nothing except breast milk and that he or she is to be brought to you whenever he or she cries (if rooming-in is not available). Sometimes a doctor's order can cause hospital rules to bend.

Take advantage of rooming-in if it is available. You can stay in bed resting until your baby awakens, then change the diaper and get back into bed to nurse. By all means get your rest whether you have rooming-in or not. Take the phone off its cradle (or ask the switchboard to hold your calls) and get some sleep whenever possible.

Contrary to what you might be told in the hospital, it is not necessary to limit to a few minutes (three to five) and then gradually increase the amount of time you nurse the baby on each breast in an attempt to avoid sore nipples. If sore nipples are going to occur, they will do so regardless of any such precautions. In the early days, your milk may not let down in the first minute or two of a feeding. If you do limit the amount of time at the breast to under five minutes your baby may not get all the milk available and if over a period of time a breast is not emptied, you may develop a breast infection.

Ignore any nurse or doctor who clucks disapprovingly and tells you your baby “looks hungry.”

If your baby is brought to you for a feeding and is fast asleep, try not to view this as a personal rejection. Several explanations are possible:

a) He or she may have been fed formula or water in the nursery and isn't hungry. Remind the nurse that you are breastfeeding and ask if the baby has been fed. Make it perfectly clear that you want to feed the baby your way.

b) The baby may have been hungry before the scheduled feeding time, cried, and then fallen asleep. In either case, don't slap the baby's heels or bottom to force the baby awake; some babies will nurse in their sleep. Try gently stroking the cheek with your nipple. The baby may turn toward it, open his or her mouth, and nurse. If that doesn't occur, cuddle and talk to your child, gently let the baby feel your presence. Ask the nurse if you can come to the nursery when your baby awakens and breastfeed him or her then.

If the baby is brought to you awake and crying but refuses to nurse or begins to nurse and drops the nipple, don't be upset and don't give up. He or she may be frantically hungry. Remember, the baby is learning how to get the next meal just as you're learning to give it. Be soothing, gentle and firm, and rock your infant. Try expressing some milk into the baby's mouth and t.hen offering the breast again. Don't let anyone talk you into giving a bottle because “the poor dear is so frantic”.

In general, hospitals are not conducive to establishing a nursing relationship. Scheduled feedings, constant interruptions during the day, and not being in your own familiar surroundings contribute to fatigue and lactation difficulties. Perhaps the best advice I can give is to go home as early as your medical condition and the condition of your baby permit. Try to have help with the housework so you will be free to rest and nurse your baby. If you have no help, let everything else wait. You need to rest and care for your baby.

Many hospitals have nurses who are wonderfully supportive and will help you and your baby learn to breastfeed. Understand, however, that when a hospital is overcrowded and/or a nurse has had no personal experience with breastfeeding she may not have the time or ability to assist you; besides, bottle feeding may seem easier to her. It would be wise to have the La Leche League manual, The Womanly Art of Breastfeeding, and Karen Pryor's Nursing Your Baby with you in the hospital for easy reference. If you have any questions or problems, call a La Leche League leader. She can offer advice, suggestions, and support.

If your baby must stay in the hospital for a period of time after you are permitted to go home, try to arrange to visit several times a day to nurse your child. Or, if this is impossible, you may be able to arrange to collect your milk at home and send it to the baby, following the hospital's instructions. Even if neither is possible, you can pump your breasts (ask the hospital if you can borrow an electric breast pump or use a manual pump available at drugstores) to keep your supply up until the baby comes home. While in the hospital, or during the early weeks at home, some newborns develop a form of jaundice that some pediatricians feel necessitates the immediate cessation of breastfeeding. If you are faced with this situation, you can temporarily suspend breastfeeding (while you pump your milk to keep up your supply) and then continue to nurse your child after the problem clears up.

Whether your hospital experience is positive or negative, I suggest you write a letter to the supervisor of nursing and let her know your feelings. This may encourage the department to give the kind of support and information so much appreciated by breastfeeding women and their families.

At Home

GENERAL ADVICE. When you are home from the hospital, get into bed and rest. Don't overtax yourself with entertaining or housecleaning. While this advice is important for all new mothers, it is especially critical for breastfeeding women. The best way to prevent nursing problems is by getting adequate nutrition, plenty of rest, and avoiding stress. You can clean the house in a few weeks; pamper yourself now.

It is not necessary for you to eat special foods or avoid others while breastfeeding. Just eat a well-balanced diet and drink plenty of fluids. You may find that your baby nurses less avidly or develops gas after you have eaten large amounts of certain strongly flavored or gassy foods. Your diet is reflected in the flavor and content of your milk, but unless you make a connection between something specific you have eaten and gas or less interest from your infant, it is unnecessary to restrict your diet in any way. If you are in doubt about what you should be eating, ask your pediatrician for advice and/or read the section on nutrition in The Womanly Art of Breastfeeding . I believe it is best to ignore schedules and to nurse your baby on demand. He or she knows when it is time to nurse; the clock does not. By the end of the first six weeks you will most probably observe a schedule of sorts developing. Many babies begin to sleep through the night at this point too. Remember, the first six weeks are the hardest; after that, nursing becomes dramatically easier as you and your baby adjust to each other and. to breastfeeding. Believe it or not, by the time the baby is three months old, caring for your infant, including nursing, will come naturally to you.

DETRACTORS. Knowledge is your best defense against people who think they are doing you a big favor by trying to influence you to stop nursing. Breastfeeding women are the exception today, not the rule, and many of the people who make negative statements do so with the best of intentions. They may have been convinced of the advantages of bottle feeding when they had children. When formula was introduced on the market it was presented as the “scientific” way to feed babies, and women of that generation may not understand why some of today's women would prefer something “unscientific” or “primitive.” It's also possible that they had a negative nursing experience themselves and want to “spare” you. Being able to answer a critic's statement factually and with confidence will help bring an end to any pressure that may exist. Read books and articles.

Besides friends and relatives, there are some medical professionals who, consciously or not, try to subvert breastfeeding women. The majority of doctors are men, many of whom have had little or no experience with breastfeeding women. The courses in medical schools and many medical textbooks emphasize the different types of formula, not how to assist lactation. There are some obstetricians who advise expectant mothers not to breastfeed “because you are the nervous type.” It is often difficult to tell the difference between doctors who are supporters of breastfeeding and those who are detractors because many of the detractors do not even realize they are against nursing. If questioned, some go into long arguments extolling the benefits of nursing while subtly trying to convince you to stop. On the other side of the coin are the doctors who strongly believe in the value of breastfeeding and offer a wealth of knowledge and advice. How can you tell the supporters from the detractors?

1. Pediatricians who routinely dispense formula samples to all their patients, breastfed or not, are consciously or unconsciously stating their preference.

2. Be suspicious of comments such as “I'm totally in favor of breastfeeding, but have found few women who are successful at it,” or “Go ahead and try, but it's been my experience today that some women tell me they're having problems and I know they want me to tell them to stop.” (A supportive pediatrician does not predetermine that you will fail before you even get started!)

3. If your doctor suggests you feed the baby formula after every nursing, you may rightfully suspect that he or she is unsympathetic or poorly informed. Breastfeeding works on the basis of supply and demand. Your breasts will produce enough for your baby if you nurse as frequently as the baby wants to. Short intervals between nursings are your baby's way of telling you his or her appetite has increased so your breasts will produce more milk. Filling the child with formula defeats this process. Another sign of a non-supportive pediatrician is the advice to start giving the baby cereal when a mother calls complaining that her six-week-old baby wants to nurse very frequently. The fact is that at six weeks most babies go through a growth spurt and need to nurse more frequently, which encourages the production of more milk.

4. On the other end of the spectrum you might hear: “Your baby is getting too fat. Your milk must be too rich. You’ll have to stop breastfeeding and give formula.” (Breastfed babies generally don't know about overeating. They take in only what they need at each feeding. As long as you are wholly nursing - no solids, no formula - your baby most probably will not be overweight.)

5. Some doctors decide quite arbitrarily that it’s time to wean the baby: “You've been nursing for long enough,” or even more subtly, “You mean you're still nursing!” You should be the sole judge of when it's time to end the breastfeeding relationship with your child unless there is a sound medical or nutritional reason against it. Some women decide to breastfeed for a certain length of time and no more. Others believe in the value of baby-led weaning and stop nursing when the child indicates he or she no longer has this need. However, if you must take medication that would be harmful to your child and no other prescription can be substituted, if the doctor orders weaning and you want to continue nursing, ask about the possibility of pumping your milk, discarding it, and temporarily formula-feeding your child in order to keep up your milk supply.

6. There is no nutritional reason to start solids before your baby is four to six months old. Question the reasoning of any pediatrician who suggests otherwise. Often cereal is started early as a means of getting the baby to sleep through the night, filling the infant up so he or she doesn't awaken. However, nutritionally speaking, this is replacing a complete food - your milk - with one that is incomplete - cereal. The baby will sleep through the night when he or she is ready to. (If your baby is sleeping a six to eight hour stretch from early evening to the middle of the night - say from 7 P.M. to 2 A.M. - you might try to get him or her to sleep this stretch of hours at your convenience. Before you go to sleep - say at 11 P.M. - try to nurse the baby. Many babies will nurse in their sleep or will awaken briefly to nurse and then sleep six to eight hours from that feeding. If the baby awakens again at 2 A.M. anyway, wait a week or two before trying again.)

If you receive breastfeeding advice from your pediatrician that seems incorrect, call a La Leche League leader and ask if, through the League, she can contact medical personnel who are knowledgeable about and sympathetic toward breastfeeding and can obtain information for you.

If you find your pediatrician does not share your views about breastfeeding (or anything else, for that matter), you will have to decide whether or not to continue using his or her services. You have the right to use the services of any doctor you choose - even after you've had several office visits and have called the doctor for advice. Admittedly, this is a difficult decision to make. If you do decide to switch, ask a La Leche League leader to recommend a doctor who is sympathetic to nursing. When you have made the switch to a new doctor, write a letter to your original pediatrician telling him or her why you decided to switch. I believe it's important to let the doctor know what your feelings are. It's possible that the doctor is not aware of his or her undermining practices. Some women choose to continue using a doctor they know is not supportive of nursing. They may decide the doctor's reputation is such that they'll put up with the inconvenience caused by his or her lack of knowledge and support in this one area. Many of these mothers also believe that the only way to re-educate such doctors is by providing them with the model of a successful breastfeeding woman themselves. If you are in a situation where you decide to continue using your present doctor's services although he or she is not supportive of breastfeeding, you will have to rely heavily on other sources for support and information. If at any time you have occasion to disagree with anything your pediatrician says about breastfeeding based on your readings, show the doctor the source (preferably more than one) which contradicts what he or she says. Referring to several items in print is stronger than saying “I read that somewhere.”

THE “CONSTANT NURSER”. A baby who wants to nurse for hours on end and is otherwise inconsolable can detract from the breastfeeding experience. As much as they may enjoy nursing, at some point most mothers in this situation are tempted to say, “Enough! I've had it.” Some women even begin to question whether they have enough milk or whether they're starving the baby. While it is possible that your baby is going through a growth spurt and is nursing frequently to increase the milk supply, it is highly improbable that your baby will starve. If you are faced with endless nursing, ask yourself if you've been particularly tired or tense. It is possible that your let-down reflex isn't functioning well yet and your baby isn't getting all the milk your breasts have to offer. As your nursing experience increases, your let-down reflex will become well-established and nothing will interfere. Until then, try to relax. Put your feet up during each nursing. Think of a fun time you've had. Drink a glass of milk, juice, or even wine. Get more rest. It is also entirely possible that your baby nurses for so long simply because he or she enjoys it. Infants are born with a strong sucking instinct.

If you're the mother of a “long distance nurser,” you have several options. The most obvious is to let the child nurse. Curl up in front of a television or pick up a book to keep you occupied. If you have older children, use this opportunity to read stories to them, put together puzzles, or play word games with them. Another option might be to use a pacifier. It should be made of one molded piece to prevent any part from falling off and becoming lodged in the baby's windpipe or throat. It should also be large enough so that the entire pacifier cannot become lodged in the throat. Pacifiers should not be overused, however. Your breasts need the stimulation of the baby's sucking to continue to produce milk.

LEAVING THE BABY. Many women feel they need to leave the baby and get away by themselves or with their mates for a few hours. This is especially true if the baby is very demanding or fussy and the new mother has little time for herself. If you are breastfeeding and need time off, you have several options.

  • Leave as soon as you nurse the baby and return before the next anticipated feeding. During the first few weeks these intervals are very short, but soon they become more predictable and can be extended for several hours.
  • Provide a bottle of previously expressed breast milk.
  • Provide a bottle of formula or milk (as per your pediatrician's advice).

If you only occasionally (once or twice a week on nonconsecutive days) leave the baby with a bottle but breastfeed at all other times, your milk supply will not diminish. You may decide you'd like to skip an early morning nursing this way and count that as part of the total number of missed nursings a week. When your baby begins solids, the sitter can feed these in your absence.

I suggest you not give any relief bottles during the first two weeks while your milk supply and let-down reflex are becoming established. Thereafter, if you do plan to give an occasional bottle (either of breast milk or formula) this should be done regularly once or twice a week regardless of whether you leave the baby. If not kept familiar with drinking from a bottle, at some point many babies will reject it altogether. If this happens, and you want to leave the baby but would miss a feeding, ask your pediatrician if you can give the baby plain yogurt. If the doctor approves, see if your child will take it before leaving him or her with a sitter.

Physical Problems

ENGORGEMENT. This condition, caused by the filling of the milk ducts, the increased amount of blood in the veins and arteries, and the swelling of breast tissue, is often experienced when the milk comes in. This is partly due to the four-hour feeding schedule imposed by most hospitals. Nature intended that nursing be on a demand basis from birth on, and the separation of mother and child practiced by most hospitals is contrary to this intent. You may also find you engorge the first few times the baby skips a feeding during the day or begins to sleep through the night. In this case, your breasts fill up to satisfy the baby as per your infant's original requirements; but if he or she sleeps past the original feeding time, you may be “overfull” for the next nursing. In a few days, supply and demand even out again and the problem disappears. The symptoms of engorgement are hard, often painful, lumpy breasts that may feel hot to the touch. To relieve the discomfort you can manually express some of the milk. A hot shower is also soothing and will help the release of milk. The application of either heat or ice is also helpful. The idea is to make yourself as comfortable as possible while your body adjusts to the baby's needs. Depending on how long you're away, overfilling can also occur if you leave the baby with a sitter who will feed him or her previously expressed breast milk or formula. (If you want to insure no decrease in your supply, carry a manual breast pump, go into a restroom, and empty both breasts.)

LEAKING. Although the sudden release of milk from the breasts can occur at different times, the reason is always the same: something has triggered your let-down reflex. This can happen while you quietly stand and watch your child sleep, while having sexual relations, or while out for dinner with or without your baby, or when you hear someone else's baby cry. It's also very common in the early weeks for one breast to leak while the baby is nursing on the other breast or for both breasts to leak when you are overfull. Nursing pads worn inside your bra to absorb any leakage are helpful. You can cut up pieces of clean cotton cloth to fit your bras, wash, and reuse them; or you can buy disposable pads at the drugstore. (If you use the disposable pads, try to find large, thick, round ones without plastic. If these are not available, either wear the plastic side away from your skin or remove this section entirely, as it can be irritating to your nipples. An effective way to stop the leaking is to place the heel of your hand, or even one finger, against the nipple for about a minute. Yes, leaking can be embarrassing - especially if you're out in public wearing a thin T-shirt that suddenly becomes noticeably wet. If you are having this problem and feel self-conscious, carry a sweater, poncho, or shawl you can put on to conceal the wetness until you get home. (A baby in a baby carrier covers it all up!) Be assured that in time you will no longer have this inconvenience.

SORE NIPPLES. As I said, your nipples have to toughen to adapt to the new stresses placed upon them. Many women find they have a day or two of soreness which disappears. This can be quite uncomfortable and in severe cases the nipples may even crack or possibly bleed. If this happens, expose your nipples to the air for several hours a day (you can cut holes in an old sweater and wear it around the house) or place tea strainers in your bra to allow air to flow around the nipples. Cautious use of a sunlamp can be helpful, as can sunlight or the heat from a light bulb or high-intensity reading lamp. Breastfeeding authorities recommend that you do not use alcohol, soap, tincture of benzoin, or any similarly drying substance on your breasts. Pure hydrous lanolin may be applied and does not have to be washed off before the baby nurses. Nursing in different positions each time will eliminate a constant strain on the same area of the nipple. Note: if the condition is due only to sore nipples, the painful sensation should occur only for the first few moments of any feeding, should stop when your milk lets down and should be less noticeable when you begin to nurse on the second side. Also, therefore, it is wise to begin feedings on the less sore side or express some milk at the beginning of a nursing to get the milk flowing so it will take less time for your let-down reflex to operate. The discomfort should continue for no more than a few days. If the entire nursing procedure is painful, If the pain continues for longer than several days, and/or if the discomfort extends from the nipple area into the breast, check your baby for white patches along the roof of the mouth. This might indicate the presence of an infection called “thrush” which can be cleared up easily. Contact your pediatrician for information. Even if thrush is not present, call your obstetrician.

CLOGGED DUCT AND MASTITIS. Mastitis (breast infection) has several causes. In some cases, bacteria (staphylococcus) enter the breast through a “crack” in the nipple. They may be present in the baby's mouth or throat and transmitted through the nipple (cracked or otherwise) during a feeding. It is also possible a milk duct is clogged, preventing the passage of milk, which results in a back-up; or, more commonly, the letdown reflex for one reason or another is temporarily malfunctioning. In either case, if the milk doesn't flow, an environment conducive to the growth of bacteria either already normally present in the breast or transmitted by the baby develops. This causes infection. A red, sore lump on the breast is a symptom of a clogged duct and should be cared for so that mastitis does not develop. Check that your bra fits properly and is not constricting, as this can cause a clogged duct. Increase the number and duration of nursings to keep your breasts fairly empty. Rinse your nipples before each feeding and nurse in different positions. Gently massaging the sore area toward the nipple might help. If engorgement, headache, fever, and a flu-like feeling develop, call your obstetrician. Breastfeeding authorities recommend that you rest in bed, apply heat to the sore breast, and continue the increased nursings. Your doctor may prescribe antibiotics and/or analgesics. Be aware that your baby may get diarrhea from the medication or that the taste of the milk may change slightly after four or five days. Although some obstetricians still order weaning in cases of mastitis, breastfeeding authorities insist it is most important that you continue to breastfeed to keep the milk flowing. Even though you have an infection, your milk will not harm the baby, nor will most antibiotics or mild analgesics. If you abruptly terminate nursing when you have mastitis, a breast abscess in most likely to develop.

ABSCESS. An abscess is an accumulation of pus, confined to one area that is surrounded by damaged and inflamed tissue. Breast abscesses usually form when mastitis is neglected or improperly treated. In the case of an abscess, your obstetrician will tell you to nurse only on the “healthy” breast. But empty the abscessed breast either manually or with a breast pump to keep the milk flowing; discard the milk. It is usually necessary for the doctor to lance the abscess to promote drainage of the pus. When the abscess heals, you can resume nursing on both breasts.

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