Breastfeeding Help - Common Breastfeeding Questions

In a nutshell, breastfeeding is a built-in stage of a woman’s fertility cycle, well-designed and tested by nature. Throughout puberty and pregnancy a woman’s body is preparing to make milk to nourish the baby right from the start and to connect with the baby, helping the transition into motherhood. Birth and the release of placenta triggers the onset of the mature milk production, opening the floodgates, as sticky jelly-like colostrum turns into creamy plentiful milk. Even if the baby decides to make an appearance before the full term of pregnancy, the mother’s body already has been producing colostrum from around mid-term of pregnancy. Some women can see drops of colostrum on their nipples, and some never see it until it changes into the mature milk on Day 3-7 after the arrival of the baby. As the baby starts suckling on the breast, the ‘demand-supply’ mechanism kicks in and the breasts adjust the milk production to meet the demand of the growing baby. Therefore it is very important to let the baby to feed whenever they are looking for it and knowing when the baby is feeding well.

Signs that the baby is feeding well:

• The attachment to the breast is comfortable for you
• The baby has a big mouthful of breast and is clearly swallowing every few sucks.
• The baby may take one, two or more sides to finish a feed and falls asleep/settles, but awake (if older).
• The baby is producing 3-4 poos and plenty of wet nappies daily.
• The baby is gaining weight and is happy and alert.

If we had to summarize the answer to this question in one sentence, it will be: “Keep the baby on mother’s chest immediately after birth and do not disturb”.

Giving the mother and the baby space and time, allowing the baby to look for the breast, nuzzle and take it with the mother’s gentle guidance maybe all it takes for the two to connect and begin nursing.

Medication in labour and traumatic/instrumental birth can impact on the normal development of events. If the baby is premature, has difficulty latching on the breast due to tongue-tie or discomfort or sleepy from a difficult birth, it is worth keeping an eye on how long they sleep and how often and how effectively they nurse. Taking some expressed colostrum with you to hospital as a back-up and learning how to hand-express can be very useful in the first few days of your baby’s life.

www.laleche.org.uk/antenatal-expression-of-colostrum/

www.laleche.org.uk/beginning-breastfeeding/

New mothers (and even those with more than one child) would agree, that the first few days, weeks and even months after birth is a vulnerable time for most of them. Your life has been turned upside down by this small, sweet-smelling creature, who depends on you for meeting all of his or her needs. You are recovering from a marathon of birth, and it may be that it left you in shock. Your body has shifted into milk-making gear and the baby practically lives on your chest. You are starting to recognize feeding cues, learning about behaviours and trying to respond as best as you can. And then the doubts start creeping in (potentially prompted by well-intended comments from outside). Why is the baby feeding so often? Does she still want to suckle, she has only just fed? You can’t put him down, he would only sleep in your arms. The baby has lost some weight or dropped down the centiles on a graph. Your breasts no longer feel full and engorged, but rather soft and floppy. You start to wonder whether your baby is getting enough milk.

Practically anything in those early days can undermine mother’s confidence, so it’s worth taking stock of the situation and knowing what to watch out for.

Is Baby:

• gaining weight (at least 20+grams per day from Day 7. It is normal to some weight in the first week (up to 7%)
• alert and has a firm skin tone and good colour and feeds 8-12 times in 24 hours
• produces plenty of wet and soiled nappies (3-4 poos and 6-8 wet nappies per 24 hours from Day 3 and up to 6 weeks when it may slow down)
• feeds are comfortable and baby settles on the breast to sleep.

If the above is all going well, you can trust your baby to be getting what they need.

If the Baby is:

• not able to latch to the breast or struggles to stay on for more than a few sucks
• makes clicking/slurping noises when suckling
• never seems to be satisfied even after swapping the breasts multiple times
• feeds what can be described as ‘constantly’
• causing pain/trauma on the nipples when feeding
• very sleepy and not interested in feeding

it may mean that the baby is not able to transfer milk efficiently and it would be important to seek help from a breastfeeding counsellor or a Lactation Consultant.

There are indeed very few instances when the mother may not be able to produce a full milk supply for the baby (due to physiological/hormonal reasons). In most of those rare cases she will be able to produce most or some of the needed milk. Limited supply does not mean that the breastfeeding relationship is not worth working on and establishing, breastfeeding is so much more than nutrition and even with partial supply both mother and baby will hugely benefit from it.

Here is a useful resource to consult if you are worried about your milk supply:

kellymom.com/bf/got-milk/perceived-insufficient-milk/

False signs of insufficient milk supply:

Softer breasts

When the colostrum changes to milk, many mothers experience engorgement (very full, sometimes hard and uncomfortable, breasts). Days later, as the baby starts taking the milk, the body adjusts the volume of milk it produces according to baby’s needs. You are no longer producing for 2 or more babies! The breasts start feeling softer. This is actually a good thing, as persistent fullness of the breasts may mean that the baby is not drinking efficiently. This can lead to milk getting blocked along with inflammation and discomfort. Ideally, if the baby is feeding at breast with no apparent challenges, avoid pumping to prevent overstimulating milk production.

Baby feeding very frequently or for long period of time

Early days, weeks and even months is the time of an incredible growth and development in babies, probably the most intense in our lives. Just imagine that the baby’s brain doubles in size in the first 6 months, the birth weight doubles very quickly and all this is sustained and nourished as well as protected by your milk and being in your arms.

Understanding the normal newborn behavioru, their experiences in your tummy and immediately after and their need for suckling which is as strong as the need for food, provides reassurance as to why the baby nurses so often.

I love this post explaining normal newborn behaviour in a simple way:

theleakyboob.com/2011/08/baby-explains-normal-newborn-behavior

What can undermine a healthy weight gain:

It’s important to remember that most mothers will produce a plentiful supply for their babies, just as they were able to grow and nourish the baby in pregnancy. What may undermine the mother’s milk supply is whether the baby is not able to take the breast at all, attaches with a shallow latch, suckles weakly and is not able to stimulate the breast to keep producing plentiful milk. Scheduling feeds, introducing a dummy, shortening feeds due to discomfort as well as underlying health problems in baby can also impact on the weight gain.

When to seek support from a Breastfeeding Counsellor or a Lactation Consultant:

• whenever you feel concerned
• if the initial weight loss in the first week exceeds 7%
• if the baby is very sleepy and not feeding well or is seeking the breast all the time, getting frustrated and either falls asleep or is not able to settle when suckling at breast
• if the baby is not producing sufficient number of wet and soiled nappies
• if mother’s nipples are sore/the latch is still painful/uncomfortable beyond the first week of life (even if it looks ‘perfect’).

Useful links:

breastfeeding.support/how-to-make-more-breast-milk

www.laleche.org.uk/my-baby-needs-more-milk

Many mothers feel that the end of maternity leave comes around quickly and unexpectedly. Now that the initial challenges of caring for a young baby and breastfeeding have been ironed out and the mother-baby dance has really taken off, many mothers find they need to start planning the first serious separation with the baby – them going back to work. It may feel daunting as you have started to really enjoy your baby and have found your feet in this new motherhood business. The reassuring thing is that not only breastfeeding can continue, but that it will also make the transition to the new stage of your life easier, being the point of familiar and reliable connection and a moment of breathing out for you and your baby together.

The practical benefit of continued breastfeeding is that breastfed babies are less sick and nursing mothers take less time off due to baby being unwell.

Here are a few tips on making breastfeeding work well for you and your baby when you return to employment outside your home:

• Being available to feed the baby whenever you are together.
• Watching out for breasts filling up uncomfortably while away from baby and making sure to express/relieve the pressure (if the baby is 6 months or under – expressing for each missed feed to maintain good milk supply).
• Supporting the person who will be caring for your baby with paced bottle-feeding or with using a cup to offer expressed milk.
• If the baby is being cared for in the nursery or any other setting outside your home, spending time in that environment so you can start producing antibodies to any viruses and offering them to the baby with your milk.

Whatever your shift pattern, your working hours and the nature of your work, your body will adapt to produce less milk when you are separated from your baby and rev it up again when you are together. Your unique bond and nursing relationship will help you through the change and both of you will appreciate the connection through nursing when you unite at the end of the day apart.

A ‘nursing strike’ can be a stressful time for both mother and baby. If the baby is under 12 months, it will rarely be a sign of weaning, but can be a reaction to a number of things, ranging from teething, a blocked nose or another discomfort to nipple confusion and starting to use a dummy. Some nursing strikes start and end without a clear reason.

Most of the strikes last from a couple of days to over a week. If it’s hard to work out what caused it, it may be reassuring to know that most babies would instinctively take the breast in their sleep or when they are most relaxed. Offering the breast at night, when cuddled together in bed can prove most successful. Depending how old the baby is, the mother can offer expressed milk in a cup or a bottle (practicing the paced bottle-feeding technique). If the breasts fill up, keeping them soft by hand-expressing or pumping will keep them comfortable. The hardest thing will probably be remaining calm and taking the pressure off the baby to feed/not trying to push to take the breast. Being accessible to the baby, going back to the baby moon stage with lots of ‘me&baby’ time with focused and undivided attention on the baby without the pressure to feed. Carrying the baby in a soft sling, having the breast accessible while in the sling, going to a breastfeeding group with other babies breastfeeding in the room may be helpful for baby to get back into it.