1. DO NOT let anyone tell you it is necessary to toughen up your nipples for breastfeeding.

2. DO some reading about breastfeeding. Good choices are:

~ The Breastfeeding Book: Everything You Need to Know About Nursing Your Child from Birth Through Weaning
~ The Womanly Art of Breastfeeding: Seventh Revised Edition
~ The Nursing Mother’s Companion: Revised Edition
~ The Ultimate Breastfeeding Book of Answers: The Most Comprehensive Problem-Solving Guide to Breastfeeding from the Foremost Expert in North America, Revised & Updated Edition

3. DO NOT think you need to buy a lot of breastfeeding-related products. The great thing is all breastfeeding really requires is you and the baby!

4. DO, however, consider whether you might enjoy shopping for breastfeeding products and learn how to choose and use a breast pump safely if you will be returning to work.

5. DO NOT listen to people who pressure you to formula-feed.

6. DO attend a La Leche League meeting while you are pregnant (find a local group in the United States or other countries) and surround yourself with family, friends, and medical professionals who are supportive of breastfeeding. (If you are wondering, here’s how to pronounce “La Leche” League!)

7. DO NOT accept or keep any free formula samples “just in case.” (For thoughts on what to do with any samples you might receive, see this post).

8. DO have the phone number of a local La Leche League leader and/or lactation consultant with you at the birth.

9. DO NOT neglect to talk to your health care providers and birth attendants about your birth plan and your desire to breastfeed.

10. DO believe in yourself! Taking these 10 steps can give you the knowledge and confidence to have a good breastfeeding experience.

Enjoy these other entries in this month’s carnival (and watch for additions throughout the day):

~ Motherwear Breastfeeding Blog: A Breastfeeding-Friendly Birth Plan
~ BreastfeedingMums: Preparing for Breastfeeding
~ Natural Moms Talk Radio: Breastfeeding during Pregnancy and Tandem Nursing
~ Crunchy Domestic Goddess: Breastfeeding while Pregnant (Trying at Times but Ultimately Worthwhile)
~ Permission to Mother: Low Milk Supply in Pregnancy
~ API Speaks: On Breastfeeding while Pregnant
~ Milk Donor Mama: Her Experience of Preparing for Breastfeeding and the Advice She Offers Now

Post from: Breastfeeding 1-2-3

__ In the cradle or cross-cradle positions, the baby should be resting on his side, his tummy facing your tummy, shoulder and hips aligned, mouth level with the nipple

__ The baby’s mouth should be covering at least a half inch of the areola, the dark area of skin around the nipple

__ His nose is touching or nearly touching the breast

__ Both the top lip and bottom lip are flared out

__ Once your milk lets down (starts to flow freely), you can see the baby’s jaw moving all the way back by his ear

__ The baby’s temple may wiggle, too

__ You can hear the baby swallowing (you might notice a pattern, such as “suck, suck, pause for swallow.” The pattern will slow as the baby fills up and takes in less milk). Dr. Jack Newman describes an “open mouth wide – pause – close mouth” pattern that indicates whether the baby is swallowing big mouthfuls of milk.

__ Absence of pain (if breastfeeding doesn’t hurt, that’s a great sign that the latch is good. Some women may experience initial soreness, tenderness, and even pain in spite of a good latch, but it’s a good idea to work with a La Leche League leader and/or lactation consultant to rule out problems with latch, thrush, or other things that could cause pain).

__ The baby’s tongue is extended over his bottom gums and is cupping the breast (if you peeked, you could see a little triangle of tongue in the corner of his mouth, but there’s no reason to peek if everything feels right).

__ When the baby pops off (or the latch is gently broken), the nipple does not look unusually squished or angled like the tip of a new lipstick (a distinct line across the nipple might be a sign of tongue-tie).

One final way to gauge latch (and the baby’s consequent intake of milk) is to watch the baby’s output! Is the baby having enough wet and poopy diapers?

Post from: Breastfeeding 1-2-3

Post from: Breastfeeding 1-2-3

Oversupply and Foremilk/Hindmilk Imbalance

It may take several weeks for a mother’s milk supply to regulate. When a mother experiences oversupply, the baby can take in too much low-calorie, lactose-rich foremilk and not enough high-calorie, fat-rich hindmilk. That can lead to fussiness, gassiness, low weight gain and/or green, watery stools. A mother can attempt to remedy the foremilk/hindmilk imbalance by “block feeding”: feeding on the same breast for any feedings during a two to three hour period. The mother nurses on one side per feeding, and if the baby wants to nurse again within two to three hours of starting that first feeding, she continues to nurse the baby on that same side so that the baby gets more hindmilk. During that block of time, the mother can express just enough milk on the other side to prevent engorgement, plugged ducts or mastitis.

Adverse Reaction

It is possible that the green stools are evidence of a sensitivity, allergy or negative reaction to something the mother consumed. Green stools with mucus is a one of the possible signs of a food sensitivity, along with fussiness, trouble sleeping, pain, eczema or rash, congestion, and blood in the stool, among other things. If you suspect an allergy, read more about allergies here.

Interestingly, some mothers taking the galactagogue fenugreek report green, watery stools as a side effect in their babies. It’s unclear whether this is from the fenugreek herb itself or the mother’s increased milk supply from the galactagogue.

As always, if you have concerns about your baby’s health, consult a doctor. Certainly if the green stools persist or there is any question about possible low weight gain, seek medical attention.

Post from: Breastfeeding 1-2-3

“Some tenderness…” Right…. I can’t tell you how much Lanolin I used each time (I’m nursing my second now) and it STILL hurt like hell in the beginning. I am quite sensitive to pain. What would have been helpful with my first was knowing that a) we were doing it the right way and b) the pain would eventually go away. As it was, I concluded that if she was getting milk and thriving, we must be doing it right.

While I wouldn’t suggest toughening your nipples (why start the pain early?), I can certainly see where the practice came from. I’ve seen this advice in many different bf’ing resources, I really feel that this is not helpful to women just starting out with bf’ing. Sure, you have to get the latch right. But if it is right, and it still hurts, knowing that eventually the pain will go away would be more helpful. Otherwise, they may give up, thinking that “it just doesn’t work for them.”

Just my 2 cents…

Dawn

Dawn, thanks for sharing your thoughts. You’ve got a good point. I know at least two mothers for whom breastfeeding hurt for a number of weeks and then the pain simply went away. There are a few reasons why a mother-baby pair might “outgrow” nursing pain.

It’s possible in such cases that the baby has a short frenulum (”tongue-tie”). While it might be necessary to consider clipping a short frenulum, it is possible for the condition to improve on its own. The Breastfeeding Answer Book states:

Breastfeeding problems related to a short frenulum may resolve over time without special treatment. The movements of the tongue may cause a short frenulum to stretch (Riordan and Auerbach, p. 357) or the baby may adapt his mouth and tongue movements to improve breastfeeding effectiveness.

It’s also possible that the baby simply has a short tongue. In that case, improving latch-on and positioning helps in the short-term, and in the long term breastfeeding gets easier and easier as the baby’s tongue grows.

For some nursing dyads, there may be an unusually great disparity between the large size of the mother’s areola and nipple and the small size of the baby’s mouth. In most cases, as tiny as the little newborn seems, the baby can get enough of the areola for a proper latch, but in some cases it can be more difficult at first and the problem gradually lessens as the baby grows.

I hate to hear of mothers simply bearing the pain (although kudos to those who work though that difficulty!) as perhaps there are some techniques that could help. As I mentioned above, a baby with tongue-tie might require a frenotomy (also called a frenulectomy or frenectomy). If the mother cannot find a doctor willing to perform the surgery or if the mother does not desire surgical intervention, there are some exercises to try to help the baby learn to extend his tongue. Short-term use of a nipple shield might help alleviate the difficulties as well.

The other problem I have with telling women to just hang in there — that there will be pain but it will go away — is that there are other causes of nipple pain that will not correct themselves with time (thrush being an example that springs to mind). Seek help if you’re in pain. At best there will be a solution, at a minimum there will be support to get you through hard times such as Dawn’s.

Post from: Breastfeeding 1-2-3

When I was talking to my mom last night, she asked me if anyone (namely my midwife) had suggested that I ‘toughen my nipples’ in preparation for breastfeeding. This is my first baby, so I’ve been reading all sorts of books and articles–mostly about pregnancy and labor, but some beyond–and I’ve never seen this mentioned anywhere. Is this still common practice, or at least a good idea? Or is it just an old school of thought? Thanks!

Good question! I am totally cringing at the thought of “toughening up my nipples” and I want to assure all prospective mothers that it’s completely unnecessary! The idea that a woman would need to toughen her nipples is outdated. The key to comfortable breastfeeding is a good latch. Breastfeeding shouldn’t hurt, and if it does it can generally be chalked up to latch (or thrush, especially if the mother or baby has had antibiotics). Of course there’s a learning period in the beginning as both mother and baby learn how to breastfeed — something that people think is supposed to come naturally actually requires a bit of knowledge and practice. There may be some tenderness in the beginning, and that can be helped both with pure lanolin (such as Lansinoh), and by expressing some breast milk onto the nipple and letting it air dry (breast milk has healing properties).

Consider taking a breastfeeding class, either before or right after the birth. Two good books to help you prepare for breastfeeding are The Breastfeeding Book: Everything You Need to Know About Nursing Your Child from Birth Through Weaning by Dr. Sears and The Nursing Mother’s Companion: Revised Edition by Kathleen Huggins, RN. You can also attend a La Leche League meeting while you’re pregnant. Have a local lactation consultant or La Leche League leader’s phone number handy so you can call for advice right away if you have concerns. Best wishes!

Post from: Breastfeeding 1-2-3

What a fantastic resource! It’s great to have a 24-hour telephone helpline available especially since in the wee hours of the night things often look most desperate for new mothers. Don’t forget you can also find a local La Leche League group for support during the daytime as well.

Post from: Breastfeeding 1-2-3

Q: My 12 month old son is used to being nursed to sleep, but with three teeth coming in at once, he is now also a dedicated biter.

He bites me so often and so hard that I have had to limit his nursing sessions for the first time. His first birthday ended in hysterical screaming all night… he couldn’t sleep without the breast, but can’t seem to feed without biting. It’s been like this for days.

I have been firmly telling him “no” and taking him off the breast when he does this, I have offered him cold things to chew on. Giving him infants’ paracetamol for his teeth seems to help a little, but it’s really not a permanent solution!!

Unfortunately, the only other advice I have received on this topic is to either bite him back or wean him… neither of which suits either my parenting plan or appeals to logic.

A: Steph, I’m sorry to hear that you’re getting bitten! That must be very distressing for you. Good for you for exploring gentle ways to get him to stop. I hope I can help by affirming what you’re already doing and offering some other things to try, and maybe some other moms will share some tips in the comments too!

Before we scare new mothers away from breastfeeding, first let’s reiterate that many if not most babies do not bite, and of those that do, for many it’s a one-time incident that does not cause injury and does not get repeated.

If a baby does bite, what should you do?

~ A bite might make you yelp involuntarily, but do not purposely yell at or frighten your child as this could cause a nursing strike (a refusal by the child to nurse at all). While it’s easier said than done, keep your reaction to a minimum so your baby doesn’t bite again just to see a repeat performance of your reaction.

~ If you can help it, don’t pull the baby off the breast without breaking the latch or you might risk damage to the nipple. As you state a firm “no” or “no biting,” break the latch by inserting a pinky finger in the corner of the baby’s mouth. Alternatively (and counter-intuitively), you can try pulling the baby into the breast or gently plugging the baby’s nose. Blocking the airway briefly will prompt the baby to open his mouth to breathe.

~ Analyze when in the nursing session the bite occurred. If the bite took place at the end of a nursing session, consider your child a great communicator — he’s certainly found a crystal clear way to tell you he’s done! He’s also given you a good clue about how to stop further biting. The key is to watch him at the breast during each feeding and anticipate when he is poised to bite again. In particular, watch for tension in the jaw that might signal a bite. As the baby stops sucking vigorously and begins to start pacifying, drifting off to sleep or showing other signs of boredom such as playing with his hands or turning his head to look around the room, gently break the latch. If he protests, you can consider switching sides and letting him continue to nurse as long as he’s actively suckling.

~ If you’re nursing your baby to sleep and he won’t settle without the breast, try the gentle-removal technique from The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night. Essentially that technique involves breaking the latch repeatedly until the child settles to sleep without being on the breast.

~ If the biting is happening as your child is drifting off to sleep, consider changing up the sleep routine or adding in new elements. For a while I used a “white noise” alarm clock that played sounds of the forest, brook or ocean. My daughter began to associate those noises with going to sleep and was more likely to settle once the latch was broken. Some babies, particularly older ones, might accept a change in the sleep routine altogether such as: nurse first then rock in the rocking chair, sing songs, rest in the bed together etc.

~ If the bite happened at the beginning of the nursing session, run through the possible causes for the biting such as teething or frustration with waiting for letdown.

~ If a baby is teething, have him chew on a cold well-rinsed wash cloth before a nursing session to numb his gums. It can help to keep a supply of wash cloths in the freezer for this purpose. Over the counter pain medications and homeopathic teething tablets are options too.

~ If you think your baby is biting over frustration waiting for the milk to letdown, try hand-expressing or pumping just enough to get the milk to letdown before starting the nursing session.

~ If a baby is biting at the beginning of the nursing session and still needs to nurse again, you may obviously have reservations about putting the baby back to the breast. Stay vigilant in watching for signs of biting and keep your pinky finger poised to break the latch. If your baby bites and you break the latch, consider waiting a few moments before allowing the baby to nurse again. The older the child, the longer the wait and the greater the separation, i.e. for a 4-month-old a brief “no biting” and breaking of the latch might be sufficient. For an 8-month-old, you might break the latch and set the child down next to you or sit him up in your lap, just momentarily. For a one-year-old, you could stand him up on the floor next to you with a quick, “No biting. Biting hurts mommy. You can nurse again when you are ready to be gentle.” I’m talking a matter of seconds. You don’t have to wait for the child to show any acknowledgement or remorse. The point is not to frustrate or punish the child but rather to associate biting with the natural consequence of being removed from the breast and from the comfort of mom’s arms for a moment.

~ Praise your baby’s good behavior at the breast. In addition to creating a negative association with biting, create a positive association with not biting! Recognize your child with praise and kisses when he pops off the breast properly.

Moms, leave a comment if you have a tip for Steph. What are some gentle ways to deal with biting?

Post from: Breastfeeding 1-2-3

Here’s my beautiful glass of water. When we renovated our kitchen recently we treated ourselves to a new set of water glasses from Pottery Barn! I like them because they’re sturdy and weighty — they feel good in your hand! They also come in three different sizes, perfect for a small glass of juice, a healthy serving of milk or a refreshing drink of water.

What’s the rule about drinking water when you’re breastfeeding? It’s the same rule for everyone, breastfeeding or not: drink enough to satisfy thirst. Drinking any more than that can actually decrease your milk supply! One study showed that consuming 25 percent more fluids than the “drink to thirst” recommendation led to a decrease in milk supply. I also learned from lactation consultant Linda Wieser at the LLL area conference that drinking more than 80 ounces of water per day can reduce a woman’s potassium levels and have a negative impact on milk supply.

So, while it’s a good idea to keep a glass of water handy next to the place where you typically nurse, there’s no need to force yourself to drink extra water. Just enjoy a glass as you feel the need!

Post from: Breastfeeding 1-2-3

Nursing is going well but suddenly the baby seems unsatisfied and wants to nurse all the time. The mother’s breasts feel less full, particularly in the evening. Is the mother’s supply low?

In the early days a nursing mother’s breasts may feel full or even engorged. If a mother has oversupply issues, this feeling of fullness may be constant and she may experience more than one episode of engorgement. If that feeling of fullness is suddenly gone, is the mother’s milk supply low?

In the first scenario, the baby is likely going through a growth spurt. Growth spurts typically occur around three weeks, six weeks and three months of age. During these times of rapid growth, the baby wants to nurse more often than usual. A mother may worry that the baby is not getting satisfied at the breast, but that more frequent nursing is simply the baby’s way of increasing the mother’s milk supply. The more the baby “demands” the more the mother will “supply.” It’s not a sign that the baby is not getting enough milk or needs supplementation. The mother’s breasts may feel less full but they are continually producing milk and the rate of milk production actually increases when the breasts are less full and slows as the breasts fill.

What about the mother who always felt full but suddenly does not? This mother’s milk supply may be regulating. That means that instead of tending to over-produce, the principle of supply and demand is starting to regulate the production of milk. It can take 6-12 weeks or more after the birth for the milk supply to regulate. While it can be very disconcerting for a mother when her breasts feel less full suddenly, it can actually be a blessing. Oversupply can lead to plugged ducts and mastitis. It can also give the baby problems with a foremilk/hindmilk imbalance. So it’s a good thing if the milk supply regulates and the mother can rest assured that the wheels of supply and demand are functioning.

My baby seemed so unsatisfied that I gave him a bottle and he sucked it right down!

If a mother is worried that her baby is not getting enough milk and she offers a bottle of artificial baby milk, the baby may well take it whether the baby needs it or not. The flow from a baby bottle is much faster. Gravity does all the work and the baby does not have to suck hard to get the fluid out. Thus a baby may take in more than the baby needs (and may consequently spit up more). If the baby then goes longer in between feedings (and thus appears more “satisfied”) that may be because it’s harder for the baby to digest artificial milk. Breast milk is the perfect baby food and is easy for the baby’s undeveloped digestive system to process.

So what are signs that the baby is getting enough breast milk and supplementation is not necessary? The best indicators are: adequate wet and poopy diapers, weight gain and lack of lethargy. For a baby six weeks and younger, it’s a good sign if the baby has at least five wet disposable diapers or six wet cloth diapers per day (one to two is normal in the first few days before the mother’s milk comes in). Look for three to four bowel movements the size of a quarter (once the baby passes the meconium and starts having yellowish breast milk poop). Older babies may start to have fewer bowel movements–even as little as one per week is normal as long as the baby continues to gain weight normally.

If the baby does not have enough wet and poopy diapers, weight gain is a concern, or the baby seems lethargic, consult a doctor. If the doctor suggest supplementation, try to troubleshoot any breastfeeding concerns, discuss ways to increase milk supply and consider supplementing with expressed breast milk.

Post from: Breastfeeding 1-2-3