Dear Angela,

I have a friend who is on bed rest and will probably have premature multiples. I gently asked whether she plans to breastfeed and she responded with comments about how she isn’t sure but she’s sick of strong pressure from very pro-breastfeeding women. She says she’ll commit to at least 4 weeks of “trying,” but I could already hear excuses in her explanation, such as “I’m really tiny and I don’t think my body will produce enough”, and “I’ve heard they actually don’t want you to breastfeed premies because the babies don’t get all the nutrients they need, plus they can have trouble latching on.” She also says she’s having a night-nurse and that formula will be easiest for that situation. She also constantly comments on how she hates that she’s gained weight and is worried about getting “much bigger” during her pregnancy. I do know that she wants to do what is best for her babies, and I want to help her get her past her body issues that might be keeping her from focusing on what she needs to do. Any advice on what to say to give her the best advice without seeming to pressure or judge her?

Thanks for your expertise!

Readers, please chime in and leave a comment with your thoughts on how to reassure a pregnant woman about her ability to breastfeed. Any mothers of multiples and/or premature infants out there? I’d love to hear from you on this one.

I do have several thoughts to get the discussion started. I will break this complex question down into various issues that have been raised.

Information versus Advice

It is lovely that you want the best for your friend and her babies, and I am glad that you are trying to be sensitive to her feelings. One way to help her without pressuring her or judging her is to focus on sharing information rather than advice.

While breastfeeding cannot be considered a religion, or, heaven forbid (pun intended), a cult, bear with me while I make an analogy. Which person is going to have more success: (1) the one who gives someone a cross and says “You should pray! If you’re not religious, you are subject to eternal damnation!” ["You should breastfeed! If you don't, your babies will be sicker!"], or (2) the one who gives someone a Bible and says, “This really helped me. You might find it interesting” ["I found this parenting and breastfeeding resource to be really helpful. I thought you might like to have it"]? What about (3) the one who says, “I can’t believe you don’t plan to go to church on Sunday!” ["You're going to formula-feed?!"] compared to (4) the one who says, “The service on Sunday is about a topic you might like. I can give you a ride if you want to join me”? ["I know you have questions about milk supply, breastfeeding twins and breastfeeding premature infants. Here's the phone number for free breastfeeding information and support." Or, "I attend a La Leche League meeting each month. Let me know if you want to join me!"]

Contrary to popular belief, La Leche League leaders are trained to give information rather than advice. Leaders are there to support women who want to breastfeed, not to convert women who have no desire to so. Breastfeeding is a personal decision. Giving a pregnant woman factual information empowers her with the tools to make her own informed choice. Lactation consultants are also invaluable resources for information and support (and sometimes it can be easier for women to process the information when they are paying for the service — they’ve paid their money for the information and now it’s theirs to do with as they decide).

Breastfeeding after Infertility

The question does not mention whether this pregnant mother conceived through infertility treatments or not, but as someone who experienced primary infertility, I can recognize the self-doubt that sometimes comes into play. It’s hard to trust your body to do what it is meant to do (make breast milk to feed babies) when your body “failed” you when it came to getting pregnant in the first place. Add to that a need for bed rest, and it’s no wonder this woman is worried about her body producing enough milk.

A 2007 study showed that women who use assisted reproductive technology such as IVF to conceive are less confident about their mothering skills, more anxious about caring for a newborn and less likely to be breastfeeding at three months. Such women could benefit from additional parenting information and extra support for breastfeeding.

Small Breasts Make Plenty of Milk

The size of a woman’s breasts does not matter when it comes to milk production. Milk production is simply a matter of supply and demand (the more a baby or babies suckle at the breast, the more the mother will produce). Breast size can affect milk storage capacity (but not necessarily).

Milk supply is one of the biggest concerns among breastfeeding women.

Using Formula in the Night

Given that milk production is a matter of supply and demand, any feeding during which a baby or babies receive formula is a feeding during which the breasts are not being stimulated to produce milk, which in turn lowers the mother’s milk supply. Overnight feedings are particularly important for milk production. Substituting feedings for “convenience” in the night can become a vicious cycle in which the mother’s milk supply drops and she feels the need for further supplementation. Especially in the early weeks, if a mother is not putting a baby to the breast for a feeding, she should consider pumping during that time. Pumping is not as efficient as a baby’s suckling, but it can help maintain milk supply.

Breastfeeding May Help Promote Healthy Weight Loss

The good news is that breastfeeding burns extra calories! Many, but not all, women find that breastfeeding helps contribute to post-partum weight loss.

Breastfeeding Premature Infants

It’s troubling that this pregnant mother is already hearing negative things from medical professionals about breastfeeding. Unfortunately, doctors get very little (1-2 hours) of training on breastfeeding during their medical education. Check out this piece I wrote on how to get good medical advice on breastfeeding (it also has links for other articles on where to get good breastfeeding information). There is a lot of good information out there on breastfeeding premature infants.

To ask questions or read other mothers’ stories, check out this kellymom.com breastfeeding forum on NICU babies. La Leche League also has a forum on breastfeeding premature infants.

For inspiration, read this mother’s story of breastfeeding her triplets, born at 32 weeks and 4 days (they spent 18 days in the NICU).

Breastfeeding Twins

It is a myth that breastfeeding twins is too difficult to manage. One of the wonderful parenting and breastfeeding resources out there is Mothering Multiples: Breastfeeding and Caring for Twins or More! In this interview with the author Karen Kerkhoff Gromada, she shares her experience breastfeeding twins and offers lots of helpful information.

Kellymom.com has compiled a fantastic list of resources for breastfeeding multiples. There is also a La Leche League forum on breastfeeding multiples.

Readers, what do you think? How can this woman best support her pregnant friend? Does anyone have a story to share about breastfeeding multiples or premature infants?

Post from: Breastfeeding 1-2-3

When I was pregnant with my second child, my first daughter nursed right through the pregnancy and happily tandem nursed with her new little sister. My experience this time around has been different. My 3-year-old simply is not as attached to nursing at this point. She had already cut back on nursing to about three times per day, and my milk supply dropped quickly. As my milk supply dropped, I found nursing to be more and more uncomfortable, and I found myself limiting the length (but not the frequency) of nursing sessions. Once I became pregnant, I experienced both breast tenderness and a further decrease in milk supply. Consequently, we are down to one nursing session per day, which my daughter self-limits. At this point, she mainly wants to know that she can nurse if she so desires, but when she latches on she quickly finds there’s not much milk and she’s not all that interested in nursing after all. I can see that she will soon wean altogether.

The very helpful book (should you find yourself pregnant and breastfeeding) Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond notes:

Reports seem to indicate that 26 percent of children self-wean during pregnancy…. Although 31 out of 57 babies, or 57 percent, of the children who were nursing at the beginning of their mothers’ pregnancies were no longer nursing by the end, the investigator specifically records that the weaning was baby-led in 15 of those 31 cases and mother-led in 16.

I guess I’d characterize our weaning as part mother-led, part child-led. At any rate, I think we’ll be among the 57 percent who are not nursing by the end of the pregnancy.

After nearly six years of continuous breastfeeding, I am looking forward to a little break. At the same time, though, I am mourning the nursing relationship and all the benefits for my child and me. Right now my three-year-old has a terrible cold and accompanying cough. If I had the milk, I’d be getting as much of the wonderful antibodies into her as possible to help her fight the cold and hopefully prevent an ear infection. As it stands, I’m worried that she’ll get even sicker. I can remember way back when my firstborn was just four months old, and a La Leche League leader with older children basically lamented, “That first illness after weaning is the worst. Your child gets more sick than usual because he’s not getting the antibodies from you. Not only that, but he doesn’t have nursing to comfort him when he’s not feeling well.” Subsequently I heard other leaders say, “Of course when you wean is up to you, but I don’t recommend it during cold and flu season!” Ah, wise women!

For more thoughts on breastfeeding “Beginnings and Endings,” read these entries in the carnival (updated throughout the day):

~ The Motherwear Breastfeeding Blog – Weaning
~ How to be a Badass Dad – The Breastfeeding Father
~ Leche Baby! – Weaning a Toddler
~ Mama Knows Breast – One Mom’s Story of Breastfeeding Challenges
~ Breastfeeding Mums – Beginnings and Endings
~ Adventures of Pip and Squeak – A Complicated Relationship
~ Nature Moms – Mama Knows Breast
~ Crunchy Domestic Goddess – Inauspicious Breastfeeding Beginnings
~ Tales of Life with a Girl on the Go – Breastfeeding Beginnings

Post from: Breastfeeding 1-2-3

Q: “Hi, I’m hoping that you, or someone you know can help. I’m a tandem nursing mom to my 2 1/2 year old and my 12 week old. I never had any nursing issues or problems with my first. I am currently suffering from mastitis for the second time in 4 weeks! On top of that, my 2 year old was just diagnosed with Herpangina (a form of Hand, Foot, and Mouth) virus. I guess it’s very contagious by saliva and I’m praying that my 12 week old doesn’t get it. My pediatrician completely frowns on tandem nursing, so I kind of left this little detail out when we just saw her for my son’s herpangina.

When he started getting sick, I immediately started cleaning my breasts/nipples after he nursed to protect the baby. My OB said that actually cleaning the nipple could cause mastitis!?

Did I actually cause the mastitis this second time? How can I protect my infant from the Herpangina? What am I doing wrong this time to get Mastitis twice since I never got it with my first child? What can I do differently to avoid getting it again? Thank you so much for any advice you can give!”

A: First off, congratulations on your 12-week-old! I’m sorry to hear you have endured repeated bouts of mastitis this time around. Mastitis can be very debilitating and has a nasty way of kicking you when you’re already down. You should be very proud of yourself for working through both cases and continuing to tandem nurse.

Recurrent Mastitis

Let’s address each of your questions separately. Did you cause the second bout of mastitis? It’s true that mothers are generally advised not to wash their nipples with soap because the soap can remove essential oils from the surface of the breast. I doubt though that washing your nipples caused the second bout of mastitis. When a case of mastitis comes closely on the heels of a previous bout of mastitis, it’s likely that the first case never really went away and the “second case” is really just a second flaring-up of the first. When battling mastitis, it’s important to rest-rest-rest and nurse-nurse-nurse. If you take antibiotics to treat the mastitis, it is imperative that you take the full prescribed course of antibiotics and you do not stop taking the pills once you start feeling better.

Spreading Germs

How can you protect your infant from the herpangina? It’s fine to rinse your nipples with plain water, and for a little added protection from virus transmission you could express some breast milk onto your nipples and let the milk air dry. Breast milk has antiviral and antibacterial properties. However, KellyMom says it’s really not necessary to take any special precautions to prevent the spread of germs between nurslings (with the exception of thrush):

By the time symptoms occur in a viral illness, the two nurslings will have been in close contact for days (both in the home and at the breast), and thus the well child will have already been exposed to the illness. In addition, your breasts will have already started to produce antibodies specifically for that illness. These antibodies will help the sick child get well quicker and will also help protect your other child from illness….

Washing the breasts between nurslings might even reduce the breasts’ exposure to the pathogens and therefore reduce the breasts’ efficiency at manufacturing antibodies.

Avoiding Mastitis

What can you do differently to avoid getting mastitis again? As I said, breast infections kick us when we’re down, so the key is to stay otherwise healthy and (reasonably!) well-rested. Follow these ten tips for breast health.

Share Your Experience

How have other mothers dealt with mastitis? Have any other tandem nursing mothers dealt with viruses? Leave a comment!

Post from: Breastfeeding 1-2-3

I’ll tell you my routine – it’s really exciting! I feed, I burp, I change diapers, I pump. And then I have a tiny window of time to myself. I can breastfeed them both at the same time, which for me is a huge accomplishment!

Marcia should feel doubly proud (pun intended) for breastfeeding her twins. A University of Melbourne study released last month found that women who use assisted reproductive technology such as IVF to conceive are less confident about their mothering skills, more anxious about caring for a newborn and less likely to be breastfeeding at three months.  Based on the study of 150 women, the researcher concluded that women who used IVF to conceive should receive additional parenting information, reassurance and intensive support for breastfeeding.

I recently spoke to a new grandmother who described the difficulty her daughter had breastfeeding after IVF. Explaining why her daughter stopped breastfeeding, the woman essentially said, ”Her doctor told her she might have a hard time breastfeeding after all the fertility drugs and she did.” I’m not aware of any research that supports the notion that fertility drugs cause difficulty with breastfeeding, but it’s very clear to me that the doctor’s words served as a damaging and self-fulfilling prophecy! How dare that doctor sabotage that woman’s ability to breastfeed! Even if the doctor had concerns, the expectant mother should have been encouraged to seek support to ensure the breastfeeding relationship–not told not to be surprised if it didn’t work out!  

The sad thing is that breastfeeding can actually restore a woman’s confidence in her body and help her feel empowered after infertility. That’s what Michigan mother Sue Stuever Battel described as her experience and that was my experience too! Based on the above quote from Marcia Cross about what a “huge accomplishment” it is to nurse her twins it sounds like she feels empowered as well! Congratulations to Marcia Cross on her new babies and her breastfeeding success!

Post from: Breastfeeding 1-2-3

“What a fun website! I was surfing for info for my daughter on caring for a toddler while nursing a baby, and ran across your site. Ah, memories of nursing back in the dark ages of the ’60s came back. My first son had a lot of colic, which we dealt with poorly, but as a consequence, he nursed right through my second pregnancy, more for comfort than for nourishment. He was 15 months old when the baby was born, and he was thrilled when the milk came in. I nursed them both until the oldest was three, when I just felt that was enough (plus my mother-in-law and others were horrified, and I just caved, I guess). He was none too happy, and I would sneak around nursing #2 (at night, etc), but that didn’t last long. When the boys were 2 1/2 and 3 1/2, along came #3. Since I was pretty stressed out caring for three children and my milk seemed to be causing colic, she was weaned at 6 months. Sixteen months later came baby #4, a second girl, who repeated the pattern. Baby #5 came yet 16 months later, and one month after his birth, we were in the middle of the great stress and confusion of moving to a different job and state. I just threw up my hands and weaned him at 6 weeks. Two years later, after two more moves, #6 came along. Being older and wiser, I nursed her for two years. She self-weaned as the milk dried up, because we were expecting our last, a fourth daughter (born in 1978) who nursed for three years, when I decided that was long enough (she wanted to continue). So, I’ve run the gamut of nursing times, and from this vantage point, I would advise mothers to relax and do what they feel is best. For some reason, my milk many times led to runny diapers and I finally landed on baby carrots to counteract this with #7. Immediately, the diapers were firmer. She was only a few weeks old when I tried this, and I wish I had figured it out with #1. So, that’s my nursing story, for better and worse.”

To read other breastfeeding stories, click here. To share your story with me, click here.

Post from: Breastfeeding 1-2-3

**** Australians might enjoy the Australian Breastfeeding Association (ABA) 2007 calendar (gorgeous photos if you just want to take a peek!) for AUD $15.00 including GST.

**** Lucky residents of Sonoma County, California might find paper versions of the 2007 Breastfeeding Calendar at area hospitals and health clinics (everyone else can click on the link to watch the slide show). After January 1, 2007, area moms can submit their own photos in the 2007 photo contest for a chance to win a $100 gift certificate.

La Leche League of Canada offers its 2007 Calendar for CDN $15.00.

**** In the United Kingdom, the International Baby Food Action Network (IBFAN) sells its 2007 Calendar with facts and dates given in English, Dutch, German and French. The price is £5.00 (add an additional £2.00 for shipping outside the UK).

Available to everyone in the United States, the 2007 Beauty of Breastfeeding Calendar is put out by the Childbirth and Postpartum Professional Association (CAPPA) in Colorado for USD $12.99.

If you’re looking for a calendar with breastfeeding activism slogans instead of photos, check out over 100 inexpensive options at CafePress.com.

Post from: Breastfeeding 1-2-3

After my newborn’s arrival, our mother-toddler-newborn nursing triumvirate went through a three-month adjustment period. My toddler was thrilled with the return of plentiful milk, and I think she was grateful to her baby sister for that! My newborn also nursed like a pro, just like her big sister had as an infant.

When I came close to engorgement again in the early days, I simply asked my toddler to nurse and she happily obliged. Fortunately, I did not have an overabundant supply this time around. I had far fewer instances of plugged ducts. I did experience a return of the post-partum Graves’ disease, and my second child did follow in her sister’s footsteps with hourly night-waking. When I became completely run-down, I battled repeated cases of mastitis. I learned to rest, rest, rest and nurse, nurse, nurse, and conquered mastitis without antibiotics. I realized though that I needed more sleep. My husband and I started working on getting our baby to sleep better at night. She allowed my husband to put her to bed at an earlier age than my first-born did, and her night-nursing is down to two to three times a night.

I also realized that I could not continue to nurse both girls on demand. I needed my toddler to accept some limits on our nursing sessions. I tried limiting the number of nursings per day, but she could not handle that. Emotionally, she needed that connection with me, particularly with a new baby in the house. Instead of the number of nursings, we limited the duration. She could nurse for the length of two ABC songs, and then I would say, “Three, two, one, done, pop off please!” Given that she knew when the nursing session would end, and she had the warning of “three two one,” she readily complied with this restriction. Eventually, she was ready to limit nursing to waking in the morning, after her nap, and before bed (with exceptions for when she received a bump or scrape and needed comforting). Those sessions developed nicknames, “mum-mum,” “mum-mum after nap” (or “afternoon mum-mum”) and “mum-mum before bed” (a.k.a. “last mum-mum of the day.”) You see, early on I had tried to teach my daughter to say “num-num” as our code word for nursing, but she called it “mum-mum.” For a long time, “mum-mum” and “Ma-ma” were pretty much indistinguishable!

There have been many times that I’ve been incredibly grateful to be nursing. The time the 14-month-old fell and got a pebble lodged in her forehead and I nursed her to sleep before throwing her in the car to go to the pediatrician’s office. The time the two-year-old tripped and knocked out one of her top teeth on a concrete floor. The time the six-week-old was hospitalized for a high fever. All the times my children have needed comfort, nutrition, and re-connection. Nursing has become part of my parenting style. I know that when the time comes we’ll get by just fine without nursing, but for now, I’m happy we share this wonderful nursing bond.

If you’d like to share your breastfeeding story (about getting started, persisting through difficulties, toddler nursing, breastfeeding during pregnancy, tandem nursing, adoptive breastfeeding or any other aspect of breastfeeding), please email me!

Post from: Breastfeeding 1-2-3