Published in the Fall 2005 Issue of Birthing Magazine
Learning to breastfeed can be a difficult and frustrating time for first-time mothers and their babies. Under the best circumstances, most of us have patience and determination to learn a new skill. However, after the physically draining effects of labour and birth, breastfeeding can easily become frustrating if the baby is slower to learn to latch at the breast.
Birthing a baby is the most energy draining, intense physical and mental marathon of your life. And while it is exhilarating to hold your baby after all the anticipation, wait and worry, you are then obligated to pick yourself up and respond to the needs of your newborn at the expense of your own. Your body aches, you are exhausted, urinating is uncomfortable, the menstrual-like discharge can be messy and first time mothers especially can be unsure of themselves when it comes to caring for newborns.
During this period just after birth, your internal resources are fragile and you can be vulnerable to outside criticism or disapproval. With respect to breastfeeding, “well-intentioned help” can easily sabotage the breastfeeding process. Many new mothers are offered suggestions from people who truly believe that they are providing great advice, when the advice is dated and can actually interfere with the breastfeeding process. Here are a few situations that can arise, the problems that they can create, and suggestions on how to handle them.
The Postpartum Period
“You are so very tired. Why don’t you sleep and let us take care of your baby?”
Yes, it is true that you are tired after giving birth. However, if you let your nurse or someone else watch your baby while you sleep, you won’t know if they decide to feed your baby formula to give you a longer rest. The colostrum that your breasts produce just after birth is extremely concentrated with nutrients, immune factors and energy-rich natural sugars, and a newborn baby drinks colostrum approximately a teaspoon at a time. Because her stomach is extremely small, this amount of colostrum is a normal and healthy amount for her to ingest per feeding in the first few days of her life. If your baby is fed an ounce or more of formula, her stomach will become used to a larger volume and suddenly the colostrum that your breasts produce is not enough.
To counter this approach, keep your baby in your room with you, sleep when she sleeps and feed her on demand. If you can sleep while a family member or a friend is visiting, ask him or her to wake you as soon as the baby starts to stir so that you have time to latch her to your breast before she becomes wide awake and angry. It is difficult to breastfeed a hungry, angry, crying baby-- have you ever tried to eat when you are supremely upset? To help conserve energy, you can ask a nurse to help you position the baby so that you are feeding lying down. This position gives you extra rest while you cuddle and bond with your baby.
The baby is losing body weight and we are going to have to supplement her with formula.
Actually, it is normal for a baby to lose weight after birth. When a baby is growing inside her mother’s uterus, she is constantly fed nutrients and liquids through her umbilical cord. After birth, the constant stream of food and drink ends and breastfeeding begins. However, a baby can be really tired after birth, and it can be difficult for her to stay awake long enough to have a good feed. The answer is to let her breastfeed often and to do your best to keep her alert while she eats. You might want to wake her every two hours to feed to ensure that she’s getting a good supply of breast milk. Unwrap your baby, place her naked onto your bare chest and snuggle under the covers together. She is then able to breastfeed more easily and the smell of mom helps her to relax and feel secure. Keep offering the breast and encourage her to suckle even if it is a gulp at a time. Once your milk comes in, it will be easier for her to get more fluids and nutrients in each breastfeeding session. It can take up to three weeks for a newborn to regain her birth weight.
There is a point, however, when a baby can become dehydrated and that is cause for concern. At 7% loss of body weight, your health care practitioner will want to monitor the baby’s breastfeeding times and whether or not she pees and poops regularly. Supplementation may become necessary, but offer the breast first and then supplement afterwards. This allows your baby to continue to practice learning a proper latch and helps to establish a good supply of breast milk. It can take time for the baby to learn the physical act of breastfeeding, and once she does, supplementation will no longer be required.
Once You Are Home
“You should feed your baby on a schedule.”
Our mothers and grandmothers were advised since 1946 by Dr. Spock’s Baby and Child Care book to bottle-feed their babies and put them on rigid schedules because it was “more sanitary and more scientific.” At that time in history, scientists and pediatricians did not realize how much more breast milk offered besides nourishment—Secretory IgA that coats the lining of the baby’s intestines to provide better immunity from bacteria, viruses and parasites; Bifidus Factor that helps to establish good bacteria in the baby’s large intestine, natural fats that promote brain and nerve development; and the exactly perfect proportion of fats, proteins, carbohydrates, vitamins and minerals that the baby needs.
While ill-advised, it is possible to achieve a schedule for a bottle-fed baby because the cow’s milk proteins found in formula take more time to digest than the proteins found in human breast milk. An example of the difference would be eating a serving of tofu compared to a New York Steak. Tofu digests more easily than steak just as human breast milk is more easily digested than cow’s milk formula. Breastfed babies are supposed to eat often---the baby leads the “breastfeed on demand” process because her sole purpose at this beginning stage of her life is to ensure her survival by establishing a good and abundant milk supply.
You always get to feed the baby and I can’t. Couldn’t you let me give her one bottle at night?
The problems with introducing bottles into a baby’s schedule when she is busy establishing her milk supply are twofold:
First: a newer baby can become confused with the two different types of feeding. Breastfeeding is a very active process. A baby draws a good amount of breast tissue into her mouth (more than you realize) to form a teat. She has to suck for quite a few seconds before the letdown reflex begins and the milk begins to flow. When a baby is feeding well, the rhythm that develops is to suck a few times and then to gulp the milk that pools in her mouth.
Bottle-feeding is a totally different process. A bottle-fed baby doesn’t have to work at all to get milk. The milk dribbles from the nipple of the bottle and the baby gulps away to her heart’s content. If a breastfeeding baby encounters two types of feeding, one that she has to work at and one that is incredibly simple, she might just opt for the easier one, especially if she is having difficulties learning how to latch.
Second: it is the physical act of sucking at the breast that stimulates the brain to increase milk production. If a baby is using one of her feeds to drink formula, the mother does not get the stimulus to produce more milk. This results in less milk available for the baby, which causes her to be hungry and fussy. The same problem arises when soothers are introduced into a newborn’s life before the breast milk supply is firmly established. A soother can provide comfort, but it interferes with the baby sucking at her mother’s breast. Soothers and bottles should only be introduced after the breastfeeding process is comfortable for both mother and baby, not before.
One way to satisfy the needs of your partner, your parents, your in-laws and other family members who want to feed your baby is to give them an activity to do that is special just for them. Partners can take over bath time and actually climb into the bath with the babies to enjoy skin-on-skin closeness. Other family members can be shown infant massage techniques that promote the bonding process between themselves and the baby, or suggest that they hold the baby on their chests and drape a warm blanket around the two to provide the satisfaction of a good cuddle. Be creative, there are lots of ways to show love that don’t involve bottle-feeding.
It is important to remember that learning the skills of parenting a newborn take time and quite a lot of energy. Breastfeeding is one of these skills and if you can remain as calm as possible, you have a much better chance of success. Here are a few tips to make breastfeeding easier from someone who learned the hard way:
Latch your baby as she is waking up. Babies wake up hungry and if you wait to latch a baby until she is fully awake and crying, you have lost a good five minutes of time that the baby is sleepy and relaxed and better able to take the breast. You have extra time to get a proper latch and if it isn’t right, you are able to try again without you or the baby becoming upset. Once your baby starts to twitch and smack her lips in her sleep, prepare yourself for breastfeeding: go to the bathroom, get yourself a big glass of water and a snack, grab the portable phone, get yourself comfortable and organized and try to latch her while she is still half asleep. You get much better results if you do.
- Get as much sleep as you can—you have more internal strength (and patience) if you have plenty of rest. One way to accomplish this is to spread out your available help after your baby is born and schedule visits from family members for after your partner goes back to work. This is a great approach because you have alone time to bond as a family and you can learn how to breastfeed without an audience. If your family members can come to see you and the baby after your partner returns to work, you have extra help with the chores that need doing such as cooking and laundry and you can take that extra time to rest and bond with your baby.
- Delay the visits of the more critical people in your life to when you are feeling stronger and more secure in your parenting skills. New parents are quite vulnerable during the first month or so of a new baby, especially a first baby. This is not a time to have to defend yourself from an overcritical family member or friend.
- If you get advice that is contrary to your way of thinking, all you have to do is say “thanks, I’ll think about that” or “I’ll talk to _________ (partner’s name) and we’ll think about that.” The person giving the advice feels heard and you are not obligated to do the suggested activity on the spot. Both of you save face this way.
Breastfeeding can be frustrating to learn for some women and if you find that you and your baby are struggling, get help immediately! There are great lactation consultants around the Calgary area. The help of a positive, knowledgeable person could make the difference for a new mother to be able to successfully breastfeed her baby.