Breastfeeding in the Fish Pond

My aunt called me this afternoon to say that my cousin C. is having a little bit of a hard time with this breastfeeding thing and the woman at the hospital wasn't any help, and would I be coming to see her anytime soon?  So I did what any good self-respecting experienced breastfeeder would do:  called the in-laws to watch the kidlets, called C. to see what I could do over the phone, and traipsed a county over to see my cousin and her baby.

Today was the first day they were feeding the baby, and she was having some good moments and some not good moments.  She had some problems while the lactation consultant was manhandling her, but the next feeding went better.  (Note to Lactation Consultants:  Why do you do that?  I know it's breastfeeding, but just because my child has a right to get all grab happy and chow down and I've asked for some help from you DOES NOT give you the right to try and get all grab happy with my private parts without asking first.  Sheesh.)  I answered a few questions and gave her a few tips after watching her feed the baby, and then realized that I've found myself giving the same advice to different people over the years.

So, without further ado, here are my tips for a successful foray into the breastfeeding world.  (Disclaimer:  I am NOT a lactation consultant.  I am not a doctor or a nurse or a medical anything.  I am not a member of La Leche League.  I am not really a lactivist, either.  I don't care how you feed your child - it's your business, not mine.  I am, however, a mom who has breastfed three babies a combined total of almost four years with varying degrees of success, and have learned a thing or two that might be helpful if you want to breastfeed.)

1. If you plan ahead and your hospital offers it, take a class on breastfeeding, preferably with your partner.  Yes, your partner.  If you are like me you don't remember your own name on a good day, and when you are pregnant it is compounded greatly, so it helps to have someone there who will remember things.  Also, I firmly believe that a supportive partner increases the chances of breastfeeding success.  With Trout, BigDaddyFish would help make sure her latch was good and make sure I had her positioned the best way.  He would sometimes get subsequent babies in the night and latch them on without even WAKING ME UP.  Yeah.  Trust me, that's worth its weight in gold, right there.  Take someone with you, and spend a couple of hours learning the basics of positioning and latch.
2. The basics of positioning.  Baby should be tummy to tummy with you, facing your body.   Otherwise baby has to twist his/her neck around like Linda Blair in The Exorcist, which isn't a very comfortable position for eating (try it sometime, you'll see).  Even in the football hold (where baby is held in a more or less upright position with head at the breast and legs/butt by your hip), your baby's body should be facing yours.  I found after my c-sections that the most comfortable position was laying on my side with the baby laying next to me - that way, no stress on my staples.  Football hold rarely worked for me, but I have a bigish belly and really short arms, so I imagine that if you are normal sized and all, it would work for you.  The other two positions are the cradle holds, where baby is cradled in your arm(s) with his/her belly against yours.  I found in the beginning, being a larger boobied girl, that I was most successful if I held the baby with the arm furthest away from the breast I was using, with my hand on the back of the baby's head, and used the arm closest to the breast to hold the breast in place - the damn things were just too big for such a little baby to handle.  After a couple of weeks my kids all developed enough head strength/expertise that I could hold them cradled in the crook of my arm and be fine.
3. Latch basics.  Okay, the first thing to remember is lips.  Baby's lips need to be flanged outward, kinda like making a fish face.  The lips can't be tucked in over the gums, or baby won't be able to suck properly, and it will probably make you hurt.  Second is that you need to put as much of the aereola (dark part of the breast surrounding the nipple) as possible into that kid's mouth.  Yes, even us of the big boobie persuasion.  There are milk ducts all around the nipple, not just in the nipple proper, and you want the kid to get the most benefit for each suck.  Third, you have to get the kid to open his/her mouth wide enough to achieve this.  If the baby is not cooperating to open wide, tickle the side of the baby's cheek or the baby's lips with the nipple - this should make the baby pounce eagerly.
4. Feed the baby as much as possible in the beginning to build up your milk supply.  Trout was a very sleepy baby; she slept through the night from day one, and rarely stayed awake for a full feeding.  I was told to wake her every 3 hours or so to feed her during the day, and let her sleep at night (I was actually waking her up at night and the pediatrician told me I was insane and to get some sleep - she wouldn't let herself starve).  Trout never nursed particularly well, she went on lots of nursing strikes, and I was never convinced she was getting enough (she had enough wet diapers, but gained weight super slowly).  She weaned herself at 8.5 months suddenly, just went cold turkey, and I was both in physical agony and emotionally very disappointed.  I am convinced that if I had cut back and woke her to feed every two hours or even 1.5, we would have had a better experience.  With Little Man and Sunny, I fed both of them on demand (someone had said if the baby moves, feed it, so I did) and it ended up being about every 2 hours in the beginning, and they were both better nursers for longer.  Tips for waking a baby who falls asleep during feeding:  Strip baby to diaper to feed - no, baby won't freeze to death.  Remember she/he is up against your body and getting your warm milk.  Tickle the soles of the baby's feet.  Blow in the baby's face.  Change the baby's diaper.  If all that fails, use a cool washcloth to wipe baby's face (yes, sounds cruel as hell, but is sometimes necessary).  All had to be done with Trout.  I think she'd still rather sleep than eat.
5. Try to feed at least 10-15 minutes per side per feeding.  CAVEAT:  If you find you have an overabundant supply (baby is getting sprayed, has trouble when your milk letsdown, or is excessively spitty due to getting too much milk) it is okay to just feed from one breast at a feeding, just remember to alternate so one doesn't dry up and leave you lopsided.  Frequency will help build up/maintain supply.  Duration is also important, as the breastmilk containing the most fat is hindmilk, which comes up at the end of the feeding.  Some babies are very efficient, some like to linger; my first two were all business and done after about 5 minutes on a side, whereas Sunny would have nursed 24/7 if I'd let her.  Their weight gain and amount of wet diapers were good, so I knew that they were getting enough of the good stuff, so I could feel comfortable "watching the baby, not the clock."
6. Make sure you pump if you are going to miss a feeding for any reason, at least in the first couple of months.  Breastfeeding is a supply/demand operation - if you don't empty the supply, the body won't make as much.  Pumping will never be as good at getting milk out as a baby, so don't be discouraged if you find you can't pump much, especially in the beginning.
7. Be careful about bottles.  Some babies can switch back and forth between bottle and breast quite easily (Little Man), others prefer the bottle because it is easier to get to the milk (Trout), and others won't take a bottle at all (Sunny).  I recommend waiting until about 4 weeks before trying to introduce a bottle of anything, but if you need to introduce the bottle due to returning to work, try to get someone besides you to feed the baby a bottle every day after the 4 week mark, if possible a mom who is an experienced bottle feeder.  I waited too long to try with Sunny, and she never would go for it, no matter who offered it.

Debunking some myths about breastfeeding that seem prevalent to me:

• It doesn't matter how big or small your breasts are.  You should be physically able to breastfeed unless you have had a breast reduction or have something hormonally wrong.  There is a lot of misinformation out there, but basically if you stick with it and are motivated, most moms can do this.  (Please, don't jump all over me with the "I tried and it didn't work" thing - I know some people who couldn't do it, and that's disappointing and sometimes heartbreaking, but it's not a crime and you aren't a bad person.  I also know some people who just didn't want to put in the work it would have taken to make it work.  It is okay.  I don't care how you feed your child - the child will be fine as long as the child gets fed.  That simple, really.  Just own your decision if you decide you don't want to do what it takes to do it - don't blame it on not being physically able to)
• It shouldn't hurt.  Ever.  Be uncomfortable, a little in the beginning, but not hurt.  If it hurts, if you are bleeding, ask for help from someone knowledgeable.  It is usually a correctable problem.  (After Little Man was born and was in the NICU, once I got home and was pumping I had the sucking pressure turned up too high on my pump, and it both hurt and made me bleed.  The milk I pumped was orange.  I was pissed because it hurt and I had to dump it all out because it was full of blood.  It was a pump setting I'd used once I'd gone back to work after Trout, and it didn't occur to me that it had been a while and maybe my breasts needed to toughen up again.  They did.  So even if you have breastfed before, expect a little discomfort at first with the next child)
• If you are going to pump, a good pump is worth every penny you pay for it, even if you rent it.  I burned up two pumps in under two months of pumping a lot due to clogged milk ducts before I broke down and spent the $$$ to buy a Medela Pump In Style.  God, did it make a huge difference.  It is way way more comfortable, feels more like a real baby (even if it is a blasted milking machine), and will pump way more milk in a short amount of time.  If you can't afford to shell out the $$$, check with your hospital or local lactation consultant; most have them to rent.  However, if you will be working outside the home and need to pump milk for your baby, ultimately it makes sense to buy a good pump.  It is worth the investment.  ALSO, don't be afraid to buy a used pump.  The pieces that touch the breast or the milk are all sold separately, usually for around $20-$30, so you don't have to use the parts that touched someone else if you don't want to.  If you aren't as cootie-shy, the pieces can all be boiled and sterilized and will be fine.  When pumping, it helps to have a picture of your baby and to think about your baby (I always tried to think about how my baby felt in my arms and how he/she smelled), and this will help with your letdown reflex, which will let you pump more milk.
• If your baby isn't getting enough milk from your breasts, you can still continue to breastfeed while supplementing with formula.  Any amount of your milk that your baby gets will be beneficial.  Ideally, use a Supplemental Nursing System, but if you can't, just try to nurse as much as you can before giving the baby a bottle.

Let's see, a few other things.  It may not seem like baby's getting much the first couple of days, before your milk comes in.  Actually, the stuff baby is getting, colostrum, is full of antibodies and is wonderful stuff for baby, especially premies.  Keep at it.  When your milk comes in, you may find you feel like you have a fever, and just feel awful - it is normal (freaked me the hell out the first two times it happened, though).  I sweated like crazy when my milk came in.  If your breasts hurt when your milk first comes in (because your body doesn't know how much to make yet so it makes too much), it sounds crazy but put raw cabbage leaves in your bra.  Really.  Works great.  I leaked like a sieve with all 3 of mine, so nursing bras and pads were a must.  I found the washable kind weren't adequate - I don't know how many pairs I would have needed to keep myself contained, but I kept running out.  I used disposables - Lansinoh pads were the most comfortable and most effective at containing leaks.  Change the pads often - you don't want to get mastitis (had it 3 times, it sucks) or thrush (twice).  Some women are comfortable going braless, but I just could not let these huge things flap around like that, plus then I just soaked my shirts and sheets and everything else.  Make sure you have a good, supportive nursing bra with soft cups; no wires (yes, wires offer support, but when breastfeeding they can compress milk ducts leading to clogs, which can lead to mastitis, and besides, they hurt like hell).  If this is your first child, buy one nursing bra a size bigger than what you are during the last month or so of pregnancy; after baby comes and your milk comes in, measure or get measured to ensure proper fit.  You'll probably need 3 or so good bras - one to wear, one to get soaked/puked on, and a spare to put on when a previous one is in the wash.

I think I've worn myself out here.  Feel free to ask questions if something doesn't make sense or if I didn't address the particular issue you have.  And remember, please, I am not passing judgment on how you feed your child; as I said, I don't care how you choose to feed your child, as long as the child is fed.  Whatever works is what is best.

Baby Mackenzie is adorable, doing well, and I am jealous as to how well C. is doing after a c-section, because I never did that well, even after Little Man's and his was a piece of cake.  I hope I was able to help C. with her breastfeeding issues, and I hope I can help you all, too, if you need it.  Breastfeeding is a beautiful and rewarding experience, and worth the work, for all parties involved.