Tips for successful breastfeeding

We all know by now that breastfeeding your baby provides the best nutrition for your baby and is the safest choice for most women. We also know that many women want to breastfeed their babies but find it difficult to impossible for a variety of reasons. While nursing issues are common, it is rare that they cannot be solved with the right support and the commitment of the mom to seeing it through.

So many moms today have the commitment part down, but underestimated the importance of the "right support." Breastfeeding is painless when done correctly. When it isn't, the pain is intolerable. Sometimes the situation resolves itself. If it doesn't, it can become too painful for the mom to nurse, and an unplanned and unwanted transition to formula can be the result. With the right support, even the most challenging and seemingly bleak breastfeeding situations can be remedied and the pair can nurse  successfully. 

While you are still pregnant, you can start discovering and creating who, what and where your support system is. 

So what is helpful for breastfeeding?

A good start. A low to no intervention birth, baby with mom immediately after birth skin to skin until the end of the first feed, about two hours. If this initial step doesn't happen, then restart again as soon as mom does get baby. ie, put naked baby on mom's bare chest and let them discover mom. This delayed start works better if the baby hasn't been bathed. You can opt out of the bath at the hospital, just let them know before the baby leaves the room. You can also put it in your birth plan. Having a doula at your birth has been proven to help breastfeeding outcomes (ahem!) and can help you get closer to this ideal first two hours or more.

Realistic vs unrealistic expectations. Sometimes nothing is wrong, nothing needs to be fixed, but because mom and/or her partner, nurse, doctor, mother, friend etc don't know what to expect with breastfeeding, interventions are applied that actually interfere with the process instead of helping. A newborn goes through a nine stage process at birth that can take up to two hours. If the two hours are interrupted and not skin to skin at the time of birth, they may need even more time skin to skin with their mother to go through their stages. For more on the nine stages see: http://www.magicalhour.com/aboutus.html. I have a video showing these stages that I share with my clients prenatally. 

Most women today tell me they want the "first hour" and to "nurse immediately", but don't know what that really looks like. They ask nervously as soon as baby is on their chest, 
"Is the baby nursing yet?! Are they getting anything?! Am I doing this right?!" 
When you understand the nine stages a newborn goes through, you will realize that its pretty hard to do it wrong. Just let the baby be. Your partner can keep the nine stages on a check list and make sure noone takes the baby before they are done. This will go a long way.  An once of prevention is worth a pound of cure!

OK, so these last three paragraphs say essentially the same thing. That is because I cannot stress enough how helpful the appropriate start of breastfeeding can be. When given the time and patience, many newborns latch on themselves. Baby-led latch takes time, but it is often the most effective way to do it.

And of course, that doesn't always happen and maybe you can use an experienced lactation counselor to help get things started. But even so, if you followed the above plan, they will most likely be able to correct the latch easier and faster than if  you and the baby didn't get two hours of uninterrupted skin to skin immediately after the birth, or shortly after, as soon as possible, without a bath.

As the baby gets the hang of it, the next thing that many women mistake as an issue is the frequency with which a baby will nurse. Your newborn should be nursing 10-12 times per day. There is nothing so demanding to compare it too and many women worry that their baby is overeating, too attached to them, just nursing for comfort, and/or other misconceptions. There are instances where the baby doesn't have a good enough latch, and then they aren't getting enough transfer of milk at each feeding so then they nurse more often. This would need to be identified by an experienced lactation counselor, IBCLC, postpartum doula, and/or nurse experienced with lactation. But usually, its just the normal frequency of nursing that surprises women. Let me clarify this now, they nurse a lot. A lot, a lot, a lot. 

Your supportive team:
You need people around you who 1) support your breastfeeding and 2) know how to spot issues and resolve them. Make sure your OB or midwife supports breastfeeding. I think it'd be rare to find a midwife who doesn't support breastfeeding. But still. And make sure your prediatrician supports breastfeeding. When interviewing pediatricians, you might want to ask them if they are using the breastfed baby growth chart or forumla-fed baby growth chart. Also consider asking them what % of their clients nurse exclusively the first 6 months and what % continue with solids and nursing through 12 months (the WHO recommendation). Consider having a doula who is experienced in breastfeeding. If the birth doula you love doesn't do postpartum/lactation, there are plenty of postpartum doulas and lactation consultants and counselors who focus just on this special time. I do both by the way, birth and postpartum/lactation support.

If your close family members do not support your breastfeeding, this can be very difficult. It may be more than you want to deal with right after you give birth, but breastfeeding is so important, you can't really afford to allow them to interfere. For some moms with really tough families, just not telling them about your breastfeeding, and/or not having them over too often is the best they can do. Hopefully your family will be supportive and they won't add any challenges. Of course grandmas want to help, and they still can. A nursing mom really needs someone to come bring a hot meal, clean the house and do some laundry. Tell them your doula Maiysha said so!

Find and go to your local breastfeeding support group! This is so priceless! And if it isn't, find a different group that is. While breastfeeding is natural and we've been doing it forever, we have traditionally always done it within a supportive community. These groups provide this last missing piece of the puzzle. Find them before you deliver because once you deliver you are too tired and busy to do anything extra. If your breastfeeding is going well and you don't need any help, still go because you can help moms who are struggling. Just seeing other women nurse can help women figure out how to correct their position and their latch.

Classes and books? Everyone learns differently and these can help too. What classes and books provide is educating you to have more realistic expectations for nursing, what the flags are for problems, and when to seek help. But if you already followed my above tips, you would already have that. There are many books out there, I recommend The Ultimate Breastfeeding Book of Answers, Jack Pitman and Teresa Pitman, anything from Ina May Gaskin, La Leche League, and/or Karin Caldwell, just not the What to Expect when your Expecting series.

Then last but not least, know that there is a time and place for formula, and that is OK. If your baby gets bathed, a pacifier, formula in a bottle and is away from your for hours after birth, you can still nurse. Make sure you get an experienced lactation support by your side asap. It may take a longer to get things started, and you may need more hours of professional help to mitigate the fact that the baby's natural rhythm is off the track, but it can be done most of the time.

Safer Use of Infant Formula: 
If you do need to and/or choose to use formula, please do safely. Properly sanitize all bottles and nipples, and be sure and prepare properly. From the WHO website:
Powdered infant formula (PIF) has been associated with serious illness and death in infants due to infections with Enterobacter sakazakii. During production, PIF can become contaminated with harmful bacteria, such as Enterobacter sakazakii and Salmonella enterica. This is because, using current manufacturing technology, it is not feasible to produce sterile PIF. During the preparation of PIF, inappropriate handling practices can exacerbate the problem. WHO recommends mixing powered formula with water at a temperature of at least 70 degrees C, 158 degrees F - to kill E. sakazkii. Formula made with hot water needs to be cooled quickly to body temperature if it is being fed to the baby immediately. If formula is not being fed immediately, refrigerate it right away and keep refrigerated until feeding. Please read the full recommendation through the following link:
http://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf

This may seem like overkill, especially when we see moms in the park pouring water from their bottle of Poland Spring into a bottle, scooping in the formula and then shaking, but this is very dangerous.  Please do take care when preparing bottles and formula.

Now that you know that formula isn't as easy as it seems, you may as well keep on breastfeeding. Breastmilk never gets a re-call!