When you have a baby, everything about life changes. The love of your child may hit you like a ton of bricks. Or, like other love relationships, it may creep up on you slowly. Some parents take the coming baby experience with a laissez faire attitude. They trust they will get through childbirth and child raising by the seat of their pants. Others plan everything, like a military expedition, trying to think of every possibility and plan for every outcome. Others take a middle of the road attitude. Whatever the personal style of the parents, they will be bombarded with all sorts of advice and warnings. Some of it will be useful, and a lot of it, not.
If the parents are “researchers,” they may discover many opposing viewpoints on almost every issue. The “planners” may find this frustrating and overwhelming and make a firm commitment to adopt a viewpoint that causes issues within their relationship with each other and the baby. The “flyers” may find themselves validated when everything goes smoothly or be able to adjust to any bumps in the road they encounter. The key is having two parents on the same wave length – which often doesn’t happen! It’s a good idea for parents to discuss these things before baby comes and be prepared to change strategies if they find that the planned one is not working for them and their baby.
The truth is, babies need love, comfort, security, food, and warmth. Breastfeeding provides that very first connection that simultaneously provides all of a baby’s needs with one activity. The challenge comes in providing those needs for the baby while caring for the mother and father. Here is where family and community support becomes vital.
If you are a laissez faire sort of person, consider the possibility that childbirth may not go in a predictable pattern. It helps to have supportive folks in the wings ready to step in and give a hand if you need it. Have the conversation with family and friends so they understand your point of view, but can plan to be available in case you need a little help with coping in the first days. If you are a researcher or a planner, try to accept that there unforeseen events may occur and contingency plans may be required. Give yourself room to breathe and try not to set impossible goals as a measure of success.
Babies are non-stop needy. They go from having their needs supplied without any effort on their part before birth to a world that is cold, bright, hard and must be engaged to get anything that they need. Babies have massive brains (compared to other animals) but few connections established. Everything must be learned from scratch. Primitive reflexes such as suck, swallow, breathe that are essential to survival are present but baby must associate those with actions that bring food and satiation together. Those associations build over time. Connections between the brain and mouth and neck become more secure by 5-8 weeks. This becomes obvious to parents when baby begins to smile in response to interaction with other humans. In these early days, babies need to be near their mothers, enjoying skin to skin contact and free access to mother’s breasts for nourishment and comfort. Interestingly, this time when baby is mainly reflex-driven is also the time when mother’s milk supply is built and established. Frequent and unrestricted access to breastfeeding has been shown to increase milk supply better than scheduled and limited feeds. Frequent breastfeeding helps to increase hormone levels and sensitivity of lactation tissue to hormones of milk production. For mom to be available, it helps to have household and toddler assistance (if needed) during this early period. Slings and wraps that keep baby close to mom can help reduce stress.
Sometimes parents are tempted to use artificial carriers such as car seats, Rock ‘n Plays, swings and other devices that put baby in a semi-upright position and provide movement and/or noise like the uterine environment. The thought is that these devices will give parents a break and are harmless. Studies, however, show that babies who spend too much time in these are more likely to develop acquired torticollis, reflux and plagiocephaly. Here’s an article that gives more information about one product. By age 3 months, babies have progressed and gained more head and neck control and can use these products without some of the side effects.
As babies grow and mature, they become more sociable. Stomachs grow and babies can take more milk in at a session and sometimes go longer between feedings. Feedings can also be shorter at times. The unique personality of your baby becomes more obvious as time goes on. Your relationship grows and develops. Most moms find that after 3 months, breastfeeding becomes easy – and so much easier than all the work it takes to bottle-feed a baby. Breastfeeding becomes more than just a way of transferring nourishment to your child – it is a communication tool, a way of comforting, and a way of teaching about relationship.
In most non-Western cultures, breastfeeding to 2 years and beyond is the normal pattern. Of course, older babies do not nurse as frequently as newborns and some sessions may last only a couple of minutes. Extended breastfeeding (breastfeeding exclusively for the first 6 months and thereafter as long as the child desires) is associated with better development of facial structures, reducing the need for orthodontics in children nursed over 18 months. Family-friendly solid foods can be introduced starting at 6 months of age. For more information on introducing solid foods to older babies, check out this website:
Whatever your parenting style, know that it is possible to grow and adapt as time goes by. You are not committed to one style of parenting forever. You can compromise and change as you need to. Love, after all, is the most important gift that you will ever give your child.
So you made it to the 6 weeks mark. You’ve overcome the breastfeeding learning hurdles and are starting to feel a little more confident about this new relationship. Your healthcare provider has released you from care and you are feeling better physically. But now comes the challenge of dealing with the realities of your life. You have to go back to work. Many women, and especially first time moms, fear this pending separation.
Some of the questions that may run through your mind include: What if my baby won’t take a bottle while I’m gone? What if my baby likes the bottle better than me? What if I don’t have enough milk? What if my boss won’t allow me time to pump? Can I juggle my work and all the responsibilities of being a mother? And what about my other relationships – partner, family and friends – can I fit all of this into my life?
Let’s take these questions one at a time.
Baby won’t take a bottle? See my post on how to bottle-feed a baby.
Wondering about pumps and choosing the right bottle?
Start saving milk for your “stash” early. Most moms have more milk than babies require by the 3rd to 4th week after birth. Get your pump and learn how to use it and start saving. Many moms find they have an abundance of milk in the morning. Nurse first, then express the remaining milk and freeze. This will serve as your back up supply for any emergencies and when you first return to work. After you start back to work, what you pump one day will be the feeding for the next day to work. Freeze what you pump on the last day before a stretch off work and use some of your stash on your first day back.
If you haven’t learned to nurse in bed, it’s time to learn. By the time a baby is 6 weeks old, she should have enough head control so you don’t have to hold her head and her latch should be secure. Check out side-lying positions. Put your co-sleeper crib next to your bed so it’s easy to transfer her into her own bed once she has nursed to sleep. Keep things simple so nighttime feedings are short and uncomplicated. Unless absolutely necessary to maintain your milk supply, do not pump in the middle of the night.
If your baby starts sleeping longer than 5 hours at night, pump right before you go to bed to keep your breasts from getting uncomfortably full during the night. You will rest better and the extra milk goes to your stash.
Try to make life simpler at home. Crockpots and quick meals will save time in the kitchen. Simplify clean up and household duties and of course, enlist help from anyone available to you. There are lots of websites out there that have suggestions for this.
Make sure you continue recommended vitamins for yourself, including adequate Vitamin D. Here’s a technical article supporting the recommendation for nursing mothers to get an extra 6000 IU of vitamin D daily for improving their own and their baby’s health. https://www.ncbi.nlm.nih.gov/pubmed/17661565
Most importantly, try to take some time for refreshment for yourself. Eat healthy as you can. Take naps. Put baby in a front carrier and get outside when the weather permits. And take lots of selfies! This time will pass quickly!
Remember that breastfeeding is not just about the milk you provide your baby. It’s about the special closeness that comes when your baby looks in your eyes while you are nursing her and she begins to realize that YOU are her source of life and nourishment, when she smiles at you and then buries her head in your breast as if to say, “I’m home!”
All babies wean eventually. Some have to be weaned early because of circumstances beyond control. Some wean by themselves. In cultures where breastfeeding is the normal way of feeding a baby, many children nurse until 3 or 4. Some tandem nurse when a new baby is born. Different circumstances may bring up different issues for mom or baby.
Sudden Weaning
When baby weans or must wean suddenly, and mom still has milk, the goal is to reduce milk supply comfortably and safely. Some measures are well known such as wearing a supportive but non-binding bra, using cool packs such as disposable diapers that have been wet and then frozen, cabbage leaves that have been crushed and placed on the skin of the breasts and changed out when limp. Hand-expression or very short pump sessions can be used to gradually reduce milk supply. This may take a week or more. When in the shower, stand with your back to the shower. Only express milk if absolutely necessary. Herbal remedies for drying up milk include peppermint, sage, oregano, lemon balm, chickweed and black walnut. Sudafed is an over the counter medication that has been shown to decrease milk production in mothers 6 weeks or more past delivery. It can take months for breasts to completely involute. Once breasts are comfortable, avoid hand-expressing “just to see”, as this may stimulate additional milk production for some women.
If baby did not choose to wean, but weaning is necessary, and she is 6 months or under, consider paced or baby-led bottlefeeding to allow him or her to be in control of the feeding as much as possible. See my printable <> for instructions on this method of feeding. For older babies, try a sippy cup without the spill-proof valve, a straw cup etc, These may be preferred. If you are using formula, see my printable <> for safe handling of formula.
Gradual Weaning
If your baby is older and you are preparing for weaning at a later date, start by limiting your feeding locations to a special area or chair. If you are nursing your baby to sleep at night, begin to develop a bedtime ritual that can be continued after weaning. Turn on white noise, rub his back and rock after you take him off the breast. If possible, as you get closer to planned weaning date, start the back rubbing and take him off the breast but hold him close as he falls asleep. Trust your instincts. The biggest hurdle is to have clear in your mind why you want to wean and when you want to wean. Start a bedtime ritual that can be transitioned to not include breastfeeding as soon as you feel it is helpful. Every child is different.
The Relationship Goes On
The close relationship you have started with breastfeeding can easily transfer to other activities that will provide comfort through your child’s senses. Touch, warmth, soothing sounds can all happen with you, even when breastfeeding is over. And the benefits of a strong immune system will last as long as he lives!
I am the grandmother of a newborn baby boy. Born a little over 3 weeks ago, I’m sitting in the living room of his parents mulling over this new role. No, this is not my first grandchild. But it’s the first one I’ve had the joy of spending uninterrupted time getting to know his little personality, observing his parents in their roles and his older brother adapting to his new role – big brother.
As a lactation consultant, I am invited into homes to observe, assist and recommend in an active role. There are barriers that must be broken down and boundaries to cross and an instant intimacy created by the need of the moment. As a mother-in-law, mother and grandmother, there are boundaries that must be crossed very hesitantly, if at all. My philosophy of breastfeeding applies in this instance – it is the relationship that we must preserve above all. Breastfeeding, with all its benefits, is primarily about establishing the primal relationship, not just getting breast milk into a baby. Relationship is about building love and respect into an unbreakable bond.
So what can a grandmother do to support the new family? I believe that the same three goals apply to this situation as to any other breastfeeding cohort: protect, promote and support. Protect by being positive and avoid offering solutions that interfere with breastfeeding. That means, don’t offer to bottle-feed the baby so mom can get a good night’s rest. Don’t give the baby a pacifier to hold off for a longer interval between feeds. Don’t buy another infant holding device (bouncer, swing, rocknplay). Don’t make negative observations such as: “your breastmilk looks kind of weak” or “he’s crying again – maybe you didn’t feed him enough” or “he has a rash – maybe you are eating something that he’s allergic to.” Don’t offer to hold the baby while mom does the laundry or fixes your supper. Instead, be encouraging. Let mom know how proud you are of her, how blessed her baby is to have her, how beautiful she looks nursing your grandchild. If she doesn’t have one, get her a sling and help her learn how to use it for carrying baby. Use it yourself when she needs a break. Watch baby while he spends time in tummy position. Fix a meal, do the laundry. Take an older sibling to the park, or play with him. If mom needs you to hold the baby, by all means, enjoy. Learn to hold baby chest to chest, a position most babies really enjoy. If the rare situation occurs that mom and baby must separate do to an emergency, and baby must be fed while they are apart, use her expressed breast milk if available and use the side-lying bottle-feeding techniques demonstrated on this site that can be printed off or video that can be watched.
If mom or baby are having some latch or comfort issues, get help for them and be a cheerleader. Learn all you can about the establishment of milk supply and how that is done. Ask her how you can best help her reach her own personal goals. Breastfeeding is an important building block in a baby’s life foundation – but it is only one of them. It also helps to remember that it takes babies 6-8 weeks to gain active control over feeding and moms need support during that time as they try to help their babies learn. Nothing tops patience and perseverance in that journey!
Nothing in my life has been as rewarding as seeing my children grow up, take a marriage partner and become parents. I almost understand how God must feel when we become fruitful and start sharing our gifts and talents with others, and pass the torch along. I keep that in mind and am grateful for that. And as I gain more grandchildren and great-grandchildren in the future, I hope to be able to give them the benefit of my hard-earned wisdom too!
What does a breastfeeding mother and baby need besides each other? Clearly, they need time and proximity so they can adjust their relationship from a continuous but unconscious provision of warmth, comfort and nutrition by mother of baby to a deliberate but more intermittent provision of those same requirements for baby by the mother. Mother needs the support of those around her to meet her physical and emotional needs while she meets those of the new baby. And this process takes time to develop its rhythm. Like new dancing partners, the dyad must become comfortable and intuitive in their actions, developing trust and coordination over time.
But — what if a separation must occur. Mom can no longer be ever-present to meet her baby’s needs. Or what if baby or mother has a physical issue that affects milk supply or delivery? How can we provide a substitute for both mom and baby that doesn’t undermine the breastfeeding relationship? The market steps in to offer its solutions: bottles, pacifiers and breast pumps! These tools offer and purport to be a temporary solution to bridge the separation on a short term basis, but often present their own challenges to mother and baby.
So, how do we select when presented these “solutions?” First, understand the basic physiology of breastfeeding. How do mothers make and release milk? How do babies obtain that milk? What is the biology that we are trying to mimic? What are the properties of the man-made materials that we use to create these tools? Over the years, inquiring minds have looked at various products on the market to try to determine how these products work and to what degree they either simulate breastfeeding or offer less interference with breastfeeding when used. The problem is, most of the methods used to test products don’t truly match what a baby does when they use the products. Ultrasound studies may show the mechanics baby uses on a bottle, for instance, but can’t really measure the baby’s adaptation to the materials or how the baby changes flow rates by altering the quality or actions used during sucking. Only a very sophisticated real-time system using pressure gauges, ultrasound and sequential weight checks can adequately assess the way a bottle performs for a particular baby. And even that can’t determine how a baby is adapting and accommodating to the bottle.
Also, keep in mind that the way a bottle is offered and the position that the baby is held affects the way baby accepts the bottle and the way it works. Babies who are breastfeeding well use their tongues to create vacuum and control the flow of the breast. When babies are held on their backs to feed from the bottle, gravity may push the flow and cause baby to react by altering the way they use their tongue.
Pacifiers
Some fairly good research has found that pacifiers introduced after the first two weeks and limited to less than 2 hours use during the day do not appear to inhibit milk supply or shorten breastfeeding. In this study, a one-piece pacifier with a rounded nipple and slight flange at the base was used for all babies in the study.(1) In this study, all babies were healthy babies with no identified risk factors such as tongue-tie etc. Early introduction of pacifiers may interfere with baby’s learning curve where he identifies and correlates sucking and swallowing with latching to the breast. Pacifiers are made of materials much firmer than mother’s breasts and do not conform to the baby’s palate. This imprinting period can last up to 6 weeks. An analogy I have sometimes used is this: introducing a pacifier is like giving a young teen porn – it is artificial, highly stimulating, and does not resemble the real shape, feel or action of the real thing. Ear, nose and throat specialists who work with babies with tongue and lip-ties have noted that babies who have used pacifiers a great deal can have issues learning how to open widely and actively extend the tongue to latch onto the breast. If possible, delay pacifiers until they are absolutely necessary, after comfortable and effective breastfeeding is established, and then limit use to less than two hours daily. Avoid orthodontic, flat or bulbous pacifiers.
A skilled IBCLC can assess a baby’s sucking technique, evaluate suck strength and make recommendations for supplementation methods if needed. They can offer suggestions to help the nursing couple to address and overcome any issues encountered. They can also evaluate mom’s supply and make recommendations for techniques, equipment and supplements as needed. They can communicate with other healthcare providers to coordinate breastfeeding and family-friendly care.
Bottles
The research that has been done on bottles includes direct ultrasound and indirect flow studies using a pump setup to mimic the vacuum levels babies use on bottles.(2) Some bottles will deliver nearly an ounce in a minute! This fast of a flow rate will cause a baby to take too much at a time from a bottle, may cause gassiness and fussiness and spitting up. Some bottles will deliver a fast rate of flow if the baby bites on the nipple. When babies must use a bottle and the flow rate or method of obtaining the milk (compression instead of sucking) varies from what is normal during breastfeeding, it can cause bottle or breast rejection. Bottles that drip when held sideways do not necessarily flow fast when baby is sucking. And, bottles that don’t drip, are not necessarily slow flowing when used by the baby. Generally, 5 ounce Newborn Dr. Brown’s bottles with regular size neck, not wide-mouthed, Special Needs Feeders, used with the small line lined up with baby’s nose, Calma feeders, and Munchkin Latch bottle are considered slow-flow, non-compression bottles. Bottles not recommended include Avent, Tommee-Tippee, Momma original, Evenflo original, and many others. This list is subject to change, however, as manufacturers constantly change or quit making products over time. The best way to test a bottle is to buy one only, try squeezing the nipple where baby’s gums would go to check for compression, and offer to baby.
When bottles are recommended for supplementation, it is a good idea to have a lactation consultation to evaluate the baby’s suck and mother’s supply. This can help in choosing the right bottle or another method for supplementation that can help preserve the breastfeeding relationship.
Check out my hand-out on using a bottle under resources.
Pumps
When I started nursing my first baby in the early 70’s, and needed to go back to school, the best you could do for a breast pump was one of these: This thing was hard to clean and could only hold maybe an ounce. Needless to say, not too many moms used them for very long or with much success. By my second child, this kind of pump was available. A little better, still not great. Fortunately, I was able to delay returning to work until he was over a year and I didn’t need to pump. By my third, the first electric piston pumps were available in hospitals. They looked like this: For the everyday working mom, manual pumps were still the only option. By 1987, when I opened the first Outpatient Lactation Service in Nashville, heavy duty hospital pumps were available for rental. Battery pumps also became available, like this:but weren’t super comfortable or effective. By 1989, along came a lighter weight rental pump This pump could do both breasts at once and was portable! By mid-1990’s the first Pump In Style, a lightweight single user pump that could double pump was available for purchase. Medela continued pioneering work in the lab, building on the work of Egnell and Whittlestone, trying to design a pump that would be efficient, effective and yet portable and quiet. Variable speed and vacuum pressures were investigated and the Symphony was invented in 2003.
Medela as well as many other manufacturers have since built and sold breast pumps of various sizes, colors and technologies. There is a huge market of mothers who realize that breast milk is what babies need but have to be away from their babies and need to provide that milk when they are apart.
So how do you choose an effective pump that’s right for you? First of all, look at your need. Have you established a good milk supply with a healthy nursing baby? Milk supply peaks at about 4 weeks postpartum and regulates at about 8 weeks. Minimum requirements for babies from 1-6 months is about 750 ml per day. That’s about 25 oz. Research has shown that a breast pump needs to be able to remove at least 70% of mom’s available supply to maintain production. More complete removal can increase production over time. Less complete removal will decrease production. This is a normal process and is how breastfeeding works when a baby nurses. If a mom only needs to be away from her baby on an occasional basis, any pump that gives her some relief and removes some milk is useful, as when she and baby are together again, the baby can remove the extra milk left behind. Or if a mom is very full and needs some extra relief, a simple vacuum “pump” (really more of a milk catcher than an actual pump) such as the Haaka is inexpensive and can do an adequate job for many moms. The Harmony pump by Medela, is a simple single manual pump that can be used. Many moms find this pump especially useful as an emergency pump when they are traveling or away from their baby because it is quiet, light and portable. For moms returning to work and needing to pump quickly, Medela, Spectra, Ameda and many other companies sell pumps. You can look at Amazon reviews. Here is the FDA’s review of breast pumps.
If you have a low milk supply, a baby in the NICU or you are in the hospital, a hospital rental-grade breast pump is the best type of pump for helping increase supply. The pump needs to be able to stimulate a let-down and then apply enough vacuum to empty your breasts quickly when you have a let-down. The flanges should fit your nipple. Medela.com has information on choosing right sizes of flanges. There are YouTube videos available and several blogs. Here’s one: http://www.medelabreastfeedingus.com/tips-and-solutions/13/choosing-a-correctly-fitted-breastshield. Look into hand-on pumping, do hand-expression after milk flow has stopped, and gentle breast massage before pumping. Some moms find that using coconut oil (if you are not allergic) inside the breast flanges improves comfort. In addition, hands-on pumping can help improve milk-removal, thus improving supply. http://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
What if you don’t feel let-down? Milk squirting or fast-dripping into the pump flange is the best sign of let-down. But constant staring at the bottles can inhibit let-down! Playing music, drinking something warm, looking at a picture of your baby and even letting the baby nurse on one breast while pumping on the other, if possible, can help your body learn to respond with let-down. Let-down is essential as the breast pushes the milk out with tiny muscles around the milk collection areas towards the nipple. Vacuum created by the baby or the pump stimulates your brain to release the hormones that cause the muscles to contract and the hormone that causes milk to be produced for the next feeding session.
Some hints for effective pumping include: warming the breasts before pumping (studies have shown up to 50% more milk obtained that way), make sure your pump flanges fit your breast (consider new Personal Fit flanges by Medela, switching the pump rhythm from “stimulation mode” to “expression mode” within 60 seconds to take advantage of the hormone surge and get milk out more quickly, increasing the sucking pressure to optimal levels (maximum comfort vacuum is best). Using soft silicone flanges can increase compression of the breast which can sometimes slow drainage of the breast. Duckbill style valves on the bottom of pumping flanges can fail or gradually decrease the vacuum the pump is creating which also can affect supply. The pump should cycle about 60 times a minute during expression phase and twice that during stimulation phase.
Pumping is one of those things that moms do to get by. It is never the best option, but in some cases it is the ONLY option a mom has to provide her milk for a baby who can’t yet do the job or when mom and baby are separated by employment or illness. It is hard work for many moms, but it is something only YOU can do, as your milk is the milk best suited for YOUR baby!
(1)Does the Recommendation to Use a Pacifier Influence the Prevalence of Breastfeeding? Jenik AG, Vain NE, Gorestein AN, Jacobi NE, Pacifier and Breastfeeding Trial Group J Pediatr. 2009;155:350-354 (2) Comparison of Flow Rates between Commercial Bottles Karen Gromada, IBCLC unpublished communication.
Sometimes, despite doing all the right things, there’s just not enough milk to totally sustain a baby with exclusive, mama-only, straight from the tap, breastfeeding. Whatever the reason – genetic, environmental, iatrogenic, mother-baby separation, illness, etc., all that can be done has been done and there’s still not enough. What to do?
Realize that breastfeeding is more about the relationship than it is about the volume of milk. Once a baby has made the connection between mom and comfort at the breast, the volume of milk obtained is not as important as the emotional connection that occurs. This is an important concept to grasp. Many babies nurse 3 or even more years. Older babies get a full diet of family-friendly foods, still need and want that connection with mom. But it’s not about the volume of milk, it’s about getting mom’s undivided attention and the feeling of security at the breast.
For a baby to make that connection between breastfeeding and safety in the arms of mama, breastfeeding needs to continue even when full breastfeeding does not provide all the baby’s nutritional needs. Giving up breastfeeding for breast pumping may seem like a solution to address issues of low supply when a baby is an inefficient feeder for some reason, but exclusive pumping does not allow for that connection and interaction to continue. Think hard before you give up direct breastfeeding.
If supplementation is required, and donor milk is available, use that to support baby’s nutritional needs as long as possible. If baby is able to breastfeed well enough, use a lactation aid at breast as much as possible for supplementation. If supplementation must be done away from the breast, use bottles in a manner that supports baby-led feeding. See other posts for more information on selecting pumps and bottles that may interfere less with continuing the at-breast feeding bond.
Recognize that babies use suckling time at the breast to help with digestion, to comfort and settle. Large volumes of milk are not needed, or even desired for this activity. Breastfeed your baby after supplementing to allow for this benefit. Breastfeed whenever possible instead of giving a pacifier. Some people call this “comfort-feeding.” In the early days, combine comfort-feeding with skin-to-skin care to build the connection between you and baby.
Accept the fact that breastfeeding length and milk volumes do not have to correlate. Adoptive mothers may not have a full supply of milk, but they can still breastfeed. Mothers of toddlers aren’t exclusive breastfeeders, but they can still breastfeed. Mothers with insufficient glandular tissue may not be able to provide 100% of their babies nutritional needs, but they can still breastfeed.
this kind of pump was available. A little better, still not great. Fortunately, I was able to delay returning to work until he was over a year and I didn’t need to pump. By my third, the first electric piston pumps were available in hospitals. They looked like this: