Ultimately, the decision to breastfeed is a personal one. In Canada, 80 to 90 per cent of women intend to breast feed when they leave the hospital with their newborns. Once you have decided to give breastfeeding a try, it is a good idea to enrol in a prenatal class about breastfeeding. There you will learn the theory and some practical tips for getting started properly. You will also have a chance to meet with breastfeeding specialists (lactation consultants and specially trained health nurses) and other couples who will soon be sharing the experience. These people will be very useful to you if you have questions or concerns.
Ensure your prenatal health care provider (family doctor, obstetrician or midwife) has examined your nipples and breasts for possible problems. A woman with persistently inverted nipples, where the nipple does not protrude even when grasped behind the areola, (see Fig. A) or who has had breast surgery will need special help or advice before the baby is born.
If your delivery is uncomplicated, your first chance to breastfeed will be in the delivery room. The first hour following birth is very special. Your infant has increased awareness and is responsive to you. It is a special time to talk to and have eye contact with your baby. The baby will signal a desire to feed. This signal will be a “rooting” action, with the baby turning toward you trying to find a nipple to “latch onto” or making a sucking action.
Latching on properly is crucial to the success of breastfeeding. Your baby must take the nipple and a large part of the areola into the mouth. To do that effectively, the mouth has to be open very wide with the tongue down and forward, so that it lies under the nipple. In this way, the milk sinuses around the areola are compressed (see diagram below) and the suction created starts, and keeps, the milk flowing.
To help your baby latch on, proper and comfortable positioning for both of you is important. Many mothers prefer to start with the “cradle hold.” Hold the baby’s head on your forearm, near the crook of your elbow, with your hand supporting the thighs or bottom. The baby’s front should be against your stomach and lower arm down around your waist. The head and body should be in a straight line.
Touching your baby’s cheek gently will prompt the rooting reflex. Touch your nipple to her lips and wait for her to open her mouth widely. Bring baby close to you so that her mouth opens wide around your nipple and over the areola. Poor latch is the most common cause of sore and cracked nipples. Having said this, it’s not surprising that when you begin to breastfeed a rough tongue and powerful suction will cause some discomfort, and at least some abrasion on your tender nipples!
Once you have mastered this basic breastfeeding position, you may want to experiment with different positions such as the football hold, or lying down. A nursing pillow, or a couple of ordinary pillows may help hold your baby at the correct level, and may prevent you from developing strain in your neck or arms. You may wonder if your baby is latched correctly. There are a number of observations that will help you decide:
A newborn baby should feed at least every three hours. This frequent feeding schedule is the best defense against two common problems in the first week of life, dehydration and jaundice. Both of these conditions can make a baby sleepy so it is important to stimulate your baby to feed frequently. It is generally safe to let your baby establish the feeding schedule after two weeks of age. One of the nice things about breastfeeding is that stimulating the breast more often speeds the production of milk. As a result, the supply of breast milk increases as the baby’s requirements increase. So a growing baby will seem hungry more often and, as you nurse more frequently, the milk supply will increase to meet the infant’s needs. Once the breasts are producing more milk for every feeding, the frequency of feeds will settle down again.
Checking for wet diapers and watching the change in the colour of your baby’s feces are good indicators of adequate feeds. After the third day, you should expect six to eight wet diapers in 24 hours. You should also expect many small stools or at least one substantial stool each 12 hours. The colour of the stool should be changing from the black/dark green of a newborn to the bright yellow “mustard with seeds” appearance of the stools of a baby on breast milk. Many breastfed babies will have frequent, loose, yellow stools and mothers often worry that the baby has diarrhea. Frequent loose stools are normal for a breastfed baby.
It is important for a breastfeeding mother to drink lots of fluids. A good guideline is to drink a full glass of water every time you nurse your baby. Eat a healthy diet, following Canada’s Food Guide to Healthy Living. The greater variety of foods eaten while breastfeeding, the more tastes the infant becomes used to. This results in the baby accepting a wide variety of solid foods later on.
Restrict caffeine products as they may cause your baby to become overstimulated, and remember that alcohol crosses into breast milk and is not advisable. However, it is probably safe to have the occasional glass of wine, beer or cocktail. Finding time and energy to cook in those early weeks will be a big challenge, so make some freezer meals ahead of time, and have lots of healthy “fast foods” such as sandwiches, muffins, yogurt, cheese and crackers around for yourself and your family.
Despite having helps many mothers to breastfeed, I found that doing it myself was more difficult than I had expected. Even though I was committed to breastfeeding, I had difficulty believing that I would succeed in the first few weeks.
I had badly cracked nipples and every feeding became a toe-curling ordeal. One day I noticed tender, red areas on my breast. The chills and sweats I had experienced the night before now made sense. I had mastitis, an infection of the breast. The hot compresses, massage and extra feeds did not help. I needed antibiotics to settle the infection.
When my daughter had “cluster feeds” and wanted to feed every hour, I was convinced I was starving her. In my fatigued and often teary state, I felt that maybe bottlefeeding would be better but I kept repeating the message from every health organization in the world – “breast is best”. I clung to the words of a good friend “hang in there”. “Hang in there” I did and the wonderful benefits of breastfeeding have been mine and my daughter’s to share.
If you are having trouble “hanging in there”, there are many resources available to help, so don’t give up easily. Your family doctor, the public health nurse, lactation consultant, a midwife, the breastfeeding clinic at your local hospital and the La Leche League are all there to assist. Get help early. Even one day of frustration can mean hours of an upset, fussy baby and desperate parents.
Breastfeeding is a learned skill. Some take to it more naturally than others. With instruction and perseverance, most women can learn and enjoy this unique connection with their baby.