Breastfeeding can be enjoyable and worry free, but problems can arise. It is great to know that most of them can be helped!
Is breastfeeding best? Yes. Is it natural? Yes. Will I ‘just know’ how to do it? Not necessarily. There is lots (almost too much!) advice about breastfeeding. It is very important – and comforting – for you to know which of it applies to you and your baby. Also, that advice given will vary greatly depending on whether your baby is one day-, one week- or one-month-old (and everything in-between). One of the biggest causes of distress I hear about is so much conflicting advice, so check in with yourself and your baby whether the program is working. If not, try to get a different plan that works to provide nutrition – enough for your baby – and to have real progress with any painful condition of the nipples and breasts, as well as mother’s exhaustion.
Remember, just about all breastfeeding problems can be solved, or at least understood and managed.
Before baby arrives
Check your nipples – are they flat or inverted? If so, check with an expert and make a plan. Excellent positioning and latching and, in some cases, a shield will help when baby arrives (see Shield). Or a Niplette during pregnancy may stretch the tissue causing inversion. If you have had trouble nursing a previous baby - not enough milk or too much – seek help also. Painful nipples and yeast also can be prevented with your next baby. Regarding breast reduction, you can probably nurse well but will need extra support.
Baby is here: the first week. Your new job.
Most jobs: an interview, training, a good night’s sleep before your first day! Motherhood: plunge in! Some moms get off to a great start and have help in the hospital. Others, because of baby factors, small mouth, tongue tie, receding chin, sleepiness and many other reasons have a hard time and our hospital and medical system is stretched to the limit. But all is not lost, don’t quit. Get help!
Baby’s nutrition
The most important learning you do is recognizing your baby’s behavior and cues, such as nuzzling, seeking food by mouthing anything near. When you see this, feed the baby!
Some numbers may help, but don’t be rigid. Just have the weight checked in the first week:
• Average number of feeds per 24 hours: eight to 12.
• Feeds are irregular, not by the clock. Feed whenever baby wants.
• A wide awake baby or baby roused from a light sleep will feed better than one woken from deep sleep. So watch for these times.
• Both (two) breasts at each feed as much as possible (an exception would be an experienced mother who has had a huge supply previously).
• About 15 to 20 minutes per side. If baby is faster – and gaining well – no worries, just enjoy.
• Day one to three – black stools (sticky).
• Day three to five – changing through brown, mustard to yellow.
• Day five – thick, seedy, yellow stools.
• At least six heavy, wet diapers by day four or five.
• Weight loss is normal, but seek help if greater than 7 per cent of birth weight. Regain birth weight by day seven to nine and about 1 oz. (30 g) daily after that for first few weeks.
How do you feel?
Accept all offers of help. Don’t let your time be taken up by visiting unless that is just what you need. Leave a nice newsy message on your phone and leave your bedroom ringer off.
Sleep when baby sleeps. Nothing will help you cope as well as having some rest.
If you are too wound up to sleep, a small dose of sedative from your doctor for a few days could do you the world of good without any harm to your baby.
Ouch! Your nipples and breasts
A few days of tender nipples can be expected. Lanolin cream is routinely given out and is soothing. If you have major cracks, bleeding, pus, non-healing blisters, severe pain (causing toe curling, breathholding, dreading the next feed) tingling, itching, stabbing, jabbing in the nipples and/or breasts, exceptional redness, flaking skin, cracks around the base of the nipple, use your lanolin as a hand cream (joke!). It will not do too much for your nipples! Seek medical help as soon as possible. LATCH is one key to prevention (see my website for illustration and details) but once damaged – and it may not be your fault – it may be baby’s own style which has hurt you (and this can be corrected). Bacteria and yeast will settle in comfortably on your nipples and cause you great discomfort and prevent healing.
I have found that a 50:50 mixture of Canesten (anti-yeast) cream and Fucidin (a prescription antibiotic cream) used generously after every feed or pump session and not washed off before next feed works best. Will baby get a bit? Yes. Will it do harm? No. If you need more treatment than this, Diflucan (fluconazole) pills used for at least two weeks will usually zap it.
A shield may be used during feeds while you heal to protect the nipples from more damage and to train baby to open wider. Or pumping for a couple of days and giving the milk to the baby.
If your baby has a tongue tie, it should be released. On day three or four, it is common for breasts to be very full. Try to rest that day, cover the entire breasts with cold, refrigerated, uncooked cabbage leaves and take ibuprofen 200 mg – two tablets up to four times a day. You may need to pump or express a little milk to soften the nipple area.
Shields are used for:
• Babies who cannot latch or stay latched – sometimes because of flat, inverted, extra small or stiff nipples, or it is ‘just the way it is.’
• Painful nipples.
Shields come in three sizes: 24mm, 20mm and 16mm and look like a Mexican hat. Generally, the largest size that the baby can nurse well with will be the best. As a safety measure, an experienced health professional without bias should observe the feeding and follow up with you within a few days.
You will hear many strong opinions – pro and con – about the nipple shield. So please tune in and the bottom line is: Is it working for you and your baby?
Help! Baby has not gained enough!
Seek a lactation consultation.
Ways to increase your supply:
• Feed frequently – both breasts.
• Pump with a good brand pump, preferably electric (Medela, Hollister (aka Egnell-Ameda).
• Best pump times – after breastfeeding in the mornings for about 10 minutes each breast.
• Take Motilium (aka Domperidone – not a fine wine!) usually 30 mg four times a day for at least two weeks, often longer.
• Supplement if needed. Expressed Breast Milk (EBM) if possible, if not enough, then with formula. Give after most feedings at the breast rather than replacing feeds, though this can be done, especially if mom is exhausted and needs a long sleep (this may help her supply). If there is significant weight loss, the formula or breast milk may be very slightly enriched according to the Calgary Health Region’s recipes. Do not do this without supervision, please.
Jaundice
If your baby is yellow, check with your doctor ASAP. Often, this resolves after a few days with good feeding and good yellow stools. But it is vital that you follow up closely with blood tests to ensure that bilirubin is dropping. Occasionally, baby needs to be under lights at the hospital.
Remember
You can get through a night, or a day. And help is at hand for you. Breastfeeding problems are really tough to have. But they can be resolved (often quite quickly). And once you and the baby have settled, breastfeeding can be a wonderful experience for you both for many months.
Dr. Evelyn Jain is a family physician, lactation consultant and Clinical Assistant Professor at the Department of Family Medicine at the University of Calgary. The Lakeview Breastfeeding Clinic is located at #70, 3915 - 51 Street SW, 403-246-7076. For more information visit www.nursingbabywell.com.
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