Breastfeeding  Overview • Re-Lactation Overciew

By Ken L. Smith Breast Health Facilitator for ACS

s natural as breastfeeding may be, many new mothers try and fail. There are many sources of good information about breastfeeding, and you should read all that you can get your hands on. There are many outside influences that come along during this time in a new mother's life, and some of the events can cause the mother to give up breastfeeding earlier than she wants to. If you have decided to breastfeed your child, then by all means do it. Green light ahead. Take no prisoners. Be aware that you may come up against some problems.

Too Much Advice
At least two sets of parents descend upon what may be the first grandchild, and they may say many things. Much of what is said is in jest, some in a style similar to a broad hint, some in an insistent whine… and then there is the Advice! We all know about the advice, do we not? The name. The middle name. The nickname. The type of diapers. Put him on a feeding schedule. Let her eat when she is hungry. You're going to put him in your bed? It is too warm in this house. Cover her up… she's cold. She's hungry. He's sleepy. You're not going to spoil MY grandchild, are you? The new mother needs none of this right now. She is learning how to become a mother, and she wants to do it HER way.

Let us be the first to give you some advice… oops. Find someone that will listen to you and will help you to carry out your decisions. They can be a 'running block ' for you to ward off some of the unwanted 'attention'. The husband comes to mind at this time. Do not forget him. He is part of this situation, and he can be your biggest ally.

Get Your Team Together (and know who your opponents are)
Before the baby is born, interrogate your doctor and the nursery staff at the intended place of birth, to determine their feelings about breastfeeding. Determine if they will actually assist you or work against you. The first few days are critical to ensuring your success in breastfeeding. If you detect a problem, you may want to ask someone else, or at least set down some guidelines from the very beginning.

Also, a pre-delivery discussion with the new grandmothers may be necessary, so that they understand from the beginning what your intentions are. They actually may be your best support, especially if they have time to think about your wishes. Today's grandparents were the least likely to have been breastfed as children. That was when only about 30 to 40 % of the mothers were making that choice, since that was when the "formula" came into being, and 'modern' mothers did not breastfeed their infants. It was not "the thing to do" then. Be sure that your husband understands your desires too, and that you have his support.

Find out if there is a lactation consultant available to you at the birthing facility. If there is one, use him or her. Lactation consultants can be valuable assistants at this time. There is nothing like having some experience near you when it is needed. If you have an older sister, parent, aunt or friend that was successful with breastfeeding her youngster(s) and she is supportive of your doing the same, she could be a valuable friend at this, your time of need.

Get Started Correctly
Shortly after the birth occurs, if you can work up the strength, offer the baby the breast for its first feeding as soon as it will take it. This may not happen right away, but give it a try. Some will suckle within a few minutes after birth. A delay at this time will give the doctor time to finish up with you and time for the nursery to finish up their 'check-up' that they need to do for the newborns. Be sure the nursery does not offer him/her a nipple, either from a bottle or a pacifier. This causes "nipple confusion" and just adds to your problems later. Do not ask the nurses what they usually do, but tell them what YOU want, in a nice way, of course, but make it firm. They usually work with the patient in every way that they can, and remember that everyone around you at that time are working for you and being paid by you.

When you first offer the breast to the infant, "latching on" is essential. Remember that the baby does not squeeze the nipple for milk. The baby uses a combination of the tongue stroke on the lower side of the nipple, pressure from the gums on the breast near the perimeter of the areola, and his/her own suction. Refer to our Anatomy section, for both the "Breast Exterior" image and the "Inside The Nipple" image, to see where the areola is and where the Ampullae are (ampullae is plural for ampulla). Squeezing the ampullae actually expresses the liquid. This can be tested manually, just before birth.

Manual expression is the removal of milk from the breast with the hand. Cover over the breast with your hand, allowing only the areola and the nipple to protrude from between your thumb and forefinger. Squeeze inwardly about half the thickness of the breast (or less if the breast is engorged) and in a 'stripping' action, move the hand toward the nipple, continuing to compress the breast about half way. This will compress the ampullae and force out the contents. This is the only place in the breast that retains milk. The rest of the breast goes about producing milk as the baby feeds.

Avoid excessive expression before the baby is here. A time or two will not hurt, to see if 'everything works' and what it takes to make it happen. For the first two days (or so) after delivery you do not produce milk. You produce colostrum. This may in fact be the most important thing that you can give to your child (short of life itself). It contains many things that only your body can give, and some of them can give your child an instant booster shot for many of the common childhood diseases, including diarrhea. True milk does not actually 'come in' until day three or so. Your baby is prepared for that, and will do just fine. He/she does not need supplemental feeding at this time, if ever. If you do nothing more than breastfeed for the first three or four days, you have helped your child immensely!

Latching On?
About latching on, the important thing here is to allow the baby to open his/her mouth widely, and quickly pull him/her to the breast. Try to put the actual nipple about an inch into the baby's mouth. The lips need to be near the outer perimeter of the areola. That would be assuming that the areola is not excessively large. It the mouth is as wide as it can go, then that is all that we can ask. If the baby slips down to the nipple, nothing will come of this feeding session but sore nipples. Remove the baby by slipping your finger between the mouth and the breast to break the suction. This will prevent pain when you two separate. The little bugger can build a strong suction. Wait for a widely opened mouth before latching on again. Tease the cheek with a finger or the nipple. That will encourage the mouth to open widely, then move quickly.

OK, How Much Milk?
Doctors and books tell you a lot of things about how much you should feed the baby, when you should feed it, etc., so we will not go there. We just want to remind you that if stuff comes out of the baby, stuff must be going in. Count the wet diapers and you will know he/she is getting enough. If you weigh the baby, remember that babies lose a few ounces right after birth. The doctor will keep you informed, if he/she is supportive of breastfeeding. Do Not Worry About Not Having Enough Milk! Books tell you the signs to look for, such as the number of diapers and such, to make sure the baby is being fed enough. The question here is:

How Do I Control The Amount Of Milk That I Make?
The breast makes milk as the baby takes it. This requires mom to be comfortable, relaxed, rested, well fed and hydrated, and happy (are you listening, new dad?). This enables the woman to have what is referred to as the "let-down reflex". It is when stimulation from the nipple joins from the good vibes in the brain (spell that content) to cause the release of certain hormones that must be carried to the breast gland lobules (also called alveoli or acini) where the milk is produced from mom's blood. If milk is not forthcoming, it may be a matter of either poor latching on or a matter of not "letting down".

If the breasts are distended or engorged, it may require the mother to remove some of the contents to allow the breast to soften and allow the latching on to occur. The breast actually distorts slightly to fit the baby's mouth (just temporarily… don't worry). Feed from both breasts. If the baby cannot empty the breasts, the breasts will produce a little less the next time. You may want to use a pump to remove some contents right after the baby is through. It will be ready at the next feeding. Save what came out of the breasts. It will store in the refrigerator (it will even freeze). Sometimes the mother has to take a medication after giving birth, and some back-up milk or colostrum will come in handy at that time. Replenish the saved milk periodically (if it is not frozen, don't keep it more than 8 hours). Breast milk changes as the child develops. Milk produced three weeks after delivery is not the same as milk produced three months after delivery.

If you want to increase the amount of milk available, remove every drop from the breasts. The body will try to make up for previous shortages if they were completely drained. If you leave some in there, you will make less the next time. It is sort of like government spending. If you have a budget, spend it. If you don't, you will get less next year.

What If The Baby Is Not Taking Very Much From Me?
IF…the baby is gaining weight and making the proper number of wet diapers, then he/she is getting it from somewhere. Babies DO NOT NEED WATER when they are breastfeeding. Do not let it happen. Someone may be helping you out with this, and the baby is full of water. Or… is a 'helpful' family member giving a little formula in between feedings to allow you 'to rest'. A breastfeeding infant gets all it ever needs by mouth when it takes from the breast. If something happens where the baby is not able to take your milk for even one feeding, due to illness or whatever, always remove the milk manually. If you don't, you will be starting the weaning process. If you are hospitalized and cannot breastfeed, pump your milk and send it home, have the baby room in, or… if you cannot use your milk, empty the breasts anyway, manually, at each normal feeding time. If you do not, your milk production will decrease. By the way, they make very nice electrical pumps that are quite nice and fast. They can be borrowed or rented.

Other Problems?
Sometimes husbands have reservations about their wives breastfeeding the children. Husbands may no longer see their wives as sexual partners, but as mothers. Sometimes, they feel that what has been 'theirs' in the past (her breasts) are no longer his, but no "belong" to the baby. The wife needs to be aware of these problems and should treat the situation with sensitivity.

Many women are afraid that they are 'exposing' themselves when they breastfeed a child. While it is true that some people have a problem with a breast that is doing what it was intended for, just remember that it is the other person's problem and not yours.

Some women have heard that it is illegal to breastfeed in public. If people were to just check the laws, they would find that they can breastfeed legally just about anywhere, as long as they are not acting in some flagrantly unacceptable fashion. Maybe we should print up some business cards to hand to the mothers that say "We support you in what you are doing!"

Sometimes when a mother breastfeeds a youngster that is older than three months or so, she will hear comments that disapprove of her actions, even from people that may be related to her (Are you still nursing that child?). Unless those people can find a study somewhere that shows children that were breastfed beyond six months turned into chainsaw murderers, they need to keep those kind of comments to themselves. If they speak out anyway, do not allow them to deter you from your goals. Even the medical people are changing their recommendation to a minimum of 12 months of breastfeeding, and I would be willing to bet that they will extend that to even longer as they learn more about the results from new studies. Everyone needs to know that children who are loved this much are not the ones that end up doing heinous things to others.

So, even though there are complications that come with the decision to breastfeed your child, do not let others change your mind. You have many people supporting you in your decision to do this. It is the best thing for your child.