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*Priming the pump.
The way your baby eats during the first few hours and days of his life is going to establish long-lasting patterns. He
needs to learn to latch on, and your breasts need to get frequent stimulation in order to know how much milk to produce.
Even when "nothing" is coming out (just tiny amounts of colostrum), you need to keep at it. Start as soon as you
can after birth. If your newborn needs medical attention in the hospital, or if you are separated from him for any reason,
do whatever you can to make sure you breastfeed him regularly during this time. Be aggressive; some hospitals have a policy
of giving formula and keeping the baby in the nursery at times like these, but you can cause a stink and make them bring the
baby to you every few hours. It is sad when a sick baby can't get healthful breastmilk because the doctors took him away
from the mother during a few critical hours early on. Do not let yourself skip pumping/feeding sessions in the early weeks
of breastfeeding, because this may set up a permanent decrease in capacity. Make sure you know the number of a good lactation
consultant before you deliver, because even a small problem can quickly become an emergency when the baby is hungry and your
breasts are engorged.
*Milk coming in / letdown and leaking.
NOBODY warned me about this, so I was shocked to discover that a few days after the baby was born, my boobs became huge,
rock hard, and incredibly tender and achey. I was unable to turn over in bed, and would frequently wake up in a puddle.
I had to wear a bra 24 hours a day for weeks and weeks, which feels yucky, and had to have pads in my bra, which made it difficult
to nurse in public because I was always having to juggle with them. At random times, the letdown reflex would kick in, with
a painful pins-and-needles tingling feeling. It seems like a few months passed before I could stop thinking about some discomfort
in this zone. Just to warn you, it's not a wonderful womanly feeling.
A note on public breastfeeding:
For the first few weeks at least, you can't really breastfeed smoothly and discreetly like in the movies. You can't hold
the baby at the right angle, your arm hurts, you're sweating, your boobs are hanging out, and you really need an extra arm
to do it all. If it makes you feel any better (it did me), go ahead and breastfeed openly and proudly whenever and wherever
you need to, even if your gut hangs out or there's a waiter in the corner or you have to wrangle with your pad. People should
see the reality of breastfeeding, or nobody will ever learn! If anyone bothers you about it, you can say, "YOU eat in
public, don't you?"
Comebacks for really rude comments:
It's unusual, but we heard about a woman breastfeeding in a shopping center who was asked, "Do you fuck in public,
too?" Oddly, it's almost always a woman who complains. Even if it never happens, it's fun to think about what you would
say.
--"If you're uncomfortable seeing my baby eat, you are welcome to cover yourself with this baby blanket. I'll let
you know when we're done."
--"You think this is something? You oughtta see where he came out!"
*Nipple pain.
This is almost always the result of a bad latch, and requires really good instruction on positioning. It's not your fault;
some babies just don't know how to suck very well, and some nipples aren't ideally shaped. Even if your doctor or lactation
consultant has already shown you how to do it, you may need better help. Pursue this, because it only takes a few days (or
a few minutes) of a bad latch to cause so much pain you can't use your boobs at all. (See basic latching tips at the bottom
of this page). Treat sore nipples with lanolin or Motherlove ointment, and let them rest by using only one side at each feeding
for a while. If your pain is unbearable or persists for more than a few days, you have the option of pumping instead (which
doesn't cause friction on the nipple, but does exert some pressure), or as a last resort, using a rubber nipple shield. (This
is not the same as a "breast shell," which is a hard plastic egg used to draw out the nipple. The nipple shield
is like a rubber sombrero that you lay over your nipple; the baby sucks on it, and it is easier to get a good latch. However,
a shield can cause other breastfeeding problems, like a decrease in flow (because the nipple gets only indirect stimulation)
or a bad latch later on (because the baby is used to the shape of the shield). Always consult a lactation expert before using
a shield.) If your pain feels like glass shards shooting through your breast, you may have thrush, a yeast infection which
needs to be treated aggressively. Other symptoms of thrush include shiny and/or scaly nipples, and white cottony patches
inside your baby's cheeks that don't scrape off. Start sterilizing pumping equipment and seek help immediately for this condition.
*Plugged ducts & mastitis.
Most moms will get at least one plugged duct; some will get them every week for several months. They manifest as a hard
lump in the breast tissue, where milk is backed up and can't get out. The lump is very painful, like a tender bruise. There
are many things you can do to treat this: first of all, take as many hot showers as you have time for, and apply hot compresses,
especially before feedings. (You can buy a microwaveable first-aid compress, or a special one made for breasts that has a
hole in the middle, or you can just soak a disposable diaper and microwave it. This works GREAT because of the gel inside;
just be careful not to let it break open and spill). Second, take 2 or 3 ibuprofen every 4 hours. Third, massage the lump
out toward the nipple, especially during feeding. Make sure to empty the breast every 2-3 hours, either by feeding or pumping.
You can also take lecithin supplements. It usually takes a day or two for the pain to subside; try to be patient with it!
If the breast turn bright red and hot to the touch, you may have mastitis (breast infection). This can get bad, with fever
and aches. If you don't like to take antibiotics, you can try to wait it out, but be forewarned that untreated mastitis can
sometimes ulcerate and require a surgical drain . . . yikes!
*Low milk supply.
First of all, make sure that this is really your problem! The most common breastfeeding concern is that the baby isn't
getting enough milk, and he usually is. The following are NOT necessarily signs of low supply:
--You don't get very much from pumping (a pump is less efficient than a baby and doesn't necessarily replicate the same
results)
--The baby is nursing for a shorter amount of time than he used to (he may have just become more efficient, or ended a
growth spurt)
If you have reason to believe that your supply is low (for example, if the baby is not gaining sufficient weight, or if
you have twins, etc.), here are some things to try:
--Pump after each feeding, or at least a few extra times throughout the day. (Beware: do NOT do this if you do not have
a low supply, because you can stimulate excess milk production, resulting in overactive letdown, plugged ducts, etc.!)
--Drink a LOT of water
--Take supplements like fenugreek, blessed thistle, and Mother's Milk Tea (available at Whole Foods)
--Drink beer (nonalcoholic is okay) and eat oatmeal
--RELAX while you pump or nurse, visualize waterfalls, etc.
*Overactive letdown.
It is not uncommon for milk to come out too fast, causing the baby to choke and de-latch, and sometimes bite down to try
to stop the flow (yeeow!) We even heard a story about a woman whose milk flowed so fast that the baby never learned to latch
at all; he just lapped at the spigot with his tongue! More frequent plugged ducts and nipple problems usually go along with
this condition. You can try pumping (a hand-pump is easiest) for a minute before you nurse, to release the initial gush.
However, do NOT pump too much, because you'll stimulate even more milk production in the long run. If the baby is freaking
out, you may need to pump and feed him from a bottle.
*Boob strike / bottle strike.
This is quite common and can be very emotional: if the baby refuses the breast, you feel rejected, and if he refuses the
bottle, you feel trapped. Remember that the problem will probably pass in a few days. Here are a few pointers:
--Do not give up and go to formula; keep pumping and do't panic.
--Sometimes the baby stops liking the breast because he's just discovered that the bottle delivers more milk with less
effort. Make sure you are using a low-flow nipple, or try the "Second Nature" bottle, which requires more sucking.
--Sometimes the baby has grown more interested in his environment and can't focus on eating. Go to a quiet spot and make
sure that YOU are relaxed and breathing slowly; it will rub off on him.
--If he won't take the bottle, try a sippy cup, spoon, or medicine dropper. Have different people try offering the bottle,
or put him in a non-nursing position (propped in car seat or bouncer). Do not wait until he is starving and frantic. Be
persistent. He should get through this phase.
SuperBoobs:
Breastmilk is truly an amazing substance, full of antibodies that will protect your baby from colds and allergies throughout
his lifetime. It has lots of unexpected uses!
--Squirt it in the baby's nose when he will be exposed to germs (i.e., during travel or playing with sick kids)
--Squirt it in the eyes to treat eye infection
--Freeze it (or freeze a washcloth soaked in it) to make a slushy teething aid
If possible, do not supplement with formula. As I understand it, even one bottle a day of formula can negate the beneficial
effects of breastmilk. This is because babies under 6 months old have an "open gut," where spaces in between the
cells of the digestive tract can permit foreign bodies to enter the body. Breastmilk naturally fills in these gaps, and formula
allows the gaps to remain open. This is theoretically one reason why breastfed babies are better protected against illness
and allergies.
Pumping tips:
--Note that the boobs don't work like taps; they operate according to supply and demand. So don't assume that you can
pump a lot during the day and then sleep all night while someone gives the baby a bottle. You need to pump approximately
every time the baby eats, at approximately the same time, in order to keep your supply going. That means that if you go to
a dinner party, you may end up pumping on the host's bed while you listen to everyone else having a great time in the next
room.
--You only need to sterilize pump parts and bottles ONCE, the first time you use them. After that, warm soapy water is
fine.
--Breastmilk storage follows a general rule of 5's: it's good for 5 hours on the counter, 5 days in the fridge, and 5
months in the freezer. If it has gone bad, it will smell bad, and your baby will probably refuse it; you do not need to worry
about poisoning the baby with it. Sub-rules: if the milk has been frozen and defrosted or the bottle nipple has been in the
baby's mouth, the milk will start breaking down more quickly. You should put the remainder back in the fridge right away
and use the rest within 24 hours. Do not warm it more than twice, and in general, don't make milk too warm; this kills off
some of the good ingredients, and babies do not mind room-temperature milk.
--See Product Reviews for more info on pumps.
What can I eat while breastfeeding?
Whatever you eat (including alcohol, spicy foods, prescription drugs, etc.) reaches the milk in such dilute quantities
that it usually doesn't matter, and even compromised breastmilk is better than formula. Obviously, ask your doctor about
any prescriptions, but don't worry too much. Allergies to specific foods in milk are rare, and usually manifest clearly in
the baby (i.e., serious rash). If there is a problem, it is most often with cow's milk in your diet. You will hear a lot
of folk-wisdom about other foods, but this is very seldom a significant factor. Eat and enjoy, while you have the extra 500-calorie-a-day
allotment.
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