Successfully Breastfeeding After a Rough Start: Part 2

By Karolina Gonzalez, MAS

Last time, I shared the exciting news that my baby, David, was born and that my goal to breastfeed him exclusively was more difficult to achieve than I had expected.

After meeting with the lactation consultant on day 4 postpartum, I felt someone was actually supporting our breastfeeding goals. More than anything, her words were amazingly encouraging! I started using the breast pump to stimulate milk production and the nipple shields to be able to nurse the baby as often as he wanted to. However, two days later David’s weight gain didn’t improve at all.

On day 7, I noticed his tongue was not moving forward enough for him to effectively breastfeed. The tongue plays an important role in breastfeeding! In order to extract milk from the breast, the baby needs to move his tongue forward to cup the nipple and the areola. When he draws his tongue back, he presses the tissue against the roof of his mouth. This compresses the ducts behind the areola and allows the milk to move into the baby’s mouth. Babies with ankyloglossia, commonly known as tongue-tie, might have difficulty latching onto the breast and the mother may experience nipple pain and/or trauma. These conditions can lead to other breastfeeding problems, such as slow weight gain and/or failure to thrive in the baby and ultimately a poor maternal milk supply and untimely weaning (Ballard JL et al, 2002).

Everything indicated to me that some level of ankyloglossia could have been the cause for David’s low weight gain and constant fussiness, as well as my sore nipples and perceived low milk supply. Researchers have also reported that inadequate milk supply may be rooted in decreased ejection reflex as a result of maternal nipple pain or in suppressed lactation as a result of the infant’s inability to drain the breast (Ballard JL et al, 2002). I had already heard about that while pursuing my Master’s Degree in Maternal and Child Nutrition, but now looking back, I think sleep deprivation and pain prevented me to take that into consideration in the first place!

We left to the hospital again to discuss my observations with the lactation consultant. She agreed with me and scheduled a procedure to get his tongue clipped that same day. It was a fast and I think painless procedure, since the baby didn’t even cry! Right after that, I put him to the breast and everything was different! From then on his feedings were short but he seemed satisfied and not fussy anymore. This indicated to us that before having his tongue clipped, he needed to stay at the breast longer to get some milk. He was probably nursing more because his suck was less efficient. Over the next few days, my milk started flowing much more easily and breastfeeding was not painful at all! And the most important result was that, David achieved a normal rate of weight gain within 2 days after the procedure. Our efforts were definitely worthwhile! We were successfully breastfeeding!

I really hope sharing this experience will help those moms who want to breastfeed their babies to keep on trying despite the obstacles you might face at the beginning. For those moms-to-be who are still waiting for the baby, my advice would be to keep in mind all the resources you have at hand once you leave the hospital. And make sure those around you know about them, so they can act proactively when needed! Also, by clicking here, you can read some tips to get through your baby’s first week of breastfeeding...successfully, that we published some time ago.

References:

Ballard JL, Auer CE, Khoury JC. Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad. Pediatrics. 2002;110:5, e63.

For more about tongue-tie, click here.

Successfully Breastfeeding After A Rough Start: Part 1

By Karolina Gonzalez, MAS

You might remember I was expecting a baby last summer. David was born in mid-July on a beautiful sunny morning after 4 hours of labor. It was a very fast non-medicated delivery. Everything happened so rapidly that our midwife still insists the baby almost was born in the car on our way to the hospital! But I clearly remember (and laugh about) my husband asking my mom whether or not to have coffee and toast before leaving at 4 am, while I was already opening the garage door and turning the car on. I knew we had to leave soon!

After David’s birth, both of us were very alert and he latched onto my breast as soon as he was next to me! I felt so fortunate and so in love with my little baby! Since everything with baby and mom was fine, we came back home the next day. We were all delighted with the baby, but I was really struggling with breastfeeding. On day 3, we met with the lactation consultant. The baby seemed to have a good latch and he was making sounds as if he was swallowing colostrum, but he was consistently losing too much weight. Even though I was determined not to use supplemental formula, on day 4, I was advised to do so by the pediatrician.

During the next two days and despite using the breast pump to stimulate milk production and the nipple shields to be able to nurse the baby as often as he wanted to (I was very sore), his weight didn’t improve. I was sleep deprived, tired and engorged, conditions that together increased my doubts about being able to deal with what sometimes seemed too much. However, I was determined we both could keep on learning how to do this! In the next post, I'll explain how we learned what was wrong and what was done to help David and I to breastfeed successfully.

It’s amazing how fast babies grow up! David is now a very active and joyful 8-month-old who moves as if he wanted to jump and run, even though he is just taking small steps with the help of his parents. Now, I realize I should cherish every moment with this beautiful energetic little boy, since in a blink of an eye he’ll become a grown-up! And yes, he is still a breastfed baby!

Reader Question: Nursing Your Young Baby to Sleep

By: Jennifer Goldbronn

Recently, we received a question from a reader about nursing her 11-week-old to sleep. We have been asked many times whether or not babies get “used to” being nursed to sleep and whether or not it affects his or her ability to get back to sleep alone.  Here is one reader’s story:

My baby is 11 weeks old and I nurse him to sleep. He wakes up several times a night and I doubt he's always waking due to hunger. I have read that I may be contributing to his night wakings by nursing him to sleep and thus preventing him from learning how to self soothe (ie when he wakes he's unable to settle himself to sleep and so I have to nurse him).  If I am cultivating a problem I'd like to nip it in the bud sooner rather than later.

Self-Soothing

At 3 months of age, babies are able to self-soothe back to sleep after night wakings only about 0ne-third of the time. By 1 year, infants are able to self-soothe back to sleep about half of the time.  (Burnham 2002) When babies are not able to get back to sleep on their own, they will need a caregiver’s help, whether that be rocking or singing or nursing, to get back to sleep during the night. Babies do get “used to” how they fall asleep, but not at this young of an age. As babies get older parents can create a bedtime routine that does not include nursing as the last step. For this reader, nursing or rocking her young baby to sleep now does not mean she will have to continue this routine forever!

Night Waking

Babies wake for many reasons other than hunger, though they also need to be fed frequently! Babies also wake when they are too hot or cold, lonely (at this age babies need to interact with caregivers often) or just plain uncomfortable. Since young babies enter into light sleep first, they do wake very easily so it’s helpful to wait until they get into deep sleep before you lay them down. Holding or rocking to sleep are examples of ways to soothe your baby until he enters deep sleep. (For more information about light and deep sleep, click here.) It gets easier! By around 4 months of age babies fall into deep sleep first and won’t need as much help from you at bedtime.  Here are some other tips to get a little more sleep when dealing with the inevitable waking of your little one.

More Information

Falling asleep and staying asleep are 2 very different things. Learn the difference between the two in this post. The recommendation to lay your baby down to sleep awake vs. asleep is also discussed in this post.

As we mentioned above, there are many reasons babies wake during the night; you will find a full list of reasons in this post. You can also read about establishing routines in older babies.

Sleep patterns change a lot as babies get older. Learn more about the specifics of sleep patterns of babies 6-16 weeks of age in this post.

Reference

Burnham MM, Goodlin-Jones BL, Gaylor EE, Anders TF. Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study. J Child Psychol Psychiatry. 2002;43:713-25

Pacifiers Part 2: Breastfeeding and Pacifier Use

By Jennifer Goldbronn, MAS, RD

Let’s talk some more about pacifiers! Today we will share evidence-based information about pacifier use and its effects on breastfeeding so that you can make an informed decision about whether or not to offer a pacifier to your infant.

Many parents use pacifiers as a tool to calm or soothe their infants. According to one study, about ½ of the babies in the United States are offered a pacifier by 2-weeks of age, and about 2/3 by 6-weeks. (Howard 1999)

Many breastfeeding professionals, however, recommend waiting until at least 4-weeks, or until breastfeeding is well established, before offering a pacifier to young infants. The American Academy of Pediatrics agrees, recommending that parents wait 4-6 weeks, or until breastfeeding is established. Let’s take a look at the evidence.

Why Wait?

A large, 2012 study of pacifier use found that pacifier use “most days of the week” before 4-weeks of age was associated with shorter breastfeeding duration. Mothers giving a pacifier before 4-weeks of age were 3 times more likely to have stopped breastfeeding than those who did not give a pacifier. Also, mothers giving a pacifier “most days of the week”, regardless of their babies’ ages, were 3 times more likely to stop breastfeeding compared to those who did not give a pacifier. (Mauch 2012)

In a study of the effects of pacifier use on breastfeeding duration, researchers found that pacifier introduction before 6-weeks of age was associated with an increased risk of shorter duration of both full (exclusive) and partial breastfeeding. They also found early pacifier use to be associated with fewer breast feedings per day. Women who introduced pacifiers were also more likely to report problems with milk supply at 12 weeks postpartum. (Howard 1999)

Both of the above studies are classified as observational (meaning the researchers just "observed" what people did on their own). Because of this, we can’t say without a doubt that pacifier use is associated with negative breastfeeding outcomes. When looking at the association between breastfeeding duration and pacifier use, it is unknown whether the pacifier use itself caused the breastfeeding problems leading to shorter breastfeeding or whether breastfeeding problems caused parents to start using pacifiers. However, it is plausible that in the early weeks of breastfeeding, pacifier use may interfere with moms' milk supply, lengthen time between feeds, and make it difficult for parents to see hunger cues.

Randomized controlled trials (RCTs) about breastfeeding and pacifier use would provide stronger evidence. Of 4 RCTs found as part of a 2009 systematic review, none showed a significant difference in breastfeeding outcomes associated with pacifier use. However, the studies were very different and difficult to compare. In those that compared pacifier use to non-use, it was found that many parents in the control groups, or “no pacifier” groups, still gave a pacifier even after they were instructed not to. (O’ Conner 2009)

Bottom line:

So, should you use a pacifier? That’s up to you. Most people use them but early use is associated with shorter breastfeeding duration. As our readers know, early on, babies will demand to feed many times per day. That demand is important for babies to be able to get enough to eat and for moms to build their milk supply. Waiting to introduce a pacifier seems a good idea and it is not a good idea to use one if you are having problems feeding your baby.

References

Howard CR, Howard FM, Lanphear B, deBlieck EA, Eberly S and Lawrence RA. The Effects of Early Pacifier Use on Breastfeeding Duration. Pediatrics. 1999;103;e33.

Mauch CE, Scott JA, Magarey AM, Daniels LA. Predictors of and reasons for pacifier use in first-time mothers: an observational study. BMC Pediatrics. 2012;12:7.
O’Connor NR, Tanabe KO, Siadaty MS, Hauck FR. Pacifiers and Breastfeeding: A Systematic Review. Arch Pediatr Adolesc Med. 2009;163:378-382.

Reader Question: Breastfeeding and Pumping for 6 month old Baby

Earlier this week, we received this comment from a reader:

I have a question/comment that's not exactly related to this post. My baby just turned 6 months old today and we have been successfully and exclusively breastfeeding, but I need some encouragement and tips to keep going. I love breastfeeding when I'm home with the baby. I work full-time and just really don't like to pump at work. The pump isn't particularly comfortable and it takes about 40 minutes out of my work day and I could really use that 40 minutes right now. For the past few days I've really been thinking about not pumping anymore. I've read that infants do better breastfeeding for the whole first year, but how much better? I guess I want to know is it really worth it to breastfeed after the first 6 months?

We want to let you know that we completely understand what you are going through; as working mothers, we have been exactly where you are now. Returning to work is not easy and it takes a lot of adjustment for both mom and baby. Hopefully, by combining what we’ve learned from breastfeeding research and our personal experiences, we can help you continue breastfeeding for as long as you and your baby desire.

Pumping Problems

I admit that when I first saw a breast pump, I thought it looked like the most unnatural, uncomfortable device ever! After my first daughter was born prematurely (for the story of her birth, click here), however, I had to put my apprehension aside and learn everything I could about breast pumps. Now, after pumping for both my daughters, I know more than I ever thought I would about using a pump!

The most important thing to know about pumping is that it shouldn’t be painful. If you are experiencing 

discomfort or pain only when you pump (and not when you breastfeed) here are some things you can try:

• If you are using an electric pump, try turning the suction strength down. The suction on most electric pumps can be turned much higher than anyone would ever need. Some pumps also have a “let-down” phase that can help the milk start flowing a little faster, so if yours has that feature, I recommend using it. 
  
• Limit the amount of time you spend pumping. I know it can be tempting to pump until you feel like every last drop of milk has been removed, but pumping for too long can cause discomfort. I know every woman is different, so I can’t give you an exact time limit, but I found that 15-20 minutes was the longest I could pump in one sitting.
  
  
• Make sure you have the right size breastshield (also called a flange). The breastshield/flange is the funnel-like part of the pump system that touches the breast directly. Most pump kits come with a standard size, but many women (myself included) need a bigger size. If your nipple rubs against the sides of the shield while you are pumping, you probably need a bigger size. 
  
• Make sure the pump is working properly. It is possible that your pump isn’t functioning properly, causing discomfort. Many of the pump companies have technical assistance (check the company website for more information).

You also mentioned that pumping disrupts your work schedule. Since I am not sure the specifics about your job requirements and working environment, I am not sure what you can do to address that issue. Because I sit at a computer most of the day, I was able to pump and work simultaneously. If that is an option for you, there are some bra-like products that enable women to pump “hands-free” or you can create your own by cutting holes in sports bra tank top. If it isn’t possible for you to pump and work at the same time, you can try pumping during your lunch break.

Benefits of Breastfeeding – Does Duration Matter?

While much of the breastfeeding research focuses on the benefits of exclusive breastfeeding versus partial breastfeeding and/or full formula-feeding, there is evidence to show that longer breastfeeding durations provides increased benefits for both mothers and babies. The American Academy of Pediatrics Policy Statement, “Breastfeeding and the Use of Human milk” states that “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child” and  “Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother, especially in delaying return of fertility (thereby promoting optimal intervals between births).”

Additional tips that may make breastfeeding work for you

• Although breast milk continues to be a major source of nutrition as babies approach 1 year of age, keep in mind that as your baby gets older, he will be eating more and more solid foods.  Scheduling one of your baby’s solid food meals for when he is not with you can help you breastfeed more often when you are together.
  
  
• As your gets more used to eating other foods, things will get easier and easier and eventually you shouldn’t need to pump much at all. You can talk to your pediatrician or a Lactation Consultant to get more information about the best way to spread out pumping.
  
  
• Take time to consider all your options.  You mentioned that you enjoy breastfeeding and it is important to remember that your opportunity to breastfeed your son lasts for a relatively short period of time. Every family is different and only you know what is best for you and your baby, so take the time to make a well-informed decision that you will happy with in the long run.

We hope this information helps our anonymous reader and anyone else going through a similar experience.  

The Active Mommy Conundrum: Can Exercise Harm Breastfeeding? Part I

By Taryn Barrette, RD and Jane Heinig

I don’t have children yet, but I’ve always imagined that one of my favorite things to do with my new baby would be to take him for a jog. I lead a pretty active lifestyle and feel that it is important to share my love for fitness with my children – but I also plan to breastfeed and I was concerned about the potential for exercise to affect my milk supply. I had also heard that lactic acid can build up in breast milk.

So, I began to wonder: Does exercise reduce milk supply? Does exercise lead to lactic acid in breast milk? And if so, can the baby actually taste it? If lactic acid is present in the milk, will the baby refuse to drink it? How am I ever going to be the active mommy that I’ve always dreamed of? In today’s post, we will discuss the effect of exercise on breast milk volume. Next time, we’ll talk about breast milk and lactic acid.

Exercise and Breast Milk Volume

In many countries around the world, the idea that physical activity would interfere with breastfeeding would be considered crazy or a joke. Most women in the world must maintain very active lives despite having young children in tow. Many women have physically demanding occupations and many more must walk great distances for food or water. Women with access to their children (not separated for many hours with no way to express their milk) are able to breastfeed despite their activity levels. The challenge comes when a woman’s occupation prevents her from being able to feed her baby. Her body will make less milk if less milk is removed. But exercising, especially in short to medium bouts, even at very high levels does not reduce milk supply. A series of important studies looking at this phenomenon where conducted here, at UC Davis. In the first of the studies, the researchers followed small groups of women who were either sedentary or extremely active (marathoners, masters swimmers, triathletes) and they found no difference in the women’s milk supply or in their infants’ growth. In fact, they found that the athletes tended to have higher milk volumes and greater energy content in their milk. In a follow-up study, the researchers took a group of sedentary women and increased their activity by putting them on a supervised exercise program (some of these women were also put on low-calorie diets). Once again, they found that there was no effect of the exercise on the mothers’ milk supply or their infants’ growth. Other studies have indicated that exercise did not interfere with lactation among women who were overweight when they began exercising. All of this research shows that going out for a jog (when you’re ready and the doctor says it’s ok) is a great idea!

References:

Lovelady CA, Lonnerdal B, Dewey KG. Lactation performance of exercising women.Am J Clin Nutr. 1990 Jul;52(1):103-9.

Lovelady CA, Garner KE, Moreno KL, Williams JP. The effect of weight loss in overweight, lactating women on the growth of their infants. N Engl J Med. 2000 Feb 17;342(7):449-53.

Lovelady CA, Nommsen-Rivers LA, McCrory MA, Dewey KG. Effects of exercise on plasma lipids and metabolism of lactating women. Med Sci Sports Exerc. 1995 Jan;27(1):22-8.

Answers to Mothers’ Common Questions about the First 3 Days Postpartum

In our previous post, we shared a study reporting postpartum mothers’ most common concerns in the first days and weeks postpartum. Their questions varied from concerns about their own post-operative care to those about feeding and caring for their infant. In today’s post, we’ll provide some answers to mothers’ most common questions about the first 3 days postpartum. For more detailed information on any of the topics below, please see the reference section at the end of this post.

Post-Operative Care


Whether you’ve had a C-Section or an episiotomy, it’s important to know what to expect from the procedure itself and how to care for the stitches and wounds afterwards. It’s important to breastfeed in a position that is most comfortable for you and doesn’t put pressure on your incision.

Cesarean Section
Wound care of your incision is monitored for redness and infection by your healthcare team while you are in the hospital. You will be encouraged to shower and get up to walk within 24 hours. You will also be prescribed pain medication. It is important that you feel comfortable asking for adjustments to the dosage if you are experiencing changes in pain. Pain management is important for healing and being able to comfortably care for your newborn. Once you are home, you may need someone to help you monitor your incision (from experience, it was difficult to see the incision myself). One last piece of advice from my own experience: place a pillow over the incision (on top of your clothing) because the area will be very tender, especially while holding your baby or adjusting your position.

Episiotomy
For episiotomies, wound care begins immediately. You will most likely be prescribed pain medication as well as a topical antibacterial cream for the incision itself. An ice pack will help with pain and inflammation. Sitting in a warm bath with Epson salt (“sitz bath”) 2-3 times per day will cleanse the wound and relieve some of the pain.

Uterine Massage
Uterine massage is important to help deliver the placenta and to aid in uterine contractions. This ensures that the uterus expels all of the excess tissue and returns to its normal size. Most nurses will do this for you while you are in the hospital.

Returning to Your ‘Normal’ Figure


I have to admit I was a little surprised to see this was a concern of mothers in the first few days postpartum! There is so much pressure in our society to conform to the ideal body image that we see in the media. Remember, it took you about 40 weeks to carry your baby to term, and most healthcare professionals say that it will take about 40 weeks or up to 1 year to get back to your pre-pregnancy weight. Pregnancy weight gain not only includes weight from your baby but from body fluids and tissues to support the growth of your baby as well. During the first few days postpartum, you should not push yourself too exercise too hard or too soon. Your body needs time to rest, relax, and heal. If you’re jealous of how svelte stars like Angelina Jolie and Reese Witherspoon manage to look red-carpet ready in just a few months after giving birth – consider this – if you had the money to hire a 24/7 personal trainer, nutritionist, chef, nanny, and buy an unlimited supply of Spanx, then you could look like them too!

Physical Activity in the Postpartum Period
How soon you can begin to exercise after giving birth will largely depend on what kind of shape you were in prior to your pregnancy and your fitness during pregnancy. Most people will say that you can resume activity and exercise “when you feel up to it” but moms recovering from a c-section may be asked to wait until their 6-week check-up before restarting an exercise regimen. For all moms, easy walks up to 30 minutes in length can begin a few days postpartum and you can slowly increase exercise intensity as your body regains strength.

Concerns about Your Baby’s 1st 3 Days

Recognizing Infant Illness
Newborn babies will cry, wake, and need to be fed often! Healthy newborns (after they are cleaned up!) will have warm, pink skin and will try to interact with you. If your baby abruptly changes his behavior – i.e. suddenly begins to cry more often than usual and cannot be consoled or becomes lethargic, this may be a sign of illness or injury. Keep in mind that sometimes a baby’s “good” behavior can be misleading. Babies that sleep all of the time, do not wake to feed consistently, or never cry may not be feeding or growing well. Call your pediatrician immediately. If you swaddle your newborn, it is important to un-swaddle them to change diapers and to monitor their skin tone and color. If you are worried that your baby may be sick, call your doctor or advice nurse.

Feeding
Newborns have very tiny stomachs so they can only eat very small amounts at a time. So if it seems like your baby wants to eat “all the time” – You’re right, he needs to eat frequently! During the first 3 days, babies should be fed whenever they show hunger cues -which can be up to 12 times per day! (Do keep in mind that cues may be unreadable or conflicting in the early newborn period. For more information about newborn behavior in the first 72 hours, click here. Twelve feedings per day may seem like a lot, but remember that feeding takes practice, so the more you do it during those first few days, the better you and your baby will become at breastfeeding! For more information about breastfeeding after a cesarean section, click here.

Note: Days 4 and 5 postpartum usually have the most feeds. Many mothers then think that they do not have enough breast milk. This is not true! This sudden increase in feeds helps prevent engorgement (from the rapid increase in milk supply around this time) and gives mom and baby lots of practice feeding, right when they need it most.

We hope the answers to these questions provide information to those of you who are new or prenatal moms with similar concerns! Next time we’ll address mothers’ most common concerns in the weeks and months after giving birth.

References
Cesarean Section:
http://www.mayoclinic.com/health/c-section/MY00214/DSECTION=what-you-can-expect

Uterine Massage: http://apps.who.int/rhl/pregnancy_childbirth/childbirth/3rd_stage/Cd006431_soltanih_com/en/index.html

Episiotomy:
http://www.mayoclinic.com/health/episiotomy/HO00064/NSECTIONGROUP=2

Postpartum Exercise:
http://www.mayoclinic.com/health/exercise-after-pregnancy/MY00477

News Flash: Breastfeeding and Later Solid Food Introduction are Protective against Obesity in Young Children

A 2007 report from the CDC showed that 3 out of every 4 new mothers in the United States initiate breastfeeding. However, only 33% are exclusively breastfeeding at 3 months. That means 64% of babies nationally are at least partially formula-fed. (1) A 2011 study, that received widespread news coverage, now shows that formula-fed babies are at higher risk of obesity at age 3. Among those that are formula-fed and started on solid foods before 4 months of age, the risk of obesity at age 3 is even greater. (2)

Recommendations vs. Reality
Currently, 26% of infants in the US are introduced to solid foods before 4 months-of-age and, while the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) Breastfeeding Section recommend introduction of solid foods at 6 months of age, many pediatricians (and even the AAP Committee on Nutrition) continue to endorse starting solids between 4-6 months of age. However, a recent study may provide more proof that starting solid foods before 4 months of age could have negative effects lasting into early childhood. (2)

Pediatrics recently published the results from a large study conducted at Harvard that compared age of solid food introduction (less than 4 months, 4-5 months or ≥6 months) and risk of later obesity in preschoolers. (2) Sixty seven percent of infants in the study were “breastfed” (defined as at least partly breastfeeding) at 4 months-of-age and 33% were “formula-fed” (defined as never breastfed or breastfed less than 4 months). Two factors were linked to increased obesity risk at age 3:

1. Early solid food introduction among babies who were never breastfed or were breastfed for less than 4 months - Those introduced to solids before 4 months-of-age had a 6-fold increase in odds of obesity at 3 years-of-age. Interestingly, early introduction of solid foods in babies who were at least partly breastfed for more than 4 months had no effect on later obesity, and moms who “breastfed” for longer than 4 months were less likely (8% compared to 33%) to start solid foods early compared to “formula-fed” babies and babies who breastfed less than 4 months. (2)

2. Breastfeeding Status - Breastfeeding status was also connected to obesity at age 3 years, with almost double the percentage of “formula-fed” babies obese compared to babies breastfed at least 4 months. (2)

What does all of this mean?
With 1/4 of babies in the US never breastfed and 1/2 breastfed for less than 4 months, delaying solid food introduction until after 4 months-of-age may be an important step towards decreasing obesity in young children. (2) Other studies also indicate that introduction of solid foods before 4 months of age is associated with rapid weight gain in infancy and higher body fat or weight in childhood. (3,4) Also, breastfeeding, even partly, for at least 4 months may be protective against early childhood obesity. (2) This is not to say that babies don’t reap added benefits when exclusively breastfed (such as reduced risk of gastrointestinal and respiratory illness, Sudden Infant Death Syndrome (SIDS) and allergies, to name a few)! (5) However, this particular study only compared breastfed (at least partly breastfed for at least 4 months) to formula-fed (breastfed less than 4 months or fed only formula) infants.

It’s also important to note that while it is recommended to delay solids until close to 6months-of-age, developmental signs of readiness for solid foods must still be observed in the infant before solid foods are introduced. For more information about what developmental signs to look for and which foods to feed first, click here.

Next time: Baby Behavior during illness

References:
1. CDC Breastfeeding Report Card –– United States, 2010. Web. 28 Mar. 2011.
2. Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of Solid Food Introduction and Risk of Obesity in Preschool-Aged Children. Pediatrics. 2011 Mar;127 (3):e544-51.
3. Baker JL, Michaelsen KF, Rasmussen KM, Sørensen TI. Maternal prepregnant body mass index, duration of breastfeeding, and timing of complementary food introduction are associated with infant weight gain. Am J Clin Nutr. 2004;80(6):1579-88.
4. Kim J, Peterson KE. Association of infant child care with infant feeding practices and weight gain among US infants. Arch Pediatr Adolesc Med. 2008;162(7):627-33.
5. Kramer MS, Kakuma R. The Optimal Duration of Exclusive Breastfeeding: A Systematic Review. WHO, 2002.

Reader Questions: Fast Answers

Recently, we've had several questions that don't require long explanations. In this post, we'll respond to several of these questions at once. We've paraphrased the questions to make them a bit shorter.

1. What is a nursing strike?


A "nursing strike" often refers to older babies' refusal to breastfeed by turning or pushing away from mom and refusing to latch. Some mothers might interpret a "nursing strike" to mean that their babies want to quit breastfeeding. This can be very disappointing for moms who haven't yet reached their breastfeeding goals. Nearly all older babies will refuse to breastfeed occasionally, but most will return to breastfeeding fairly quickly. It is common for babies to turn and even arch away from moms when they are using disengagement cues. If they are distracted or disturbed by loud noises, over stimulation, illness or discomfort, babies may use disengagement cues to let their moms know that they need something to change before they feed. Remember, babies can't be specific about what is bothering them. It is up to parents to figure out what might be wrong. If mothers ignore these early cues, babies will escalate the cues and may start to fuss or cry. When hungry babies refuse to feed, it is important to look around the environment and reduce distractions or help babies feel more comfortable before trying to feed them.

2. Why does my baby like squeaky toys?


Babies' sense of hearing is well developed at birth and most babies love repetitive sounds. They like music with repeating melodies and toys that repeat sounds over and over. Squeaky toys can be particularly fun because they are associated in babies' minds with games they've played with mom or dad or with their own ability to predict the noises the toys can make. Babies love to anticipate experiences and events and will squeal with glee whenever they are able to predict the end of a game, like peek-a-boo, or the result of an action like squeezing a toy. See our earlier post to read more about why babies are so happy when their predictions come true.

3. Is it ok for a 5-month-old who can roll over on his own to sleep on his tummy?

As long as your baby's sleeping place is safe (e.g. firm surface and free of heavy bedding, stuffed animals, or anything that could trap your baby) babies who can roll over on their own do not have to be returned to their backs if they rollover from back to tummy during the night. However, it is best that all babies be put down to sleep on their backs no matter what they do when you turn out the light.

Next time: More reader questions and we'll introduce a new series!

Reader Question: Decreased Milk Supply

We have been getting great comments and questions from our readers! One recent question we received was about decreasing milk supply around 6 months postpartum. The mother is concerned that her milk supply is decreasing because her breasts don't feel as full as they used to and her baby seems to be hungry all the time. She is looking for answers about why this could be happening and what she can do so that she can continue breastfeeding.

First, we understand that breastfeeding your baby takes work and congratulate you for making it this far. Unfortunately, without seeing you in person it is not possible for us to give you any answers about what you experiencing. If you are having breastfeeding problems, we suggest that you schedule an appointment with your doctor or a Lactation Consultant, who will be able to address your specific situation. To find an IBCLC in your area, visit http://www.ilca.org/ and click on "Find a Lactation Consultant" on the right hand side of the page.

Quick response: Feeding a 3-week-old

We just received a question for one of our readers about a 3-week-old who sometimes is feeding quite frequently the morning and in the evening. Since feeding is such an important concern for babies and parents, we wanted to respond right away to this question.

Frequent feedings only at certain times of the day are called "cluster feeds" by most lactation professionals. Typically, frequent feedings are not unusual, especially among older babies who are trying to deal with overstimulation or growth spurts. In older babies, you'll see patterns of cluster feeding (in the evening) or for a few days while the baby works to increase the milk supply to meet his rapidly increasing needs.

With a 3-week-old, there are a few other things to consider. For many moms, the milk supply is still being established in the first month, so early cluster feeding may be just fine OR an early indicator that mom and baby may need a little help getting things back on track. First and foremost, you need to know how much weight the baby has gained since birth. Most doctor's offices are fine with requests from moms to check their babies' weight. If the baby's weight gain has been slow, the cluster feedings may mean that there may be a glitch with the breastfeeding. Your doctor or a lactation consultant should be able to help with that. If the weight gain is fine and baby is looking and acting healthy, it may be that the baby just needs a little time to be able to nurse more efficiently, may be sleeping a little too long between the other feeds, or may be very sensitive to stimulation around him. Again, your doctor or a lactation consultant can figure out what might be happening. Nearly all of these early glitches can be fixed easily.

Bottom line: Frequent "cluster" feeds are not unusual and not necessarily something to be concerned about (except that they are hard on new moms!) but they are one of those things that babies do that should get checked out by a professional. A quick weight check and a few words with someone who knows about lactation can set everyone's mind at ease.

Let us know how things go.

Tips for Successful Breastfeeding After a C-Section

Here are a few tips that can help you achieve a positive breastfeeding experience, even if your birth "plan" doesn't include a c-section.

Communicate with the hospital staff about your decision to breastfeed.
Plan ahead by letting hospital staff know that you plan to breastfeed before your baby is born. Ask that no bottles, supplements, or pacifiers be given to your baby unless medically necessary, and ask for your baby to be brought to you as soon as possible after delivery. Inquire if the hospital has a rooming-in policy, meaning they let the baby stay in your room for your entire hospital stay. This will give you time to get to know your baby's cues and let you practice breastfeeding. In case you are not able to be with your baby immediately post partum, be sure that your partner (or other support person) is aware of your feeding choices and ready to talk to hospital staff about them.

As soon as you can, put your baby skin-to-skin.
In most cases, you can start skin-to-skin contact with your baby in the delivery room, while the doctor is completing your procedure. Your partner or a nurse can hold your baby against your bare chest until you are ready to be transported to the recovery room. Keep your baby skin-to-skin as much as possible during the first few days postpartum. Skin-to-skin contact enhances bonding and ensures that your breast is readily available when baby needs to feed. It also helps regulate your baby's temperature and heart rate. If your baby is taken to the nursery, encourage your partner to stay with your baby and practice skin-to-skin contact with him until you are reunited.

Be patient, your milk will come in.
There may be a bit of a delay in your milk "coming in" after a c-section, but that does not mean that you can't breastfeed. Put your baby to the breast soon after delivery and as often as possible to stimulate your milk production. Your newborn needs 8-12 feedings in a 24-hour period. Before you start to produce larger volumes of milk, your body will produce colostrum. Colostrum is produced in very small amounts because your baby's tummy is also small. Colostrum is all that your baby needs in his first days of life. You will notice that things change quickly by day 3-5 after delivery. Your milk will change in consistency and color and the volume will increase. If for some reason you do have to supplement temporarily with formula, you can go back to exclusive breastfeeding. Be sure to talk to your doctor, nurse, or lactation consultant about the steps you'll need to take to reduce the amount of supplementation when your baby is ready.

Get some help. Your incision will make it challenging to position your baby to breastfeed comfortably.
Get help with positioning your baby at the breast to feed. A lactation consultant or nurse can show you the most comfortable positions to breastfeed that won't irritate your incision. Usually the side lying position or football hold puts less pressure on your abdomen. It can also be painful to get out of bed and pick up your baby the first few days postpartum. For the first week or so after delivery, have someone bring your baby to you and help you get into a position that is the most comfortable for you and your baby to breastfeed. Use pillows to protect your incision and keep you comfortable while breastfeeding. Also, you may have received a lot of fluid during and after your surgery. This extra fluid may make it harder in the first few days for your baby to latch onto your breast.

Tell your doctor that you plan to breastfeed, many medications are safe to take while breastfeeding.
After your surgery, your doctor will prescribe medications to control your pain. These days, many pain medications are safe to take while breastfeeding. Ask your doctor about the safety and compatibility of all medications you take while breastfeeding.

Make sure your baby is awake enough to feed. Your baby will be drowsy.
Because of the pain medications given during labor and delivery, your baby will be drowsy. It could take several days for the medication to completely leave your baby's system. A drowsy baby may fall asleep early in a feeding and thus, not feed effectively. See the next section for the best way to wake a sleepy baby to feed. Call your doctor or lactation consultant if your baby is sleeping all of the time and feeding less than 8-12 times per day.

Use a variety of ways to wake your sleepy baby.
In our last post, we told you the best way to wake a sleepy baby is to use a VARIETY of stimulation. Use different positions, touch, or words. Removing your baby's clothing is another way to change his environment (temperature or touch) to help wake him. Keep in mind that sometimes it can take up to 10-15 minutes for sleepy newborns or premature infants to fully awaken enough to feed effectively. Be patient!

With a little extra support and patience, you can successfully breastfeed your baby after a c-section. I did it, along with thousands of other mothers. That's not to say it was easy, but knowing what to expect will give you the confidence you need to achieve your happy (breastfeeding) ending.

Next time: Just when you thought the worst was over, waking up again with an older infant.

Yes, You Can Breastfeed After a C-Section!

PART 1: My Story

My beautiful baby girl entered this world after 36-hours of labor and an emergency c-section. There were complications from the surgery that led to my being sedated towards the end of the procedure. I vaguely remember the relief I felt hearing my daughter’s first cry before she was quickly taken to a nearby table where a team of respiratory therapists worked to get her breathing. Then the lights went out. (Note: this is not standard protocol for a c-section! Most c-sections are done with either a spinal block or epidural, during both of which you remain awake the entire time). My husband's instincts drove him to follow our daughter wherever she went that morning so that she would not be alone. He watched her get her first bath and have different tests done while I was still heavily sedated. I really wanted to breastfeed. So it was also important that he stay with her to ensure that she was not given any unnecessary supplements.

I awoke in a daze several hours later in a recovery room before being wheeled into the nursery to meet my daughter for the first time. My first impression was not quite love at first sight. I remember thinking: “That’s my baby? But she’s blonde!” I assumed she would have inherited my own dark hair and eyes. I felt disconnected, as many women do after delivering via c-section, and I felt disappointed that I had missed out on bonding with my daughter the moment after she was born. She wasn’t put on my chest to nuzzle and nurse and I was not the first person to hold her. Not to mention the fact that she didn’t look anything like me!

After I had settled into a postpartum room, my daughter was brought to me from the nursery. She was ravenous and a little fussy by the time she got to me. I had planned to breastfeed from the start, but I hadn’t planned on having a c-section and having to wait several hours after her birth to feed her for the first time. Luckily, I had filled out pre-registration papers at the hospital stating that I was planning to breastfeed and that I didn’t want her given any supplements or pacifiers unless medically necessary. I was so excited to breastfeed, hoping that, even though everything else about my labor and delivery had not gone according to plan, I would get a second chance to bond with my daughter by providing her with the milk that my body had made especially for her.

As my daughter attempted to latch onto my breast for the first time, she seemed almost in a panic to find the nipple. She was bobbing her head (rooting) and making little whimpering sounds. Her whole little body was tense. When my hungry child finally latched onto my breast, she sucked for a minute or two and then fell asleep. I became worried immediately. She needed to eat, and I felt it was solely my responsibility to nourish this helpless human being! No pressure at all. I now know that my expectation for this "perfect" first feeding was unrealistic. Newborns don't follow any rules! My daughter and I had to learn to breastfeed together, and that took a lot of practice.

I had taken a breastfeeding class prenatally where I learned several techniques to help wake a sleepy baby to feed. I undressed her, flicked her feet, rubbed her cheek, talked to her, etc. Luckily I was able to arouse her enough to ensure that she fed frequently. From our research with moms and babies, we've found that the BEST way to wake a sleepy baby is to use a variety of positions, touch, and words. Later, as the effects of the medications from the c-section wore off in her little body, as well as in mine, she became more effective with sucking and fed for longer periods of time.

While it was great that my daughter was more awake and alert to feed, my own pain level peaked as the medications from the delivery wore off. I remember feeling a searing, sharp pain in my abdomen (from the incision) every time I tried to sit up in bed to breastfeed my daughter. I was lucky to have great nurses who kept my pain under control with medication so that I could be comfortable enough to nurse. Still, I needed help getting her out of her bassinet and positioning her for every feeding for the first few days.

There is no doubt that breastfeeding after a c-section is challenging, but with a little help, you can have a positive breastfeeding experience!

Next time: Part 2: Tips for Successfully Breastfeeding After a C-Section

Breastfeeding comes naturally, right? One story of a not-so-perfect start to breastfeeding

The first feeding: Getting to know you
I thought latching came naturally to newborns. I had this vision of my brand new baby, this little creature I had just birthed, nuzzling up to my breast, latching on and feeding for the first time, with ease. Well, that’s not always how it works! First of all, I wound up having a C-section, and thus, a medicated baby, who, after I got out of the recovery room, was still drowsy from all of the medication. This was not part of my plan! I felt that I needed to get her on the breast quickly because I had been in recovery for awhile and thought she must be starving. The first time I put her to the breast she did latch on, but like a ravaged little animal! She was so drowsy, she would stay on the breast only for a minute or two at a time before falling asleep. I felt a little panicked: would she get enough milk? Was there any milk there? Now I know that the first feeding is more of a “getting to know you” experience between breast and baby, and not a complete meal. She may start by simply licking or mouthing your nipple. She is getting to know you.

Colostrum: The first milk
At first, your body makes a very special type of milk, called colostrum. It is yellowish, thick and sticky. It might seem like colostrum is not enough for your baby because it is produced in very small amounts, but your body is making the perfect amount for your baby, a little goes a very long way. Colostrum is packed with important nutrients and easy to digest. Keep in mind, a newborn baby’s tummy is tiny! My daughter fed every hour or two in the first few days.

After a few days, your milk will "come in" and satisfy your baby’s needs as she (and her tummy) grows. The milk will appear thinner and white (or opaque) in color. This transition is normal, and again, your milk is made to meet your growing baby’s needs perfectly.

Getting help in the hospital
In the hospital, I was lucky enough to have knowledgeable nurses to help me when I had breastfeeding questions. I also had a Lactation Consultant (LC) stop in to check on me a few times. This is not always the case. As part of a study of how women feed their babies in the hospital, we found that most women received help with breastfeeding from the hospital nurses. A smaller number received help from a LC. LC’s are healthcare professionals specially trained to help mothers breastfeed successfully. Before you leave the hospital, I encourage you to ask your nurse if you can see a LC. Their help is invaluable, as my experience below shows.

Welcome home!
When I got home from the hospital, I discovered that I no longer had 24-7 nursing care! That’s when the real fun began. When my daughter latched on at home, something changed. I started having pain when she would latch to my breast. The pain escalated and within a few hours, one of my nipples was bleeding. The pain was overwhelming to the point that I didn’t want to put her to the breast at all. Luckily, I had the phone number of an LC that I knew from a past job; I called her right away. She came over that day and helped me position my daughter so that we were both comfortable. With her help and a new breastfeeding pillow, I was off and nursing again, pain free.

Kerri’s Story
Kerri had a similar experience. She describes her first breastfeeding experience as feeling unnatural and scary. She had problems getting her daughter to latch, but when the nurse would come in to help, she would get her to latch on easily. Then the next feeding would come, and she would try to latch her on by herself and it wouldn’t work. She would get frustrated because it seemed so easy for the nurse. She felt like something had to be wrong with her - women had been breastfeeding for hundreds of years, so why couldn’t she do it?

By the second day, her nipples were cracked and bleeding. Breastfeeding was painful! She thought about giving up because it hurt so badly, but the doctors and nurses kept reassuring her that she and the baby were learning to breastfeed, together. She kept trying and was finally successful. Once she found the breastfeeding position that worked best for them both, breastfeeding became much more natural.

Tips to survive your baby’s first week of breastfeeding...successfully

Get real: latching can be hard work
It is a natural process, but it is a learned process! Both you and your baby will need time to practice breastfeeding. Your baby may not latch on comfortably the first time, especially if she is drowsy from medication during your delivery. To learn more about positioning your baby at the breast and latching her on comfortably, talk to your nurse or a lactation consultant while you are still in the hospital!

If it hurts, get help NOW
The pain might not subside without intervention from a lactation professional (LC, nurse, etc.) Do not wait to call because the pain from an uncomfortable latch could just get worse or you may even develop a breast infection.

Most babies get enough to eat if they just breastfeed frequently
As I said before, the milk your body makes is nutritionally perfect. If you feed your newborn frequently (every 1-2 hours), your body will make just the right amount of milk to satisfy her. The frequent feedings won't last forever! If you are really concerned that you are not making enough milk, talk to a lactation consultant as soon as possible.

Babies cry for many reasons, not just because they are hungry!
Your baby might cry at the end of a feeding; that does not mean she is still hungry or not getting enough milk from you. Babies cry for many reasons. They might cry because they are cold, hot, lonely, tired, over stimulated or having a bowel movement. Keep in mind that even a normal birth is a pretty traumatic experience for a baby. She was warm, safe and comfortable in your womb. Now she is in a bright, cold world with lots of loud sounds and strange new sensations in her body. You might cry too!

Know where to get help before your baby is born
In the hospital, don’t be afraid to ask your nurse for breastfeeding help. Their job is to help you learn to take care of your new baby. Lactation consultants (LCs) are employed by many hospitals to help mothers get breastfeeding off to a good start. USE THEM! They have a wealth of knowledge and experience! Ask your nurse to get you a referral to an LC before you leave the hospital, and be sure to take the LC’s contact information home with you in case you have a breastfeeding problem or question once you take your baby home.

Take a breastfeeding class, prenatally
Breastfeeding classes are helpful for learning the basics of breastfeeding. It is also helpful for your spouse or partner to attend so that they can learn ways to support you while you are breastfeeding. Breastfeeding classes are usually offered at hospitals or at your doctor’s office. Ask your doctor for more information about finding a class.

Fast forward two years My happy ending: the newborn described throughout this post just turned two years old. She is a happy, healthy toddler that still enjoys breastfeeding. The only difference is now she can ask for it!

Next time: One of our moms shares the challenges she experienced when her pregnancy & delivery didn't go according to plan