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!

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