Editor’s Note: Readers should make sure when talking to any doctor or nurse that they have been trained in lactation specifically. You wouldn’t talk to your dentist about heart surgery, or to your heart surgeon about your teeth because they are two different fields of medicine. A lot of women will get misinformation that will make their breastfeeding journey unsuccessful if they are talking to a doctor from another field that isn’t well informed on the topic. Please consult our list at the end of the article if you should require the help of an expert in this area.
For most mothers, having a new baby is a joyful, yet completely overwhelming, experience. The reality of the difficulties and doubts that mothers face in those first few months are often unexpected, with most mothers assuming that breastfeeding will come naturally and easily. Unfortunately for many mothers this is not the case, and there is a great feeling of personal failure for mothers who wanted to breastfeed their children but couldn’t. Education both before and after baby comes on what to expect and what is normal can help new mothers alleviate fears.
The World Health Organization’s recommendations are that babies are exclusively breastfed for the first six months of life, with continued breastfeeding up to the age of two years. The health benefits for mothers and for babies extend into adulthood. Yet, globally, less than 40 percent of infants under six months of age are exclusively breastfed. While breastfeeding is a natural act, it is also a learned behavior.
Research has shown that mothers require active support and breastfeeding counseling for greater success in breastfeeding and in a foreign country, far from your home and the support of your own family or healthcare system, support can be even harder to get. Latest research shows that breastfeeding reduces the risk of post-partum depression (PPD) yet for mothers who desire to breastfeed but can’t, the risk of PPD increases, and this is another reason that equipping and educating yourself and a strong support network is crucial for success.
Set yourself up for success
Be informed about birthing practices. While sometimes medically necessary, induction, cesarean section, pain relief medication (including epidurals) and IV fluids put babies at a higher risk of having breastfeeding difficulties – some medication can create sleepy newborns who eat less frequently than normal, and can delay mothers milk supply. Also, IV fluids can delay the milk “coming in,” creating engorgement in the mother’s breasts making it painful for mum and difficult for baby to latch. This also results in a false birth weight for the baby, leading to a bigger weight loss in the first week which doesn’t necessarily need to be fixed with supplementation. All of these problems can be overcome with the right support.
Jennifer Lecleir, Beijing United Family Hospital’s lactation consultant, says the key to successful breastfeeding relies heavily on a good latch. “A good latch means better milk transfer, better milk supply, and healthy thriving babies.” Educate yourself on how to get a deep latch and seek help from trained professionals or experienced mothers. Nipple pain is a sign that the latch is not as good as it could be. Latching requires practice from mother and baby, so if it hurts, unlatch baby and try again. Lecleir says that with a good latch, the mother should feel a strong pulling at the breast, as opposed to painful pinching on the nipples. When the milk is being transferred successfully, baby’s jaw will move rhythmically with a small pause before each swallow to show the milk is filling up her mouth.
How often should a newborn feed?
All our experts agree that babies should be fed on demand. Lecleir states “there should be no restrictions on length or frequency of breastfeedings in the early days.” Babies feed very often in the early days (10-12 times per day!), this is normal and the best way to establish a healthy milk supply and enhance breastfeeding behavior. Brand new babies who are sleeping more than 3-4 hours (perhaps as a result of mother’s pain relief medication, or insufficient milk intake), can be woken up to ensure they are fed the recommended minimum number of times a day (8, preferably 12).
What are some signs that your baby is not getting enough milk?
Poor weight gain after the 4th day is usually the first indication of inadequate milk intake. All babies lose seven to nine percent of their weight in the first three days (or more if mother has been given IV fluids), and then start to gain weight around day four. Lecleir says other signs include low urine output, decreased stool, or severe jaundice. Mothers may have low milk supply or she may be severely engorged due to poor milk transfer (check that latch!).
When should I seek help?
For mother: when struggling in general, severe pain throughout the feedings, damaged cracked nipples, severe engorgement, persistent high fever (greater than 38.4 degrees Celsius). For babies: poor infant weight gain or excessive weight loss.
What are some common misconceptions that are detrimental to breastfeeding and a mother’s milk supply?
Bec Taylor of La Leche League says it is a common misconception that a mother must wait for her breasts to “fill up” in order to provide enough milk for their baby. “Actually, the more a baby is able to fully empty the breast, the more milk is produced. Soft, frequently emptied breasts make milk faster than full breasts!”
Taylor adds that many families fear that the fussiness their baby displays in the evenings is related to a low milk supply, when in reality, this is actually normal baby behavior. Understanding that babies breastfeed for more reasons than just hunger (such as thirst, a need for physical touch and comfort, immunological boosts, tiredness, overstimulation and more) will help make the very normal “witching hour” fussiness more bearable.
Is there anything mothers need to be aware of after the first few weeks?
A sudden increase of demand for breastfeeding which happens prior to a growth spurt and/or a big developmental leap can unnerve many mothers, leading them to think they have “lost their milk.” Taylor says “milk supply tends to plateau around 6 weeks when the body has figured out how much it needs to make. Breasts lose their fullness and the baby usually feeds more efficiently and for less time.” Taylor explains that both these behaviors are completely normal yet they can cause doubt and confusion for mothers who were unaware of what to expect. She also adds that scheduling feeds, or delaying them until a certain time frame occurs (3-4 hourly) slows or can stop the production of milk.
Jennifer Lecleir joined Beijing United Family Hospital in 2009 as a lactation counselor, and in 2013 received her certification as an International Board Certified Lactation Consultant. She has a Bachelor of Science in Nursing, and prior to Beijing, spent years as a registered nurse working in obstetrics, antepartum care, labor and delivery, mother/baby postpartum care, and neonatal intensive care. (4008919191)
Bec Taylor, is an international school teacher librarian and volunteer breastfeeding counselor for La Leche League International (LLLI) for almost 4 years.
Alessia Chizzoniti, certified birth and postpartum doula (187 0106 2493)
Beijing United Family Hospital Pediatrics (5927 7222)
Leora Martin, lactation consultant at Oasis International Hospital (4008762747)